Helte Emilie, Söderlund Fredrik, Säve-Söderbergh Melle, Larsson Susanna C, Åkesson Agneta
Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
Science Division, Swedish Food Agency, Uppsala, Sweden.
Environ Health Perspect. 2025 Jan;133(1):16001. doi: 10.1289/EHP14505. Epub 2025 Jan 21.
Chlorination is a widespread method for drinking water disinfection that has the drawback of introducing potentially carcinogenic chemical by-products to drinking water.
We systematically evaluated the epidemiologic evidence of exposure to trihalomethane (THM) disinfection by-products and risk of cancer.
We conducted a systematic review and meta-analysis of epidemiologic studies that assessed the association of exposure to residential concentrations of THMs with risk of cancer in adults. A protocol was preregistered in PROSPERO (CRD42023435491). PubMed, Embase, Web of Science, and Cochrane were searched for publications up to April 2024. Study selection and risk of bias appraisal using the National Toxicology Program Office of Health Assessment and Translation (NTP OHAT) tool was done in duplicate. Summary risk estimates were assessed using random effects meta-analysis and one-stage dose-response meta-analysis.
The literature search resulted in 2,022 records, of which 29 publications assessing 14 different cancers were eligible for inclusion. Summary relative risks (RRs) were estimated for bladder cancer and colorectal cancer based on 5,860 and 9,262 cases and 84,371 and 90,272 participants, respectively. The summary RR of bladder cancer for the highest exposed compared with the lowest was 1.33 (95% CI: 1.04, 1.71), and in the dose-response analysis, RRs were statistically significant above THM concentrations of . For colorectal cancer, the summary RR was 1.15 (95% CI: 1.07, 1.24).
According to the World Cancer Research Fund criteria, we found limited-suggestive evidence that THM in drinking water increases the risk of bladder and colorectal cancer at levels below current regulatory limits in the US and EU, indicating that these fail to protect against cancer in the general population. https://doi.org/10.1289/EHP14505.
氯化是一种广泛应用于饮用水消毒的方法，其缺点是会向饮用水中引入潜在致癌的化学副产物。
我们系统评估了接触三卤甲烷（THM）消毒副产物与癌症风险之间的流行病学证据。
我们对评估成人接触住宅环境中THM浓度与癌症风险之间关联的流行病学研究进行了系统综述和荟萃分析。研究方案已在国际前瞻性系统评价注册库（PROSPERO）中预注册（注册号：CRD42023435491）。检索了PubMed、Embase、Web of Science和Cochrane数据库，以获取截至2024年4月的出版物。使用美国国家毒理学计划健康评估与转化办公室（NTP OHAT）工具进行研究选择和偏倚风险评估，由两人独立完成。使用随机效应荟萃分析和单阶段剂量反应荟萃分析评估汇总风险估计值。
文献检索共获得2022条记录，其中29篇评估14种不同癌症的出版物符合纳入标准。基于5860例膀胱癌病例和84371名参与者、以及9262例结直肠癌病例和90272名参与者，分别估计了膀胱癌和结直肠癌的汇总相对风险（RR）。与最低暴露水平相比，最高暴露水平下膀胱癌的汇总RR为1.33（95%置信区间：1.04，1.71），在剂量反应分析中，THM浓度高于 时RR具有统计学意义。对于结直肠癌，汇总RR为1.15（95%置信区间：1.07，1.24）。
根据世界癌症研究基金会的标准，我们发现有限的提示性证据表明，在美国和欧盟当前监管限值以下的水平，饮用水中的THM会增加膀胱癌和结直肠癌的风险，这表明这些限值未能保护普通人群免受癌症侵害。https://doi.org/10.1289/EHP14505 。
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