Do disinfection byproducts in drinking water have an effect on human cancer risk worldwide? A meta-analysis

In the present study, a meta-analysis was carried out to clarify the association between disinfection byproducts (DBPs) in drinking water and human cancer risk worldwide. Kidney, colorectal, esophagus, urinary bladder, brain, breast, leukemia, lung, and rectum cancers were selected to perform this analysis. According to preferred reporting items for systematic review and meta-analysis protocol (PRISMA) guidelines, the relevant studies were identified and selection criteria (inclusion and exclusion criteria) were applied. Next, effective subgroups in these studies (gender, type of drinking water source, and type of DBPs) were analyzed. The quality of the studies was evaluated using the Newcastle-Ottawa Scale. In addition, this overall study included analyses of 16 case–control and 3 cohort studies. The overall odds ratio (OR) with 95% confidence intervals (CI) between DBPs and cancer risk was 1.01 (95% CI, 0.94–1.09). The summary ORs of cancer risk were 1.04 (95% CI, 0.89–1.19) for kidney; 0.98 (95% CI, 0.87–1.09) for colorectal; 1.07 (95% CI, 0.84–1.29) for esophagus; 0.93 (95% CI, 0.80–1.06) for pancreatic; 1.00 (95% CI, 0.83–1.18) for brain; 1.13 (95% CI, 0.99–1.26) for breast; 0.93 (95% CI, 0.72–1.13) for leukemia; and 1.18 (95% CI, 1–1.36) for lung cancers. The results of this meta-analysis suggested that there is not a significant association between DBPs in water and cancer risk. In addition, subgroup analysis shows a positive association with colorectal and kidney cancer risk in men, as well as colon and breast cancers in females. Studies of both genders have shown a significant association between lung and pancreatic cancers. Moreover, this study finds a significant relationship between cancer rate and consumers of city water and bottled water sources. In analyzing different types of DBPs in water, chlorine and trichloromethane show a significant association in increasing cancer risk.