Esophageal cancer mortality and total hardness levels in Taiwan's drinking water

Association of Domestic Water Hardness with All-Cause and Cause-Specific Cancers: Evidence from 447,996 UK Biobank Participants

BACKGROUND

Accumulating evidence suggests that domestic water hardness is linked to health outcomes, but its association to all-cause and cause-specific cancers warrants investigation.

OBJECTIVE

The aim of this study was to investigate the association of domestic hard water with all-cause and cause-specific cancers.

METHODS

In the prospective cohort study, a total of 447,996 participants from UK Biobank who were free of cancer at baseline were included and followed up for 16 y. All-cause and 22 common cause-specific cancer diagnoses were ascertained using hospital inpatient records and self-reported data until 30 November 2022. Domestic water hardness, measured by CaCO 3 concentrations, was obtained from the local water supply companies across England, Scotland, and Wales in 2005. Data were analyzed using Cox proportional hazard models, with adjustments for known measured confounders, including demographic, socioeconomic, clinical, biochemical, lifestyle, and environmental factors.

RESULTS

Over a median follow-up of 13.6 y (range: 12.7-14.4 y), 58,028 all-cause cancer events were documented. A U-shaped relationship between domestic water hardness and all-cause cancers was observed (p for nonlinearity < 0.001 ). In comparison with individuals exposed to soft water (0 - 60 mg / L ), the hazard ratios (HRs) and 95% confidence intervals (CIs) of all-cause cancer were 1.00 (95% CI: 0.98, 1.02) for those exposed to moderate hard water (> 60 - 120 mg / L ), 0.88 (95% CI: 0.84, 0.91) for those exposed to hard water (> 120 - 180 mg / L ) and 1.06 (95% CI: 1.04, 1.08) for those exposed to very hard water (> 180 mg / L ). Additionally, domestic water hardness was associated with 11 of 22 cause-specific cancers, including cancers of the esophagus, stomach, colorectal tract, lung, breast, prostate, and bladder, as well as non-Hodgkin lymphoma, multiple myeloma, malignant melanoma, and hematological malignancies. Moreover, we observed a positive linear relationship between water hardness and bladder cancer.

DISCUSSION

Our findings suggest that domestic water hardness was associated with all-cause and multiple cause-specific cancers. Findings from the UK Biobank support a potentially beneficial association between hard water and the incidence of all-cause cancer. However, very hard water may increase the risk of all-cause cancer. https://doi.org/10.1289/EHP13606.

Scientific study on acid rain and subsequent pH-imbalances in humans, case studies, treatments

SCIENTIFIC STUDY

Acid Rain attacked South West Sweden 1960-1990, making well water acid, causing Cu dissolution from pipes, disturbing intestines. In a scientific study Ca was 6 times higher in alkaline well waters and hair. Women drinking acid water were unhealthy.

CASE STUDIES

Case studies: 1 (woman): Scleroderma had caused shortened finger tips, and loss of hair. Urinary pH was 5. Hair analysis showed severe mineral imbalances. After 1.5 years of treatment with supplements and increasing urinary pH with NaHCO₃, symptoms disappeared. 2 (woman): Fibromyalgia, cataract, constipation and basal carcinoma was treated by increasing urinary pH with limestone, and supplements. 3 (man). Fe in drinking water, 3.4 mg/L, had caused intestinal disturbances and subsequent symptoms. Fe was elevated in hair. Aloe vera juice, lactic bacteria and digestive enzymes healed his intestines. Mg, antagonist to Fe, decreased severity of Fe overload. Drinking water guideline of 0.2 mg Fe/L is suggested.

Assessment of hydrogeochemical characteristics and quality of groundwater resources in relation to risk of gastric cancer: comparative analysis of high- and low-risk areas in Iran

The chemical quality of groundwater supplies in two high-risk area (HRA) and low-risk area (LRA) for gastric cancer in Iran was assessed through hydrogeochemical analysis and water quality indices. For this aim, Piper and Schoeller diagrams and water quality index (WQI) were applied. In addition, exposure to nitrate via drinking water and its corresponding risk were also assessed using Monte Carlo simulation technique. Data on physicochemical properties of groundwater resources were obtained from Iran Water Resources Management Company. Sampling and analysis of tap water for nitrate concentration were conducted in two cities of Shiraz (as a representative of LRA) and Ardabil (as a representative of HRA). According to Piper diagrams, the dominant hydrogeochemical facies of groundwater supplies in HRA and LRA were Na-HCO₃ (43.75%) and Ca-HCO₃ (41.77%), respectively. The predominant cations in groundwater resources of HRA were found to be Na⁺ (68.06%) and Ca²⁺ (31.94%). For LRA, the typical cations were in decreasing trend: Ca²⁺ (39.64%) > Mg²⁺ (18.35%) > Na⁺ (17.26%). For two areas, HCO₃^-, SO₄^2- and Cl^- were, respectively, the most frequent anions. Two-sample Wilcoxon test showed that there were statistically significant difference between two areas in terms of anions and cations concentrations (p value < 0.05). The mean of total hardness (Ca²⁺ + Mg²⁺) concentration of water supplies in LRA (528.1 mg/L) was higher than HRA (263.1 mg/L), whereas the mean of Na⁺ concentration was found to be lower in LRA (90.6 mg/L) compared with HRA (108.1 mg/L). The sum of nitrate intake and its risk in LRA was higher than HRA. WQI results showed that drinking water quality in HRA and LRA ranged from excellent to poor and most water resources were of a good quality class. Further studies are suggested to investigate the role of drinking water in the etiology of gastric cancer in Iran.

Urinary Magnesium and Other Elements in Relation to Mammographic Breast Density, a Measure of Breast Cancer Risk

PURPOSE

Heavy metals and other elements may act as breast carcinogens due to estrogenic activity. We investigated associations between urine concentrations of a panel of elements and breast density.

METHODS

Mammographic density categories were abstracted from radiology reports of 725 women aged 40-65 yr in the Avon Army of Women. A panel of 27 elements was quantified in urine using high resolution magnetic sector inductively coupled plasma mass spectrometry. We applied LASSO (least absolute shrinkage and selection operator) logistic regression to the 27 elements and calculated odds ratios (OR) and 95% confidence intervals (CI) for dense vs. nondense breasts, adjusting for potential confounders.

RESULTS

Of the 27 elements, only magnesium (Mg) was selected into the optimal regression model. The odds ratio for dense breasts associated with doubling the Mg concentration was 1.24 (95% CI 1.03-1.49). Doubling the calcium-to-magnesium ratio was inversely associated with dense breasts (OR 0.83, 95% CI 0.70-0.98).

CONCLUSIONS

Our cross-sectional study found that higher levels of urinary magnesium were associated with greater breast density. Prospective studies are needed to confirm whether magnesium as evaluated in urine is prospectively associated with breast density and, more importantly, breast cancer.

Groundwater Pollution Sources Apportionment in the Ghaen Plain, Iran

Although Iran’s Ghaen Plain provides saffron to much of the world, no regional groundwater quality (GQ) assessment has yet been undertaken. Given the region’s potential for saltwater intrusion and heavy metal contamination, it is important to assess the GQ and determine its main probable source of pollution (MPSP). Such knowledge would allow for informed mitigation or elimination of the potential adverse health effects of this groundwater through its use as drinking water, or indirectly as a result of the consumption of groundwater-irrigated crops. Total dissolved solids, sodium, and chloride in the water of the majority of 16 wells sampled within the region exceeded World Health Organization and Iranian permissible standards for drinking water. The groundwater proved to only be suitable for irrigating salt tolerant crops under good drainage conditions. Due to the precipitation of calcium carbonate in the water supply facilities, the water from all wells was deemed unsuitable for industrial purposes. Heavy metal pollution and contamination indices showed no groundwater contamination. Analysis of ionic ratios and the application of principal components analysis indicated the MPSP to be saltwater intrusion, with the geology subtending the plain, and to a lesser extent, anthropogenic activities. Reducing groundwater withdrawals, particularly those for agricultural production by using high performance irrigation methods could reduce saltwater intrusion and improve GQ in the Ghaen Plain.

Impact of Calcium and Magnesium in Groundwater and Drinking Water on the Health of Inhabitants of the Slovak Republic

This work aims to evaluate the impact of the chemical composition of groundwater/drinking water on the health of inhabitants of the Slovak Republic. Primary data consists of 20,339 chemical analyses of groundwater (34 chemical elements and compounds) and data on the health of the Slovak population expressed in the form of health indicators (HI). Fourteen HIs were evaluated including life expectancy, potential years of lost life, relative/standardized mortality for cardiovascular and oncological diseases, and diseases of the gastrointestinal and respiratory systems. The chemical and health data were expressed as the mean values for each of the 2883 Slovak municipalities. Artificial neural network (ANN) was the method used for environmental and health data analysis. The most significant relationship between HI and chemical composition of groundwater was documented as Ca + Mg (mmol·L⁻¹), Ca and Mg. The following limit values were set for these most significant groundwater chemical parameters: Ca + Mg 2.9–6.1 mmol·L⁻¹, Ca 78–155 mg·L⁻¹ and Mg 28–54 mg·L⁻¹. At these concentration ranges, the health of the Slovak population is the most favorable and the life expectancy is the highest. These limit values are about twice as high in comparison to the current Slovak valid guideline values for drinking water.

Chemical composition of groundwater/drinking water and oncological disease mortality in Slovak Republic

This study deals with the analysis of relationship between chemical composition of the groundwater/drinking water and the data on mortality from oncological diseases (MOD) in the Slovak Republic. Primary data consist of the Slovak national database of groundwater analyses (20,339 chemical analyses, 34 chemical elements/compounds) and data on MOD (17 health indicators) collected for the 10-year period (1994-2003). The chemical and health data were unified in the same form and expressed as the mean values for each of 2883 municipalities within the Slovak Republic. Pearson and Spearman correlation as well as artificial neural network (ANN) methods were used for analysis of the relationship between chemical composition of groundwater/drinking water and MOD. The most significant chemical elements having influence on MOD were identified together with their limit values (limit and optimal contents). Based on the results of calculations, made through the neural networks, the following eight chemical elements/parameters in the groundwater were defined as the most significant for MOD: Ca + Mg (mmol l^-1), Ca, Mg, TDS, Cl, HCO₃, SO₄ and NO₃. The results document the highest relationship between MOD and groundwater contents of Ca + Mg (mmol l^-1), Ca and Mg. We observe increased MOD with low (deficit) contents of these three parameters of groundwater/drinking water. The following limit values were set for the most significant groundwater chemicals/parameters: Ca + Mg 1.73-5.85 mmol l^-1, Ca 60.5-196.8 mg l^-1 and Mg 25.6-35.8 mg l^-1. At these concentration ranges, the mortality for oncological diseases in the Slovak Republic is at the lowest levels. These limit values are about twice higher in comparison with the current Slovak valid guideline values for the drinking water.

Health effects of desalinated water: Role of electrolyte disturbance in cancer development

This review contends that "healthy" water in terms of electrolyte balance is as important as "pure" water in promoting public health. It considers the growing use of desalination (demineralization) technologies in drinking water treatment which often results in tap water with very low concentrations of sodium, potassium, magnesium and calcium. Ingestion of such water can lead to electrolyte abnormalities marked by hyponatremia, hypokalemia, hypomagnesemia and hypocalcemia which are among the most common and recognizable features in cancer patients. The causal relationships between exposure to demineralized water and malignancies are poorly understood. This review highlights some of the epidemiological and in vivo evidence that link dysregulated electrolyte metabolism with carcinogenesis and the development of cancer hallmarks. It discusses how ingestion of demineralized water can have a procarcinogenic effect through mediating some of the critical pathways and processes in the cancer microenvironment such as angiogenesis, genomic instability, resistance to programmed cell death, sustained proliferative signaling, cell immortalization and tumorigenic inflammation. Evidence that hypoosmotic stress-response processes can upregulate a number of potential oncogenes is well supported by a number studies. In view of the rising production and consumption of demineralized water in most parts of the world, there is a strong need for further research on the biological importance and protean roles of electrolyte abnormalities in promoting, antagonizing or otherwise enabling the development of cancer. The countries of the Gulf Cooperative Council (GCC) where most people consume desalinated water would be a logical place to start this research.

Food preparation methods, drinking water source, and esophageal squamous cell carcinoma in the high-risk area of Golestan, Northeast Iran

Cooking practices and water sources have been associated with an increased risk of cancer, mainly through exposure to carcinogens such as heterocyclic amines, polycyclic aromatic hydrocarbons, and nitrates. Using data from the Golestan case-control study, carried out between 2003 and 2007 in a high-risk region for esophageal squamous cell carcinoma (ESCC), we sought to investigate the association between food preparation and drinking water sources and ESCC. Information on food preparation methods, sources of drinking water, and dietary habits was gathered from 300 cases and 571 controls matched individually for age, sex, and neighborhood using a structured questionnaire and a semiquantitative food frequency questionnaire. Multivariate conditional logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI) adjusted for potential confounders and other known risk factors including socioeconomic status and smoking. More than 95% of the participants reported eating meat, mostly red meat. Red meat consumption above the 75th percentile increased the odds of ESCC by 2.82-fold (95% CI: 1.21-6.57). Fish intake was associated with a significant 68% decrease in ESCC odds (26%, 86%). Among meat eaters, ORs (95% CI) for frying meat (red or white) and fish were 3.34 (1.32-8.45) and 2.62 (1.24-5.5). Drinking unpiped water increased ESCC odds by 4.25 times (2.23-8.11). The OR for each 10-year increase in the duration of drinking unpiped water was 1.47 (1.22-1.78). Our results suggest roles for red meat intake, drinking water source, and food preparation methods in ESCC, even after adjusting for a large number of potential confounders.

The potential impact of geological environment on health status of residents of the Slovak Republic

In order to assess the potential impact of the geological environment on the health of the population of the Slovak Republic, the geological environment was divided into eight major units: Paleozoic, Crystalline, Carbonatic Mesozoic and basal Paleogene, Carbonatic-silicate Mesozoic and Paleogene, Paleogene Flysch, Neovolcanics, Neogene and Quaternary sediments. Based on these geological units, the databases of environmental indicators (chemical elements/parameters in groundwater and soils) and health indicators (concerning health status and demographic development of the population) were compiled. The geological environment of the Neogene volcanics (andesites and basalts) has been clearly documented as having the least favourable impact on the health of Slovak population, while Paleogene Flysch geological environment (sandstones, shales, claystones) has the most favourable impact. The most significant differences between these two geological environments were observed, especially for the following health indicators: SMRI6364 (cerebral infarction and strokes) more than 70 %, SMRK (digestive system) 55 %, REI (circulatory system) and REE (endocrine and metabolic system) almost 40 % and REC (malignant neoplasms) more than 30 %. These results can likely be associated with deficit contents of Ca and Mg in groundwater from the Neogene volcanics that are only about half the level of Ca and Mg in groundwater of the Paleogene sediments.

The role of selenium and selected trace elements in the etiology of esophageal cancer in high risk Golestan province of Iran

Selenium (Se) deficiency is reported by some authors to be an important factor in the etiology of esophageal cancer (EC) in the Golestan province of Iran. In order to further investigate the role of Se and selected trace elements in the occurrence of EC disease, 663 samples including 206 cultivated soils, 247 sediments, 45 loess deposits and 165 grain samples from 45 villages in the Golestan province of Iran were collected and analyzed. Villages in the study area were classified into 2 groups according to the EC incidence in the local population. The results of this study demonstrate that, contrary to the expected trend, total Se concentrations in soil, grain, sediment, and loess samples increase from the low to the high EC areas suggesting that Se deficiency does not play a major role in the etiology of EC. On the other hand, antimony (Sb), and strontium (Sr) content in soil, grain, loess, and sediment samples is much higher in the high esophageal cancer area, which may be a significant factor. Total zinc (Zn) concentrations in soil, grain, loess, and sediment samples decrease from the low to the high cancer areas. Therefore, Zn deficiency may be a significant factor in EC incidence rate in the Golestan province.

Trihalomethanes in drinking water and the risk of death from kidney cancer: does hardness in drinking water matter?

The objectives of this study were to (1) examine the relationship between total trihalomethanes (TTHM) levels in public water supplies and risk of development of kidney cancer and (2) determine whether hardness levels in drinking water modify the effects of TTHM on risk of kidney cancer induction. A matched case-control study was used to investigate the relationship between the risk of death attributed to kidney cancer and exposure to TTHM in drinking water in 53 municipalities in Taiwan. All kidney cancer deaths in the 53 municipalities from 1998 through 2007 were obtained. Controls were deaths from other causes and were pair-matched to the cancer cases by gender, year of birth, and year of death. Each matched control was selected randomly from the set of possible controls for each cancer case. Data on TTHM levels and levels of hardness in drinking water were also collected. The municipality of residence for cancer cases and controls was presumed to be the source of the subject's TTHM and hardness exposure via drinking water. Relative to individuals whose TTHM exposure level was <4.9 ppb, the adjusted OR (95% CI) for kidney cancer was 0.98 (0.77-1.25) for individuals who resided in municipalities served by drinking water with a TTHM exposure ≥4.9 ppb. However, evidence of an interaction was noted between the use of soft water and drinking water TTHM concentrations. Increased knowledge of the interaction between hardness and TTHM levels in reducing risk of kidney cancer development will aid in public policy decision and establishing standards to prevent disease occurrence.

Cancer mortality in a Chinese population surrounding a multi-metal sulphide mine in Guangdong province: an ecologic study

BACKGROUND

The Dabaoshan mine in the southeast of Guangdong Province, China, is at high risk of multi-metal pollutant discharge into a local river (Hengshihe) and the surrounding area. Following approximately 30 years of exposure to these metals, little is known regarding the subsequent health effects and risks for the local residents. In our present study, we have estimated the relationships between long-term environmental exposure to multiple heavy metals and the risk of cancer mortality in a Chinese population in the vicinity of Dabaoshan.

METHODS

An ecologic study was performed. Between 2000-2007, a total population of 194,131 lived in the nine agricultural villages that surround the Hengshihe area. Heavy metals concentrations were determined in local environmental samples (water and crops) and whole blood taken from 1152 local residents of both a high-exposure area (HEA) and a low-exposure area (LEA). We calculated the rate ratio and standardized mortality ratios based on age- and gender-specific cancer mortality rates for the different reference populations (based on district, county and province). Simple, multiple linear and ridge regression models were used to evaluate the associations between exposure to multiple heavy metals and cancer mortality in the nine villages, after adjustment for age and sex.

RESULTS

The geometric mean blood levels of cadmium and lead were measured at 24.10 μg/L and 38.91 μg/dL for subjects (n = 563) in the HEA and 1.87 μg/L and 4.46 μg/dL for subjects (n = 589) from the LEA, respectively (P < 0.001). The rate of mortality from all cancers in the HEA was substantially elevated in comparison with the corresponding mortality rate in the LEA for men (rate ratio = 2.13; 95% confidence intervals = 1.63 - 2.77) and women (2.83; 1.91 - 4.19); rates were also significantly elevated compared with the rate when compared to the entire Wengyuan County area, or the provincial reference population. In addition, mortality rates were significantly increased for stomach, lung and esophageal cancer in the HEA in comparison with the corresponding rates in the LEA, in Wengyuan County and the provincial reference population for men, women and both combined. Further analysis showed that there were significantly positive correlations between exposure to cadmium and lead and the risk of all-cancers and stomach cancer mortality among women and both sexes, whilst zinc exposure showed no association with the risk of site-specific cancer mortality in the nine villages evaluated.

CONCLUSIONS

The findings of this study reveal probable associations between long-term environmental exposure to both cadmium and lead and an increased risk of mortality from all cancer, as well as from stomach, esophageal and lung-cancers.

Concentrations of inorganic elements in bottled waters on the Swedish market

This study presents the concentrations of about 50 metals and ions in 33 different brands of bottled waters on the Swedish market. Ten of the brands showed calcium (Ca) concentrations </=10 mg L(-1) and magnesium (Mg) levels <3 mg L(-1), implying very soft waters. Three of these waters had in addition low concentrations of sodium (Na; <7 mg L(-1)), potassium (K; <3 mg L(-1)) and bicarbonate (HCO(3) </=31 mg L(-1)). These brands were collected from barren districts. Nine of the brands were collected from limestone regions. They showed increased Ca-levels exceeding 50 mg L(-1) with a maximum of 289 mg L(-1). Corresponding Mg-levels were also raised in two brands exceeding 90 mg L(-1). Two soft and carbonated waters were supplemented with Na(2)CO(3) and NaCl, resulting in high concentrations of Na (644 and 648 mg L(-1)) and chloride (Cl; 204 and 219 mg L(-1)). Such waters may make a substantial contribution to the daily intake of NaCl in high water consumers. The storage of carbonated drinking water in aluminum (Al) cans increased the Al-concentration to about 70 microg L(-1). Conclusion As there was a large variation in the material as regards concentrations of macro-elements such as Ca, Mg, Na, K and Cl. Supplementation with salts, e.g., Na(2)CO(3), K(2) CO(3) and NaCl, can lead to increased concentrations of Na, K and Cl, as well as decreased ratios of Ca/Na and larger ratios of Na/K. Water with high concentrations of e.g., Ca and Mg, may make a substantial contribution to the daily intake of these elements in high water consumers. Al cans are less suited for storage of carbonated waters, as the lowered pH-values may dissolve Al. The levels of potentially toxic metals in the studied brands were generally low.