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Water Res. 2019 Oct 1;162:492-504. doi: 10.1016/j.watres.2019.07.014. Epub 2019 Jul 8.

Disinfection byproducts potentially responsible for the association between chlorinated drinking water and bladder cancer: A review.

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Department of Civil and Environmental Engineering, University of Surrey, Guildford, GU2 7XH, UK.
Department of Chemistry, University of Surrey, Guildford, GU2 7XH, UK.
Department of Civil and Environmental Engineering, University of Surrey, Guildford, GU2 7XH, UK. Electronic address:


Epidemiological studies have consistently associated the consumption of chlorinated drinking water with an enhanced risk of bladder cancer. While this suggests that some disinfection byproducts (DBPs) are bladder carcinogens, causal agents are unknown. This study aims to highlight likely candidates. To achieve this, structures of known and hypothesised DBPs were compared with 76 known bladder carcinogens. The latter are dominated by nitrogenous and aromatic compounds; only 10 are halogenated. Under 10% of the chlorine applied during drinking water treatment is converted into identified halogenated byproducts; most of the chlorine is likely to be consumed during the generation of unidentified non-halogenated oxidation products. Six nitrosamines are among the nine most potent bladder carcinogens, and two of them are known to be DBPs: N-nitrosodiphenylamine and nitrosodibutylamine. However, these and other nitrosamines are formed in insufficiently low concentrations in chlorinated drinking water to account for the observed bladder cancer risk. Furthermore, although not proven bladder carcinogens, certain amines, haloamides, halocyclopentenoic acids, furans and haloquinones are potential candidates. At present, most identified bladder carcinogens are nitrogenous, whereas >90% of natural organic matter is not. Therefore, non-nitrogenous DBPs are likely to contribute to the bladder cancer risk. Given the high proportion of DBPs that remains uncharacterised, it is important that future research prioritises compounds believed to be potent toxicants.


DBPs; Haloamides; Haloamines; Haloquinones; Mutagen X; Nitrosamines

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