title: Blood trihalomethane levels and the risk of total cancer mortality in US adults.
abstract: BACKGROUND
  Although animal data have suggested the carcinogenic activity of trihalomethanes (THMs), there is inconsistent evidence supporting the link between THM exposure and cancers in humans.
  
  
  OBJECTIVE
  We investigated the association between specific and total blood THM levels with the risk of total cancer mortality in adults.
  
  
  METHODS
  We analyzed data from the 1999-2004 Third National Health and Nutrition Examination Survey and the Linked Mortality File of the United States. A total of 933 adults (20-59 years of age) with available blood THM levels and no missing data for other variables were included. Four different THM species (chloroform, bromodichloromethane (BDCM), dibromochloromethane (DBCM) and bromoform) were included, and the codes associated with cancer (malignant neoplasm) were C00 through C97, based on the underlying causes of death listed in the International Classification of Disease 10the Revision.
  
  
  RESULTS
  Compared with adults in the lowest DBCM, bromoform, and total brominated THM tertiles, those in the highest DBCM, bromoform, and total brominated THM tertiles exhibited adjusted hazard ratios (HR) of total cancer mortality of 4.97 (95% confidence interval (CI) = 1.59-15.50), 4.94 (95% CI = 1.56-15.61), and 3.42 (95% CI = 1.21-15.43) respectively. The risk of total cancer mortality was not associated with increases in blood chloroform and total THM levels.
  
  
  CONCLUSIONS
  We found that the baseline blood THM species, particularly brominated THMs, were significantly associated with total cancer mortality in adults. Although this study should be confirm by other studies, our findings suggest a possible link between THM exposures and cancer.
authors: Institute of Health and Environment, School of Public Health, Seoul National University, Seoul, Republic of Korea.
authors: Jin-Young
authors: JY
authors: Min
authors: Department of Preventive Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea. Electronic address: minkb@snu.ac.kr.
authors: Kyoung-Bok
authors: KB
authors: Min
mesh_terms: D000328:Adult; D002273:Carcinogens / Q000032:analysis; D002725:Chloroform / Q000097:blood*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000097:blood* / Q000139:chemically induced / Q000401:mortality; D011446:Prospective Studies; D022882:Trihalomethanes / Q000097:blood*; D014481:United States; D055815:Young Adult
chemical_list: D002273:Carcinogens; D022882:Trihalomethanes; C032707:chlorodibromomethane; C025191:bromodichloromethane; D002725:Chloroform; C015044:bromoform
keywords: Cancer; Disinfection byproducts; Environmental; NHANES; Water chlorination