Municipal Drinking Water Nitrate Level and Cancer Risk in Older Women: The Iowa Women's Health Study

• Published in: Epidemiology (Cambridge, Mass.) Mass.), 2001-05, Vol.12 (3), p.327-338
• Main Authors: Weyer, Peter J., Cerhan, James R., Kross, Burton C., Hallberg, George R., Kantamneni, Jiji, Breuer, George, Jones, Michael P., Zheng, Wei, Lynch, Charles F.
• Format: Article
• Language: English
• Subjects: Age Factors; Aged; Biological and medical sciences; Cancer incidence; Cohort Studies; Epidemiology; Female; Humans; Incidence; Iowa - epidemiology; Medical sciences; Middle Aged; Mortality; Neoplasms - epidemiology; Neoplasms - etiology; Nitrates; Nitrates - adverse effects; Ovarian cancer; Ovarian Neoplasms - epidemiology; Ovarian Neoplasms - etiology; Potable water; Public water supply; Rectal Neoplasms - epidemiology; Rectal Neoplasms - etiology; Risk Factors; Tumors; Urinary bladder; Urinary Bladder Neoplasms - epidemiology; Urinary Bladder Neoplasms - etiology; Uterine Neoplasms - epidemiology; Uterine Neoplasms - etiology; Vitamin C; Water Supply; Womens health
• ISSN: 1044-3983; 1531-5487
• DOI: 10.1097/00001648-200105000-00013

Nitrate contamination of drinking water may increase cancer risk, because nitrate is endogenously reduced to nitrite and subsequent nitrosation reactions give rise to N-nitroso compounds; these compounds are highly carcinogenic and can act systemically. We analyzed cancer incidence in a cohort of 21,977 Iowa women who were 55-69 years of age at baseline in 1986 and had used the same water supply more than 10 years (87% >20 years); 16,541 of these women were on a municipal supply, and the remainder used a private well. We assessed nitrate exposure from 1955 through 1988 using public databases for municipal water supplies in Iowa (quartile cutpoints: 0.36, 1.01, and 2.46 mg per liter nitrate-nitrogen). As no individual water consumption data were available, we assigned each woman an average level of exposure calculated on a community basis; no nitrate data were available for women using private wells. Cancer incidence (N = 3,150 cases) from 1986 through 1998 was determined by linkage to the Iowa Cancer Registry. For all cancers, there was no association with increasing nitrate in drinking water, nor were there clear and consistent associations for non-Hodgkin lymphoma; leukemia; melanoma; or cancers of the colon, breast, lung, pancreas, or kidney. There were positive associations for bladder cancer [relative risks (RRs) across nitrate quartiles = 1, 1.69, 1.10, and 2.83] and ovarian cancer (RR = 1, 1.52, 1.81, and 1.84), and inverse associations for uterine cancer (RR = 1, 0.86, 0.86, and 0.55) and rectal cancer (RR = 1, 0.72, 0.95, and 0.47) after adjustment for a variety of cancer risk/protective factors, agents that affect nitrosation (smoking, vitamin C, and vitamin E intake), dietary nitrate, and water source. Similar results were obtained when analyses were restricted to nitrate level in drinking water from 1955 through 1964. The positive association for bladder cancer is consistent with some previous data; the associations for ovarian, uterine, and rectal cancer were unexpected.