Estimating and comparing the cancer risks from THMs and low-level arsenic in drinking water based on disability-adjusted life years

To determine the priority hazard in drinking water, disability-adjusted life years (DALYs) method was used to evaluate the disease burden induced by trihalomethanes (THMs) and low-level arsenic through multiple exposure routes based on the two-year sampling from drinking water in Xi'an city, Northwest China. The average concentrations of chloroform (TCM), bromodichloromethane (BDCM), dibromochloromethane (DBCM), bromoform (TBM) and arsenic were 12.67 μg/L, 1.42 μg/L, 0.60 μg/L, 0.13 μg/L and 1.00 μg/L, respectively, and the total lifetime cancer risks for all THMs and arsenic were 8.54 × 10^-6 and 4.02 × 10^-5, which were 8.54 and 40.2 times of the negligible risk level (1.00 × 10^-6), respectively. The DALYs estimation showed that the total DALYs lost for all age groups was 32.62 person-year, and the average individual DALYs lost was 4.77 × 10^-6 per person-year (ppy), which was 4.77 times of the reference level (1.00 × 10^-6 ppy). About 72.07% of the total disease burden was due to arsenic, which was considered to be the priority hazard in Xi'an drinking water. The age group of 75-80 years was found to be most vulnerable to the induced cancer risk, and skin cancer had the highest disease burden (2.24 × 10^-6 ppy). Due to the relatively high incidence rates of lung cancer and skin cancer, most DALYs lost for males were 2-4 times to that for females in the same age group. Oral ingestion made the most contribution (88.58%) to the total disease burden, followed by inhalation of THMs (11.30%), whereas dermal absorption showed negligible risk (0.12%). As the first to compare the cancer risks of arsenic and THMs to the public in DALYs in China, this study might be useful for potential strategies of risk control and management of hazardous agents in drinking water.