title: Health impacts of long-term exposure to disinfection by-products in drinking water in Europe: HIWATE.
abstract: There appears to be very good epidemiological evidence for a relationship between chlorination by-products, as measured by trihalomethanes (THMs), in drinking water and bladder cancer, but the evidence for other cancers, including colorectal cancer appears to be inconclusive and inconsistent. There appears to be some evidence for a relationship between chlorination by-products, as measured by THMs, and small for gestational age (SGA)/intrauterine growth retardation (IUGR) and preterm delivery, but evidence for other outcomes such as low birth weight (LBW), stillbirth, congenital anomalies and semen quality appears to be inconclusive and inconsistent.The overall aim of the HIWATE study is to investigate potential human health risks (e.g. bladder and colorectal cancer, premature births, SGA, semen quality, stillbirth, congenital anomalies) associated with long-term exposure to low levels of disinfectants (such as chlorine) and DBPs occurring in water for human consumption and use in the food industry. The study will comprise risk-benefit analyses including quantitative assessments of risk associated with microbial contamination of drinking water versus chemical risk and will compare alternative treatment options. The outcome will be improved risk assessment and better information for risk management. The work is divided into different topics (exposure assessment, epidemiology, risk assessment and management) and studies.
authors.affiliation: Centre for research in Environmental, Epidemiology (CREAL), Parc de Recerca Biomédical de Barcelona-PRBB, Barcelona, Spain. mnieuwenhuijsen@imim.es
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Nieuwenhuijsen
authors.forename: Rachel
authors.initials: R
authors.lastname: Smith
authors.forename: Spyros
authors.initials: S
authors.lastname: Golfinopoulos
authors.forename: Nicky
authors.initials: N
authors.lastname: Best
authors.forename: James
authors.initials: J
authors.lastname: Bennett
authors.forename: Gabriella
authors.initials: G
authors.lastname: Aggazzotti
authors.forename: Elena
authors.initials: E
authors.lastname: Righi
authors.forename: Guglielmina
authors.initials: G
authors.lastname: Fantuzzi
authors.forename: Luca
authors.initials: L
authors.lastname: Bucchini
authors.forename: Sylvaine
authors.initials: S
authors.lastname: Cordier
authors.forename: Cristina M
authors.initials: CM
authors.lastname: Villanueva
authors.forename: Victor
authors.initials: V
authors.lastname: Moreno
authors.forename: Carlo
authors.initials: C
authors.lastname: La Vecchia
authors.forename: Cristina
authors.initials: C
authors.lastname: Bosetti
authors.forename: Terttu
authors.initials: T
authors.lastname: Vartiainen
authors.forename: Radu
authors.initials: R
authors.lastname: Rautiu
authors.forename: Mireille
authors.initials: M
authors.lastname: Toledano
authors.forename: Nina
authors.initials: N
authors.lastname: Iszatt
authors.forename: Regina
authors.initials: R
authors.lastname: Grazuleviciene
authors.forename: Manolis
authors.initials: M
authors.lastname: Kogevinas
mesh_terms: D015984:Causality; D002713:Chlorine / Q000009:adverse effects*; D000013:Congenital Abnormalities / Q000453:epidemiology / Q000209:etiology; D004202:Disinfectants / Q000009:adverse effects*; D004781:Environmental Exposure / Q000706:statistics & numerical data*; D004784:Environmental Monitoring / Q000379:methods; D016021:Epidemiologic Studies; D062665:Epidemiological Monitoring; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000139:chemically induced / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000139:chemically induced / Q000453:epidemiology; D047928:Premature Birth / Q000139:chemically induced / Q000453:epidemiology; D012107:Research Design; D018570:Risk Assessment; D055101:Semen Analysis; D022882:Trihalomethanes / Q000009:adverse effects*; D014874:Water Pollutants, Chemical / Q000009:adverse effects* / Q000032:analysis; D018508:Water Purification / Q000379:methods*; D014881:Water Supply / Q000032:analysis
chemical_list: D004202:Disinfectants; D022882:Trihalomethanes; D014874:Water Pollutants, Chemical; D002713:Chlorine