ArticleJournal of the National Cancer Institute2023
Disinfection by-products in drinking water and risk of colorectal cancer: a population-based cohort study.
Article in Journal of the National Cancer Institute, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
9 citing papers in PubMed, 1 synthesis or guideline pooled it, 32 citations in OpenAlex.
- Exposure to Drinking Water Trihalomethanes and Risk of Cancer: A Systematic Review of the Epidemiologic Evidence and Dose-Response Meta-Analysis.Environmental health perspectives · 2025Pooled it
- SIMPLER: the Swedish infrastructure for medical population-based life-course and environmental research.European journal of epidemiology · 2026Article
- Gestational Trichloroacetic Acid Exposure Induces Miscarriage by Disrupting Iron Homeostasis in Trophoblasts via the KEAP1-NRF2 Pathway.Environment & health (Washington, D.C.) · 2026Article
- Disinfection byproducts in US drinking water and cancer mortality.International journal of environmental health research · 2025Article
- Chemical disinfection of secondary municipal wastewater effluents: Optimizing CT dose and tailing effects through high-intensity mixing.Water environment research : a research publication of the Water Environment Federation · 2025Article
- Health risk assessment via ingestion of disinfection by-products in drinking water.Scientific reports · 2025Article
- Rethinking the rise of early-onset gastrointestinal cancers: a call to action.JNCI cancer spectrum · 2025Article
- Changing epidemiology of colorectal cancer - birth cohort effects and emerging risk factors.Nature reviews. Gastroenterology & hepatology · 2024Review
- Pollutants, microbiota and immune system: frenemies within the gut.Frontiers in public health · 2024Review
Corrections and comments
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Authors and funding
5 authors at 4 institutions in 1 country.
Funding
Abstract
backgroundColorectal cancer is the third most common malignancy worldwide and is strongly linked to lifestyle and environmental risk factors. Although several drinking-water disinfection by-products are confirmed rodent carcinogens, the evidence in humans for carcinogenicity associated with these by-products, including colorectal cancer, is still inconclusive.
methodsWe assessed the association of long-term exposure to trihalomethanes (THMs), the most prevalent disinfection by-products in chlorinated drinking water, with incidence of colorectal cancer in 58 672 men and women in 2 population-based cohorts. Exposure was assessed by combining long-term information of residential history with drinking water-monitoring data. Participants were categorized according to no exposure, low exposure (<15 µg/L), and high exposure (≥15 µg/L). Incident cases of colorectal cancer were ascertained by use of the Swedish National Cancer Register.
resultsDuring an average follow-up of 16.8 years (988 144 person-years), 1913 cases of colorectal cancer were ascertained (1176 cases in men and 746 in women, respectively). High THM concentrations in drinking water (≥15 µg/L) were associated with increased risk of colorectal cancer in men (hazard ratio = 1.26, 95% confidence interval = 1.05-1.51) compared with no exposure. When subsites were assessed, the association was statistically significant for proximal colon cancer (hazard ratio = 1.59, 95% confidence interval = 1.11 to 2.27) but not for distal colon cancer or rectal cancer. In women, we observed overall no association of THMs with colorectal cancer.
conclusionThese results add further evidence that disinfection by-products in drinking water may be a possible risk factor for proximal colon cancer in men. This observation was made at THM concentrations lower than those in most previous studies.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.