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Colon and rectal cancer incidence and water trihalomethane concentrations in New South Wales, Australia

Md Bayzidur Rahman1*, Christine Cowie23, Tim Driscoll4, Richard J Summerhayes5, Bruce K Armstrong4 and Mark S Clements67

Author Affiliations

1 School of Public Health and Community Medicine, UNSW Australia, Room 215, Samuels building (F25), Botany Street, Randwick NSW 2052, Australia

2 Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia

3 South Western Sydney Clinical School, UNSW, Sydney, Australia

4 Sydney School of Public Health, The University of Sydney, Sydney, Australia

5 School of Health and Human Sciences, Southern Cross University, Lismore, Australia

6 National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia

7 Karolinska Institutet, Stockholm, Sweden

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BMC Cancer 2014, 14:445  doi:10.1186/1471-2407-14-445

Published: 17 June 2014



There is evidence, although inconsistent, that long term exposure to disinfection by products (DBPs) increases the risk of bowel cancer. No study has been conducted in Australia to examine this association and due to difference in the methods of disinfection the risk can vary across geographical regions and. This study was conducted to analyse the association of trihalomethanes (THMs) in water with colon and rectal cancer in NSW Australia.


Average yearly concentrations of total and individual species of THMs were obtained for 50 local government areas (LGAs). Indirectly-standardized incidence rates of colon and rectal cancers in LGAs for the period 1995 to 2001 were regressed against mean THM concentrations lagged five years, adjusting for socioeconomic status, high risk drinking, smoking status, usual source of water and year of diagnosis, including local and global random effects within a Bayesian framework. The incidence rate ratios (IRRs) for an interquartile range (IQR) increase in THMs were estimated.


Using five year lag of exposure there was a positive association between bromoform concentration and CRC in men (IRR = 1.025, 95% CI 1.010, 1.040) but not in women (IRR = 1.003, 95% CI 0.987, 1.018). The association in men was mainly found in colon cancer with bromoform (IRR = 1.035, 95% CI 1.017, 1.053). There was no appreciable association of colorectal cancer with other species of THMs. Sensitivity analyses did not materially change the associations observed.


A positive association was observed between colon cancer and water bromoform concentrations in men. Given the potential population impact of such an association, further research into the relationship between THMs, particularly brominated species, and colorectal cancer is warranted.

Cancer; Colon; Rectal; Disinfection by-products; Chlorination; Ecological studies