|Abstract||Background: Drinking water contaminated by wastewater is a potential source of exposure to mammary carcinogens and endocrine disrupting compounds from commercial products and excreted natural and pharmaceutical hormones. These contaminants are hypothesized to increase breast cancer risk. Cape Cod, Massachusetts, has a history of wastewater contamination in many, but not all, of its public water supplies; and the region has a history of higher breast cancer incidence that is unexplained by the population's age, in-migration, mammography use, or established breast cancer risk factors. We conducted a case-control study to investigate whether exposure to drinking water contaminated by wastewater increases the risk of breast cancer. Methods: Participants were 824 Cape Cod women diagnosed with breast cancer in 1988–1995 and 745 controls who lived in homes served by public drinking water supplies and never lived in a home served by a Cape Cod private well. We assessed each woman's exposure yearly since 1972 at each of her Cape Cod addresses, using nitrate nitrogen (nitrate-N) levels measured in public wells and pumping volumes for the wells. Nitrate-N is an established wastewater indicator in the region. As an alternative drinking water quality indicator, we calculated the fraction of recharge zones in residential, commercial, and pesticide land use areas. Results: After controlling for established breast cancer risk factors, mammography, and length of residence on Cape Cod, results showed no consistent association between breast cancer and average annual nitrate-N (OR = 1.8; 95% CI 0.6 – 5.0 for ? 1.2 vs. < .3 mg/L), the sum of annual nitrate-N concentrations (OR = 0.9; 95% CI 0.6 – 1.5 for ? 10 vs. 1 to < 10 mg/L), or the number of years exposed to nitrate-N over 1 mg/L (OR = 0.9; 95% CI 0.5 – 1.5 for ? 8 vs. 0 years). Variation in exposure levels was limited, with 99% of women receiving some of their water from supplies with nitrate-N levels in excess of background. The total fraction of residential, commercial, and pesticide use land in recharge zones of public supply wells was associated with a small statistically unstable higher breast cancer incidence (OR = 1.4; 95% CI 0.8–2.4 for highest compared with lowest land use), but risk did not increase for increasing land use fractions. Conclusion: Results did not provide evidence of an association between breast cancer and drinking water contaminated by wastewater. The computer mapping methods used in this study to link routine measurements required by the Safe Drinking Water Act with interview data can enhance individual-level epidemiologic studies of multiple health outcomes, including diseases with substantial latency|
|Full text||Full Text in PDF (272 KB)
|Included Refrences||45 References (List...)|
|Cited by other Articles||0 Citations (List...)|
|Name||Affiliation||Home page||Total pubs|
|Aschengrau A||Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USAemail@example.com||11|
|Brody JG||Silent Spring Institute, 29 Crafts Street, Newton, MA 02458, USAfirstname.lastname@example.org||5|
|Kennedy T||Silent Spring Institute, 29 Crafts Street, Newton, MA 02458, USA||Theresa.Kennedy@erm.com||1|
|Mc-Kelvey W||Silent Spring Institute, 29 Crafts Street, Newton, MA 02458, USAemail@example.com||1|
|Rudel RA||Silent Spring Institute, 29 Crafts Street, Newton, MA 02458, USAfirstname.lastname@example.org||5|
|Swartz CH||Silent Spring Institute, 29 Crafts Street, Newton, MA 02458, USAemail@example.com||1|
Article is cited by:
References included in article:
|Order of appearence||Full citation||SRCosmos Link|
|1||Brody JG, Rudel RA, |
(2003). Environmental pollutants and breast cancer. Environ Health Perspect, 111(8):1007-1019.
|2||Davis DL, Bradlow HL, Wolff M, Woodruff T, Howl DG, Anton-Culver H, |
(2003). Medical hypothesis: xenoestrogens as preventable causes of breast cancer. Environmental Health Perspectives X, 101(5):372-377.
|3||Wolff MS, Collman GW, Barrett JC, Huff J, |
(1996). Breast cancer and environmental risk factors: epidemiological and experimental findings. Annual Review of Pharmacology and Toxicology, 36:573-596.
|4||Soto AM, Sonnenschein C, Chung KL, Fernandez MF, Olea N, Serrano FO, |
(1995). The E-SCREEN assay as a tool to identify estrogens: An update on estrogenic environmental pollutants. Environmental Health Perspectives, 103(Suppl 7):113-122.
|5||International Agency for Research on Cancer: (1972). IARC Monographs on the Evaluation of the Carcinogenic Risk of Chemicals to Humans. Volume 39. Lyon, World Health Organization.|
|6||NTP. (2005). Report on Carcinogens, Eleventh Edition. U.S. Department of Health and Human Services, Public Health Service, National Toxicology Program.|
|7||Gold LSSTHMNBGGBABN. Summary Table by Chemical of Carcinogenicity Results in CPDB on 1485 Chemicals. [http://potency.berkeley.edu/pdfs/ChemicalTable.pdf]|
|8||Kuch HM, Ballschmiter K, |
(2001). Determination of endocrine-disrupting phenolic compounds and estrogens in surface and drinking water by HRGC-(NCI)-MS in the picogram per liter range. Environ Sci Technol, 35(15):3201-3206.
|9||Desbrow C, Routledge EJ, Brighty GC, Sumpter JP, Waldock M, |
(1998). Identification of Estrogenic Chemicals in STW Effluent. 1. Chemical Fractionation and in Vitro Biological Screening. Environ Sci Technol, 32(11):1549-1558.
|10||Routledge EJ, Sheahan D, Desbrow C, Brighty GC, Waldock M, Sumpter JP, |
(1998). Identification of Estrogenic Chemicals in STW Effluent. 2. In Vivo Responses in Trout and Roach. Environ Sci Technol, 32(11):1559-1565.
|11||Rudel RA, Geno P, Melly SJ, Sun G, Brody JG, |
(1998). Identification of alkylphenols and other estrogenic phenolic compounds in wastewater, septage, and groundwater on Cape Cod, Massachusetts. Environmental Science and Technology, 32(7):861-869.
|12||Persky JH, |
(1986). The Relation of Ground-Water Quality to Housing Density, Cape Cod, Massachusetts. Boston, MA, US Geological Survey and Cape Cod Planning and Economic Development Commission.
|13||Janik DS, |
(1987). State of the Aquifer Report. Barnstable, MA, Cape Cod Planning and Economic Development Commission.
|14||Swartz CH, Rudel RA, Kachajian JR, Brody JG, |
(2003). Historical reconstruction of wastewater and land use impacts to groundwater used for public drinking water: exposure assessment using chemical data and GIS. Journal of Exposure Analysis and Environmental Epidemiology, 13(5):403-416.
|15||U.S. Census Bureau. (1990). Census of Population and Housing, Summary Tape File 3 (Sample Data) Matrices H1, H4, H6, H7, H23, H24, H25, H28, H30, H31, H35, H37, H42, H43, H43A, H51, H52, H52A, H58, H64. [http://factfinder.census.gov/servlet/QTTable?_bm=n&_lang=en&qr_name=DEC_1990_STF3_DP5&ds_name=DEC_1990_STF3_&geo_id=05000US25001]|
|16||Cape Cod Commission. (1998). Cape Trends 5th Edition. [http://www.capecodcommission.org/data/trends98.htm] 5th edition.|
|17||U.S. Census Bureau. (2000). U.S. Census Bureau, Census Redistricting Data (Public Law 94-171) Summary File, Matrices PL1 and PL2. [http://factfinder.census.gov/servlet/GCTTable?_bm=n&_lang=en&mt_name=DEC_2000_PL_U_GCTPL_ST2&format=ST-2&_box_head_nbr=GCT-PL&ds_name=DEC_2000_PL_U&geo_id=04000US25]|
|18||Cape Cod Commission: (2003). Cape Cod Comprehensive Regional Wastewater Management Strategy Development Project. Barnstable County, Cape Cod Commission, Water Resources Office.|
|19||Barlow PM, |
(1994). Particle-tracking analysis of contributing areas of public- supply wells in simple and complex flow systems, Cape Cod, Massachusetts. Edited by: Massachusetts Departments of Environmental Management and Environmental Protections and The Cape Cod Commission. Marlborough, Massachusetts , U. S. Geological Survey.
|20||Silent Spring Institute. (1997). Cape Cod Breast Cancer and Environment Study Final Report. Newton, MA. [Prepared for Massachusetts Department of Public Health]|
|21||Mc-Kelvey W, Brody JG, Aschengrau A, Swartz CH, |
(2004). Association between residence on Cape Cod, Massachusetts, and breast cancer. Annals of Epidemiology, 14(2):89-94.
|22||Silent Spring Institute: Cape Cod Breast Cancer and Environment Atlas. [http://library.silentspring.org/atlas/index.asp] www.silentspring.org/atlas/atlas.htm.|
|23||Massachusetts Department of Public Health: (1997). Chronic Disease Surveillance Program, Behavioral Risk Factor Surveillance System. Boston, MA, Bureau of Health Statistics, Research and Evaluation.|
|24||De-Simone LA, Barlow PM, |
(1995). A Nitrogen-Rich Septage-Effluent Plume in a Glacial Aquifer, Cape Cod, Massachusetts, February 1990 through December 1992. Marlborough, MA, Massachusetts Department of Environmental Protection, Office of Watershed Management.
|25||De-Simone LA, Howes BL, |
(1998). Nitrogen transport and transformation in a shallow aquifer receiving wastewater discharge: A mass balance approach. Water Resources Research, 34(2):271-285.
|26||Belfit GC, |
(1984). Septage/Sewage Disposal Practices on Cape Cod. Barnstable, MA, Cape Cod Planning and Economic Development Commission.
|27||Belfit GC, Cambareri T, Mc-Caffery D, Prahm G, Smith B, |
(1993). Monomoy Lens Groundwater Protection Project. Barnstable, MA, Cape Cod Commission Water Resources Office.
|28||Brody JG, Aschengrau A, Mc-Kelvey W, Rudel RA, Swartz CH, Kennedy T, |
(2004). Breast cancer risk and historical exposure to pesticides from wide-area applications assessed with GIS. Environ Health Perspect, 112(8):889-897.
|29||Aschengrau A, Rogers S, Ozonoff D, |
2003). Perchloroethylene-contaminated drinking water and the risk of breast cancer: additional results from Cape Cod, Massachusetts, USA. Environmental Health Perspectives, 111(2):167-173.
|30||Massachusetts Executive Office of Environmental Affairs. (1995). 1:5000 scale orthophoto images. Boston, MA, Massachusetts Geographic Information System (MassGIS.|
|31||Environmental Systems Research Institute Inc. (ESRI). (1995). ArcGIS Software: ArcInfo Version 8.3 and ArcView Version 3.1 [computer program].|
|32||Le-Blanc DR, Guswa JH, Frimpter MH, Londquist CJ, |
(1986). Ground-Water Resources of Cape Cod, Massachusetts (map). U.S. Geological Survey, Massachusetts Water Resources Commission, Barnstable County, and National Park Service.
|33||Bratton L, |
(1991). Public Water-Supply In Massachusetts. (1986). Boston, MA, US Geological Survey and Massachusetts Department of Environmental Management Office of Water Resources.
|34||Massachusetts Department of Environmental Protection. (1997). Monitoring data for Cape Cod public water supplies, 1988 - 1995. Edited by: Protection MDE. Boston, MA.|
|35||Environmental Systems Research Institute Inc. (ESRI): (1995). ArcGIS Software: ArcInfo Version 7 [computer program].|
|36||Rodriguez-Mozaz S, De-Alda MJ, |
Barcelo D., (2(004). Monitoring of estrogens, pesticides and bisphenol A in natural waters and drinking water treatment plants by solid-phase extraction-liquid chromatography-mass spectrometry. J Chromatogr A, 1045(1-2):85-92.
|37||Künzli N, Tager IB, |
(1997). The semi-individual study in air pollution epidemiology: a valid design as compared to ecologic studies. Environ Health Perspect, 105(10):1078-1083.
|38||Rothman KJ, Greenland S, |
(1998). Modern Epidemiology. Second Edition. Second Edition edition. Philadelphia , Lippincott Williams & Wilkins:xiii, 738 p..
|39||Swartz CH, Reddy S, Benotti MJ, Yin H, Barber LB, Brownawell BJ, Rudel RA, |
(2006). Steroid Estrogens, Nonylphenol Ethoxylate Metabolites, and Other Wastewater Contaminants in Groundwater Affected by a Residential Septic System on Cape Cod, MA. Environ Sci Technol, 40(16):4894 -44902.
|40||Massachusetts Department of Public Health - Bureau of Health Statistics Research and Evaluation. (1995). Cancer Incidence in Massachusetts 1982-1992, City and Town Supplement. Boston, MA, Bureau of Health Statistics.|
|41||Morris RD, Audet AM, Angelillo IF, Chalmers TC, Mosteller F, |
(1992). Chlorination, chlorination by-products, and cancer: a meta-analysis. Am J Public Health, 82(7):955-963.
|42||Komulainen H, Kosma VM, Vaittinen SL, Vartiainen T, Kaliste-Korhonen E, Lotjonen S, Tuominen RK, Tuomisto J, |
(1997). Carcinogenicity of the drinking water mutagen 3-Chloro-4-(dichloromethyl)-5-hydroxy-2(5H)-furanone in the rat. J of National Cancer Institute, 89(12):848-856.
|43||Vieira V, Aschengrau A, Ozonoff D, |
(2005). Impact of tetrachloroethylene-contaminated drinking water on the risk of breast cancer: using a dose model to assess exposure in a case-control study. Environ Health, 4(1):3.
|44||Mcelroy JA, Gangnon RE, Newcomb PA, Kanarek MS, Anderson HA, Brook J, Trentham-Dietz AM, Remington PL, |
(2006). Risk of breast cancer for women living in rural areas from adult exposure to atrazine from well water in Wisconsin. J Expo Sci Environ Epidemiol.
|45||Ward MH, De-Kok TM, Levallois P, Brender J, Gulis G, Nolan BT, Van-Derslice J, |
(2005). Workgroup report: Drinking-water nitrate and health--recent findings and research needs. Environ Health Perspect, 113(11):1607-1614.