title: The association between drinking water source and colorectal cancer incidence in Jiashan County of China: a prospective cohort study.
abstract: BACKGROUND
  The pollution of drinking water, e.g. from rivers and pools, has long been recognized to be associated with an increased risk for colorectal cancer (CRC), but there are few direct prospective cohort studies related to person-years on the relative risks of different sources of drinking water for CRC, hence the reason for our study.
  
  
  METHODS
  Based on a screening for CRC among residents aged 30 years and over in Jiashan County, Zhejiang Province, China, a total of 64,115 residents were classified into five cohorts by their source of drinking water and followed-up from 1st May 1990 to 1st January 2001. Person-years was calculated for every cohort member and Poisson regression was used to control potential confounding variables including demographic variables and smoking history, and to attain crude and adjusted relative risks based on person-years.
  
  
  RESULTS
  A trend was seen toward increasing incidence rates for CRC from the drinking water sources of municipal, river, ditch, mixed water to well in turn as shown by relative risk rates of 29.61, 32.67, 33.45, 40.87 and 58.67 per 100,000 inhabitants. Only the role in risk of well water was significantly different from municipal water (P < 0.05). After the confounding variables were adjusted, the significant risk from well water could be seen for colon cancer, rectal cancer as well as CRC. The relative risks were 1.741 [95% confidence interval (CI) 1.001-3.029], 2.228 (95% CI 1.432-3.466) and 2.022 (95% CI 1.432-2.854), respectively.
  
  
  CONCLUSIONS
  Drinking well water over a long period was identified as playing a role in the risk for CRC, especially for rectal cancer.
authors.affiliation: Department of Epidemiology, Zhejiang University School of Medicine, Hangzhou, People's Republic of China. ck@zjuem.zju.edu.an
authors.forename: Kun
authors.initials: K
authors.lastname: Chen
authors.forename: Weiping
authors.initials: W
authors.lastname: Yu
authors.forename: Xinyan
authors.initials: X
authors.lastname: Ma
authors.forename: Kaiyan
authors.initials: K
authors.lastname: Yao
authors.forename: Qinting
authors.initials: Q
authors.lastname: Jiang
mesh_terms: D000328:Adult; D000368:Aged; D002681:China / Q000453:epidemiology; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014876:Water Pollution / Q000009:adverse effects*; D014881:Water Supply