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Am J Public Health. 1992 Jul;82(7):955-63.

Chlorination, chlorination by-products, and cancer: a meta-analysis.

Author information

  • 1Division of Biostatistics, Medical College of Wisconsin, Milwaukee 53226.

Erratum in

  • Am J Public Health 1993 Sep;83(9):1257.

Abstract

OBJECTIVES:

Individual epidemiological investigations into the association between chlorination by-products in drinking water and cancer have been suggestive but inconclusive. Enough studies exist to provide the basis for a meaningful meta-analysis.

METHODS:

An extensive literature search was performed to identify pertinent case-control studies and cohort studies. Consumption of chlorinated water, surface water, or water with high levels of chloroform was used as a surrogate for exposure to chlorination by-products. Relative risk estimates were abstracted from the individual studies and pooled.

RESULTS:

A simple meta-analysis of all cancer sites yielded a relative risk estimate for exposure to chlorination by-products of 1.15 (95% CI: 1.09, 1.20). Pooled relative risk estimates for organ-specific neoplasms were 1.21 (95% CI: 1.09, 1.34) for bladder cancer and 1.38 (95% CI: 1.01, 1.87) for rectal cancer. When studies that adjusted for potential confounders were pooled separately, estimates of relative risks did not change substantially.

CONCLUSIONS:

The results of this meta-analysis suggest a positive association between consumption of chlorination by-products in drinking water and bladder and rectal cancer in humans.

Comment in

  • Chlorination or ozonation? [Am J Public Health. 1993]
PMID:
1535181
[PubMed - indexed for MEDLINE]
PMCID:
PMC1694065
Free PMC Article
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