title: Total fluid and water consumption and the joint effect of exposure to disinfection by-products on risk of bladder cancer.
abstract: BACKGROUND
  Findings on water and total fluid intake and bladder cancer are inconsistent; this may, in part, be due to different levels of carcinogens in drinking water. High levels of arsenic and chlorinated by-products in drinking water have been associated with elevated bladder cancer risk in most studies. A pooled analysis based on six case-control studies observed a positive association between tap water and bladder cancer but none for nontap fluid intake, suggesting that contaminants in tap water may be responsible for the excess risk.
  
  
  OBJECTIVE
  We examined the association between total fluid and water consumption and bladder cancer risk, as well as the interaction between water intake and trihalomethane (THM) exposure, in a large case-control study in Spain.
  
  
  METHODS
  A total of 397 bladder cancer cases and 664 matched controls were available for this analysis. Odds ratios (OR) were estimated using unconditional logistic regression, controlling for potential confounders.
  
  
  RESULTS
  Total fluid intake was associated with a decrease in bladder cancer risk [OR = 0.62; 95% confidence interval (CI), 0.40-0.95 for highest vs. lowest quintile comparison]. A significant inverse association was observed for water intake (for > 1,399 vs. < 400 mL/day, OR = 0.47; 95% CI, 0.33-0.66; p for trend < 0.0001), but not for other individual beverages. The inverse association between water intake and bladder cancer persisted within each level of THM exposure; we found no statistical interaction (p for interaction = 0.13).
  
  
  CONCLUSIONS
  Findings from this study suggest that water intake is inversely associated with bladder cancer risk, regardless of THM exposure level.
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts 02115, USA. dmichaud@hsph.harvard.edu
authors.forename: Dominique S
authors.initials: DS
authors.lastname: Michaud
authors.forename: Manolis
authors.initials: M
authors.lastname: Kogevinas
authors.forename: Kenneth P
authors.initials: KP
authors.lastname: Cantor
authors.forename: Cristina M
authors.initials: CM
authors.lastname: Villanueva
authors.forename: Monteserrat
authors.initials: M
authors.lastname: Garcia-Closas
authors.forename: Nathaniel
authors.initials: N
authors.lastname: Rothman
authors.forename: Nuria
authors.initials: N
authors.lastname: Malats
authors.forename: Francisco X
authors.initials: FX
authors.lastname: Real
authors.forename: Consol
authors.initials: C
authors.lastname: Serra
authors.forename: Reina
authors.initials: R
authors.lastname: Garcia-Closas
authors.forename: Adonina
authors.initials: A
authors.lastname: Tardon
authors.forename: Alfredo
authors.initials: A
authors.lastname: Carrato
authors.forename: Mustafa
authors.initials: M
authors.lastname: Dosemeci
authors.forename: Debra T
authors.initials: DT
authors.lastname: Silverman
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D004202:Disinfectants / Q000009:adverse effects* / Q000032:analysis; D004327:Drinking Behavior; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D022882:Trihalomethanes / Q000009:adverse effects* / Q000032:analysis; D001749:Urinary Bladder Neoplasms / Q000453:epidemiology / Q000209:etiology; D014874:Water Pollutants, Chemical / Q000009:adverse effects* / Q000032:analysis; D014881:Water Supply
chemical_list: D004202:Disinfectants; D022882:Trihalomethanes; D014874:Water Pollutants, Chemical