Ingested nitrate, disinfection by-products, and kidney cancer risk in older women

N-nitroso compounds formed endogenously after nitrate/nitrite ingestion are animal renal carcinogens. Previous epidemiologic studies of drinking water nitrate did not evaluate other potentially toxic water contaminants, including the suspected renal carcinogen chloroform. In a cohort of postmenopausal women in Iowa (1986-2010), the authors used historical measurements to estimate long-term average concentrations of nitrate-nitrogen (NO3-N) and disinfection by-products (DBP) in public water supplies. For NO3-N and the regulated DBP [total trihalomethanes (THM) and the sum of five haloacetic acids (HAA5)], the authors estimated the number of years of exposure above one-half the current maximum contaminant level (>½-MCL NO3-N; >5mg/L). Dietary intakes were assessed via food frequency questionnaire. Hazard ratios (HR) and 95% confidence intervals (CI) with Cox models were estimated and evaluated interactions with factors influencing N-nitroso compound formation. 125 incident kidney cancers among 15,577 women reporting using water from public supplies >10 years were identified. In multivariable models, risk was higher in the 95 percentile of average NO3-N (HRP95vsQ1=2.3; CI:1.2-4.3; ptrend=0.33) and for any years of exposure >½-MCL; adjustment for total THM did not materially change these associations. There were no independent relationships with total THM, individual THMs chloroform and bromodichloromethane, or with haloacetic acids. Dietary analyses yielded associations with high nitrite intake from processed meats but not nitrate or nitrite overall. The authors detected no interactions. Relatively high nitrate levels in public water supplies were associated with increased risk of renal cancer. The results also suggest that nitrite from processed meat is a renal cancer risk factor.

Authors: Jones RR, Weyer PJ, Dellavalle CT, Robien K, Cantor KP, Krasner S, Beane Freeman LE, Ward MH. ;Full Source: Epidemiology. 2017 Mar 1. doi: 10.1097/EDE.0000000000000647. [Epub ahead of print] ;