Gallagher Lisa G, Webster Thomas F, Aschengrau Ann, Vieira Verónica M
Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts 02118, USA.
Environ Health Perspect. 2010 Jun;118(6):749-55. doi: 10.1289/ehp.0901547. Epub 2010 Feb 17.
Spatial analyses of case-control data have suggested a possible link between breast cancer and groundwater plumes in upper Cape Cod, Massachusetts.
We integrated residential histories, public water distribution systems, and groundwater modeling within geographic information systems (GIS) to examine the association between exposure to drinking water that has been contaminated by wastewater effluent and breast cancer.
Exposure was assessed from 1947 to 1993 for 638 breast cancer cases who were diagnosed from 1983 to 1993 and 842 controls; we took into account residential mobility and drinking water source. To estimate the historical impact of effluent on drinking water wells, we modified a modular three-dimensional finite-difference groundwater model (MODFLOW) from the U.S. Geological Survey. The analyses included latency and exposure duration.
Wastewater effluent impacted the drinking water wells of study participants as early as 1966. For > 0-5 years of exposure (versus no exposure), associations were generally null. Adjusted odds ratios (AORs) for > 10 years of exposure were slightly increased, assuming latency periods of 0 or 10 years [AOR = 1.3; 95% confidence interval (CI), 0.9-1.9 and AOR = 1.6; 95% CI, 0.8-3.2, respectively]. Statistically significant associations were estimated for ever-exposed versus never-exposed women when a 20-year latency period was assumed (AOR = 1.9; 95% CI, 1.0-3.4). A sensitivity analysis that classified exposures assuming lower well-pumping rates showed similar results.
We investigated the hypothesis generated by earlier spatial analyses that exposure to drinking water contaminated by wastewater effluent may be associated with breast cancer. Using a detailed exposure assessment, we found an association with breast cancer that increased with longer latency and greater exposure duration.
病例对照数据的空间分析表明，马萨诸塞州科德角上游地区的乳腺癌与地下水羽流之间可能存在联系。
我们将居住史、公共供水系统和地下水模型整合到地理信息系统（GIS）中，以研究接触受废水排放污染的饮用水与乳腺癌之间的关联。
对1983年至1993年确诊的638例乳腺癌病例和842名对照者在1947年至1993年期间的暴露情况进行评估；我们考虑了居住流动性和饮用水源。为了估计废水对饮用水井的历史影响，我们修改了美国地质调查局的模块化三维有限差分地下水模型（MODFLOW）。分析包括潜伏期和暴露持续时间。
废水排放早在1966年就影响了研究参与者的饮用水井。对于暴露>0至5年（与未暴露相比），关联通常为零。假设潜伏期为0或10年，暴露>10年的调整优势比（AOR）略有增加[AOR = 1.3；95%置信区间（CI），0.9 - 1.9和AOR = 1.6；95%CI，0.8 - 3.2]。当假设潜伏期为20年时，估计曾经暴露与从未暴露的女性之间存在统计学显著关联（AOR = 1.9；95%CI，1.0 - 3.4）。一项基于较低井抽水量假设对暴露进行分类的敏感性分析显示了类似结果。
我们调查了早期空间分析提出的假设，即接触受废水排放污染的饮用水可能与乳腺癌有关。通过详细的暴露评估，我们发现与乳腺癌存在关联，且随着潜伏期延长和暴露持续时间增加而增强。
