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Assessment of lifetime exposure to trihalomethanes through different routes
  1. C M Villanueva1,
  2. K P Cantor2,
  3. J O Grimalt3,
  4. G Castaño-Vinyals1,
  5. N Malats1,
  6. D Silverman2,
  7. A Tardon4,
  8. R Garcia-Closas5,
  9. C Serra6,
  10. A Carrato7,
  11. N Rothman2,
  12. F X Real7,
  13. M Dosemeci2,
  14. M Kogevinas2
  1. 1Respiratory and Environmental Health Research Unit, Institut Municipal d’Investigació Mèdica (IMIM), Barcelona, Spain
  2. 2Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Department of Health and Human Services, Bethesda, USA
  3. 3Department of Environmental Chemistry, Institute of Chemical and Environmental Research (CSIC), Barcelona, Catalonia, Spain
  4. 4Universidad de Oviedo, Oviedo, Spain
  5. 5Department of Epidemiology, Catalan Institute of Oncology (ICO), Barcelona, Spain
  6. 6Unit of Research in Occupational Health, Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, Barcelona, Spain
  7. 7Hospital General de Elche, Elche, Spain
  8. 8Unitat de Biologia Cel.lular i Molecular, Institut Municipal d’Investigació Mèdica (IMIM). Barcelona, Spain
  1. Correspondence to:
 Dr C M Villanueva
 Respiratory and Environmental Health Research Unit, Municipal Institute of Medical Research (IMIM), Doctor Aiguader, 80, Barcelona 08003, Spain; cvillanueva{at}


Objectives: To evaluate lifetime exposure to trihalomethanes (THM) through ingestion, inhalation, and dermal absorption in a hospital based case-control study of bladder cancer conducted between 1998 and 2001 in five areas of Spain. The study base was comprised of subjects living in the catchment areas of the participating hospitals.

Methods: Individual information on water related habits was obtained from personal interviews of 1219 cases and 1271 controls: residential and occupational history, drinking water source at each residence and job, amount of water consumption, frequency and duration of showering, bathing, and swimming pool attendance. THM levels, water source history, and year when chlorination started in study areas were ascertained through measurements in drinking water samples and questionnaires to water companies and local authorities. Estimates of THM levels covered 79% of the subjects’ person-years of exposure.

Results: Current and historical average THM levels in water were correlated. Control subjects reported that drinking water source in the last residence was municipal for 63%, bottled for 22%, private well for 2%, and other sources for 13%. For the time window between age 15 and the time of interview, average residential THM level was 32.2 μg/l. THM exposure through ingestion was 23.7 μg/day on average, and was correlated with the ingestion THM level in the workplace. Overall, 79% usually took showers, 16% usually took baths, and 13% had ever attended a swimming pool. Between 21% and 45% of controls unexposed to THM through ingestion were evaluated as moderately or highly exposed through showering or bathing, and 5–10% were exposed through swimming in pools.

Conclusion: The importance of evaluating different routes is underscored by findings from experimental studies showing substantial differences in THM uptake and internal distribution by route.

  • DBP, disinfection by-products
  • THM, trihalomethane
  • disinfection by-products
  • trihalomethanes
  • exposure assessment
  • exposure routes
  • case-control study

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  • Funding: This project was funded by the Spanish Ministry of Health (FIS 2001–2002), the EPICUR-red (ISIII-GO3/174), the Intramural Research Program of the NIH, National Cancer Institute, Division of Cancer Epidemiology and Genetics (NCI Contract No. NO2-CP-11015), and the European Union (Environment and genetic factors in bladder cancer: a multicentric case-control study in Europe. BIOMED. 1998–2001).

  • Competing interests: none