{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T11:54:49Z","timestamp":1789646089141,"version":"4.0.0"},"reference-count":71,"publisher":"American Chemical Society (ACS)","issue":"4","license":[{"start":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T00:00:00Z","timestamp":1779235200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["P30-CA023100"],"award-info":[{"award-number":["P30-CA023100"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["P30-CA033572"],"award-info":[{"award-number":["P30-CA033572"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["R01-CA077398"],"award-info":[{"award-number":["R01-CA077398"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["U01-CA199277"],"award-info":[{"award-number":["U01-CA199277"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["UM1-CA164917"],"award-info":[{"award-number":["UM1-CA164917"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["Z-CP010125-28"],"award-info":[{"award-number":["Z-CP010125-28"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"name":"California Teachers Study"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>BACKGROUND: Several drinking water contaminants are known or suspected carcinogens; however, there are only a few investigations of drinking water exposure and ovarian cancer. We evaluated associations between regulated contaminants in community water systems (CWS) and ovarian cancer risk in the California Teachers Study, a prospective cohort of female California educators. METHODS: Participants were cancer-free, without bilateral oophorectomy, living in California at baseline (1995\u20131996) with geocoded addresses linked to a CWS (N = 91,127, 92%), with follow-up through 2020 (mean = 19.0 years). Among participants with a residential duration at enrollment of at least 10 years, we computed 15-year (1990\u20132005) averages of log2-transformed arsenic, nitrate, total trihalomethanes (TTHM) (N = 59,881), and uranium concentrations (N = 56,314). We estimated hazard ratios (HRs, 95% CIs) for all epithelial ovarian cancers (n = 413) and the high-grade serous histotype (n = 199), using Cox proportional hazards regression, adjusting for age, body mass index, menopause status, oral contraceptive use, and parity. We evaluated the mixture effect (per IQR in log2 concentrations) using quantile-based g-computation. RESULTS: Almost all women (&amp;gt;99%) had average exposures below regulatory limits for all contaminants. In single contaminant analyses, a doubling in average uranium concentrations was associated with all ovarian cancer (HRperlog2 = 1.07, CI 1.00\u20131.15), whereas a doubling in nitrate was associated with the high-grade serous histotype (HRperlog2 = 1.09, 95% CI 1.01, 1.17). Findings were similar in models adjusted for other contaminants. We observed positive but imprecise associations for arsenic and TTHM in single-contaminant and contaminant-adjusted analyses. HRs per increase in the mixture were 1.34 (0.95, 1.88) and 1.77 (1.09, 2.87) for all ovarian cancer and the high-grade serous histotype, respectively. Uranium was the largest contributor (56%) to the mixture effect for all ovarian cancers, and nitrate was the largest contributor (48%) for the high-grade serous histotype. CONCLUSIONS: Novel associations between drinking water contaminants and ovarian cancer risk at levels below regulatory limits warrant further investigation.<\/jats:p>","DOI":"10.1021\/ehp.6c00169","type":"journal-article","created":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T20:15:36Z","timestamp":1779308136000},"page":"452-464","source":"Crossref","is-referenced-by-count":2,"title":["Exposures to Drinking\nWater Contaminants in Community\nWater Systems and Risk of Ovarian Cancer in the California Teachers\nStudy Cohort"],"prefix":"10.1021","volume":"134","author":[{"given":"Maya","family":"Spaur","sequence":"first","affiliation":[{"name":"National Cancer Institute , , , ,","place":["Rockville, Maryland, United States, 20892"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren M.","family":"Hurwitz","sequence":"additional","affiliation":[{"name":"National Cancer Institute , , , ,","place":["Rockville, Maryland, United States, 20892"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle N.","family":"Medgyesi","sequence":"additional","affiliation":[{"name":"Columbia University , , , ,","place":["New York, New York, United States, 10032"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander P.","family":"Keil","sequence":"additional","affiliation":[{"name":"National Cancer Institute , , , ,","place":["Rockville, Maryland, United States, 20892"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura E.","family":"Beane Freeman","sequence":"additional","affiliation":[{"name":"National Cancer Institute , , , ,","place":["Rockville, Maryland, United States, 20892"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9203-5742","authenticated-orcid":true,"given":"Jared A.","family":"Fisher","sequence":"additional","affiliation":[{"name":"National Cancer Institute , , , ,","place":["Rockville, Maryland, United States, 20892"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica M.","family":"Madrigal","sequence":"additional","affiliation":[{"name":"National Cancer Institute , , , ,","place":["Rockville, Maryland, United States, 20892"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samantha","family":"Ammons","sequence":"additional","affiliation":[{"name":"National Cancer Institute , , , ,","place":["Rockville, Maryland, United States, 20892"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma S.","family":"Spielfogel","sequence":"additional","affiliation":[{"name":"Beckman Research Institute City of Hope , , , ,","place":["Duarte, California, United States, 91010"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Komal","family":"Bangia","sequence":"additional","affiliation":[{"name":"Office of Environmental Health Hazard Assessment , , , ,","place":["Oakland, California, United States, 94612"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul S.","family":"Albert","sequence":"additional","affiliation":[{"name":"National Cancer Institute , , , ,","place":["Rockville, Maryland, United States, 20850"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiffany R.","family":"Sanchez","sequence":"additional","affiliation":[{"name":"Columbia University , , , ,","place":["New York, New York, United States, 10032"]},{"name":"Colorado University Anschutz , , , ,","place":["Aurora, Colorado, United States, 80045"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr.","given":"James V.","family":"Lacey","sequence":"additional","affiliation":[{"name":"Beckman Research Institute City of Hope , , , ,","place":["Duarte, California, United States, 91010"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1294-1679","authenticated-orcid":true,"given":"Rena R.","family":"Jones","sequence":"additional","affiliation":[{"name":"National Cancer Institute , , , ,","place":["Rockville, Maryland, United States, 20892"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary H.","family":"Ward","sequence":"additional","affiliation":[{"name":"National Cancer Institute , , , ,","place":["Rockville, Maryland, United States, 20892"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"316","published-online":{"date-parts":[[2026,5,20]]},"reference":[{"key":"2026080408085307100_cit1","unstructured":"American Cancer Society.\n          . 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Information\nabout Public Water Systems. Accessed April 12, 2023. https:\/\/www.epa.gov\/dwreginfo\/information-about-public-water-systems."},{"key":"2026080408085307100_cit8","unstructured":"United States Environmental Protection Agency.\n          . National\nPrimary Drinking Water Regulations. Accessed Jan 15, 2021. https:\/\/www.epa.gov\/ground-water-and-drinking-water\/national-primary-drinking-water-regulations#one."},{"key":"2026080408085307100_cit9","unstructured":"United States Environmental Protection Agency.\n          . National\nPrimary Drinking Water Regulations. Accessed 7 July, 2023. https:\/\/www.epa.gov\/ground-water-and-drinking-water\/national-primary-drinking-water-regulations."},{"key":"2026080408085307100_cit10","unstructured":"United States Environmental Protection Agency.\n          . Stage 1\nand Stage 2 Disinfectants and Disinfection Byproducts Rules. Accessed 7 July, 2023. https:\/\/www.epa.gov\/dwreginfo\/stage-1-and-stage-2-disinfectants-and-disinfection-byproducts-rules."},{"issue":"1","key":"2026080408085307100_cit11","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1002\/ijc.29365","article-title":"Nitrate\nand nitrite ingestion and risk of ovarian cancer among postmenopausal\nwomen in Iowa","volume":"137","author":"Inoue-Choi","year":"2015","journal-title":"International Journal of Cancer"},{"issue":"3","key":"2026080408085307100_cit12","doi-asserted-by":"publisher","first-page":"e382","DOI":"10.1097\/EE9.0000000000000382","article-title":"Nitrate\nand disinfection by-products in drinking water and risk of ovarian\ncancer","volume":"9","author":"Ammons","year":"2025","journal-title":"Environ. Epidemiol."},{"key":"2026080408085307100_cit13","unstructured":"IARC Working Group on the Evaluation of\nCarcinogenic Risks to Humans.  IARC monographs\non the evaluation of carcinogenic risks\nto humans; Ingested nitrate and nitrite, and cyanobacterial peptide\ntoxins; IARC, 2010, Vol. 94."},{"issue":"7","key":"2026080408085307100_cit14","doi-asserted-by":"publisher","first-page":"1557","DOI":"10.3390\/ijerph15071557","article-title":"Drinking water\nnitrate and human health: an updated review","volume":"15","author":"Ward","year":"2018","journal-title":"International journal of environmental research and public health"},{"issue":"11","key":"2026080408085307100_cit15","doi-asserted-by":"publisher","first-page":"1607","DOI":"10.1289\/ehp.8043","article-title":"Workgroup\nreport: drinking-water\nnitrate and health\u2500recent findings and research needs","volume":"113","author":"Ward","year":"2005","journal-title":"Environmental health perspectives."},{"issue":"196","key":"2026080408085307100_cit16","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1007\/s12011-019-01920-2","article-title":"A review of uranium-induced\nreproductive toxicity","volume":"196","author":"Wang","year":"2020","journal-title":"Biological trace element\nresearch."},{"issue":"1","key":"2026080408085307100_cit17","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1016\/S0041-008X(02)00022-4","article-title":"Transplacental\ncarcinogenicity\nof inorganic arsenic in the drinking water: induction of hepatic,\novarian, pulmonary, and adrenal tumors in mice","volume":"186","author":"Waalkes","year":"2003","journal-title":"Toxicology and applied pharmacology."},{"key":"2026080408085307100_cit18","unstructured":"IARC.\n          \n          Some chemicals that cause tumors of\nthe kidney or\nurinary bladder in rodents and some other substances, IARC Monographs;\nInternational Agency for Research on Cancer Monographs on the evaluation\nof carcinogenic risks to humans; IARC, 1999; Vol. 73https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK402094\/#p131_s5."},{"key":"2026080408085307100_cit19","unstructured":"International Agency for Research on Cancer.\nArsenic, metals, fibres\nand dusts.  IARC monographs on the evaluation\nof carcinogenic risks to humans; IARC, 2012."},{"key":"2026080408085307100_cit20","unstructured":"International Agency for Research on Cancer.\n          . Arsenic and arsenic\ncompounds.  IARC Monographs - 100CIARC, 2018."},{"issue":"1\u20133","key":"2026080408085307100_cit21","doi-asserted-by":"publisher","first-page":"178","DOI":"10.1016\/j.mrrev.2007.09.001","article-title":"Occurrence,\ngenotoxicity, and carcinogenicity of regulated and emerging disinfection\nby-products in drinking water: a review and roadmap for research","volume":"636","author":"Richardson","year":"2007","journal-title":"Mutation Research\/Reviews in Mutation Research."},{"issue":"9","key":"2026080408085307100_cit22","doi-asserted-by":"publisher","first-page":"715","DOI":"10.1002\/mc.21913","article-title":"Endocrine disrupting chemicals promote the growth of\novarian cancer cells via the ER-CXCL12-CXCR4 signaling axis","volume":"52","author":"Hall","year":"2013","journal-title":"Molecular carcinogenesis."},{"key":"2026080408085307100_cit23","doi-asserted-by":"publisher","first-page":"625","DOI":"10.1023\/A:1019552126105","article-title":"High breast\ncancer incidence rates among California teachers: results from the\nCalifornia Teachers Study (United States)","volume":"13","author":"Bernstein","year":"2002","journal-title":"Cancer\nCauses & Control"},{"issue":"7","key":"2026080408085307100_cit24","doi-asserted-by":"publisher","first-page":"1547","DOI":"10.1016\/j.socscimed.2004.07.018","article-title":"Residential mobility in the California\nTeachers Study: implications for geographic differences in disease\nrates","volume":"60","author":"Hurley","year":"2005","journal-title":"Social Sci. Med."},{"issue":"6","key":"2026080408085307100_cit25","doi-asserted-by":"publisher","first-page":"595","DOI":"10.1007\/s10552-008-9124-y","article-title":"Dietary assessment\nin the California Teachers Study:\nreproducibility and validity","volume":"19","author":"Horn-Ross","year":"2008","journal-title":"Cancer causes\n& control"},{"issue":"7","key":"2026080408085307100_cit26","doi-asserted-by":"publisher","first-page":"802","DOI":"10.1093\/aje\/kwk065","article-title":"Diet and risk of ovarian\ncancer in the California Teachers Study cohort","volume":"165","author":"Chang","year":"2007","journal-title":"American journal of epidemiology"},{"issue":"11","key":"2026080408085307100_cit27","doi-asserted-by":"publisher","first-page":"1934","DOI":"10.1017\/S1368980015003407","article-title":"Development and calibration\nof a dietary nitrate and nitrite database in the NIH\u2013AARP Diet\nand Health Study","volume":"19","author":"Inoue-Choi","year":"2016","journal-title":"Public health nutrition"},{"issue":"3","key":"2026080408085307100_cit28","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1093\/aje\/152.3.279","article-title":"Evaluation of alternative approaches\nto assign nutrient values to food groups in food frequency questionnaires","volume":"152","author":"Subar","year":"2000","journal-title":"American journal of epidemiology."},{"key":"2026080408085307100_cit29","unstructured":"California Office of Environmental Health\nHazard Assessment.  Methodology for a statewide\ndrinking water contaminant\nindicator: CalEnviroScreen 3.0.; COEH, 2017."},{"key":"2026080408085307100_cit30","unstructured":"Public Health Institute.\n          . Tracking California: Informing Action\nfor Healthier Communities. 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TAMU GeoServices, GeoInnovation Service\nCenter. https:\/\/geoservices.tamu.edu\/."},{"key":"2026080408085307100_cit37","unstructured":"United States Environmental Protection Agency.\n          . Arsenic\nand clarifications to compliance and new source monitoring rule: A\nquick reference guide. Accessed Dec 15, 2022. https:\/\/denr.sd.gov\/des\/dw\/PDF\/Quick%20Reference%20Guides\/quickguide.pdf."},{"key":"2026080408085307100_cit38","unstructured":"United States Environmental Protection Agency.\n          . Arsenic\nRule Compliance for Community Water System Owners and Operators. Accessed Dec 15, 2022. https:\/\/www.epa.gov\/dwreginfo\/arsenic-rule-compliance-community-water-system-owners-and-operators."},{"key":"2026080408085307100_cit39","unstructured":"United States Environmental Protection Agency.\n          . Radionuclides\nRule. 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EPA, 2004. https:\/\/www.epa.gov\/dwreginfo\/standardized-monitoring-framework-quick-reference-guide."},{"issue":"4","key":"2026080408085307100_cit42","doi-asserted-by":"publisher","first-page":"777","DOI":"10.1158\/1055-9965.EPI-19-0842","article-title":"Insights from adopting\na data commons approach for\nlarge-scale observational cohort studies: the California Teachers\nStudy","volume":"29","author":"Lacey","year":"2020","journal-title":"Cancer Epidemiology, Biomarkers &\nPrevention"},{"issue":"8","key":"2026080408085307100_cit43","doi-asserted-by":"publisher","first-page":"1180","DOI":"10.1002\/cncr.33369","article-title":"Assessing\nrisk factors with information beyond P value thresholds: statistical\nsignificance does not equal clinical importance","volume":"127","author":"Putt","year":"2021","journal-title":"Cancer."},{"key":"2026080408085307100_cit44","doi-asserted-by":"publisher","first-page":"2241","DOI":"10.1007\/s10552-010-9647-x","article-title":"Body size\nand the risk of ovarian cancer by hormone therapy use in the California\nTeachers Study cohort","volume":"21","author":"Canchola","year":"2010","journal-title":"Cancer Causes & Control"},{"issue":"9609","key":"2026080408085307100_cit45","doi-asserted-by":"publisher","first-page":"303","DOI":"10.1016\/S0140-6736(08)60167-1","article-title":"Ovarian cancer and\noral contraceptives: collaborative\nreanalysis of data from 45 epidemiological studies including 23 257\nwomen with ovarian cancer and 87 303 controls","volume":"371","year":"2008","journal-title":"Lancet"},{"issue":"7","key":"2026080408085307100_cit46","doi-asserted-by":"publisher","first-page":"1059","DOI":"10.1158\/1055-9965.EPI-16-0011","article-title":"Parity and oral contraceptive use\nin relation to ovarian\ncancer risk in older women","volume":"25","author":"McGuire","year":"2016","journal-title":"Cancer Epidemiology,\nBiomarkers & Prevention"},{"issue":"4","key":"2026080408085307100_cit47","doi-asserted-by":"publisher","first-page":"047004","DOI":"10.1289\/EHP5838","article-title":"A quantile-based\ng-computation approach to addressing\nthe effects of exposure mixtures","volume":"128","author":"Keil","year":"2020","journal-title":"Environmental\nhealth perspectives"},{"key":"2026080408085307100_cit48","unstructured":"qgcomp: Quantile G-Computation. 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D.\n          Endocrine\nChanges in Obesity; Endotext [Internet], 2022."},{"issue":"5","key":"2026080408085307100_cit50","doi-asserted-by":"publisher","first-page":"1403","DOI":"10.1158\/1055-9965.EPI-08-1094","article-title":"Body mass index\nbefore and after breast cancer diagnosis: associations with all-cause,\nbreast cancer, and cardiovascular disease mortality","volume":"18","author":"Nichols","year":"2009","journal-title":"Cancer Epidemiology Biomarkers & Prevention"},{"issue":"4","key":"2026080408085307100_cit51","doi-asserted-by":"publisher","first-page":"812","DOI":"10.1002\/cncr.24086","article-title":"Body mass index\nand risk of ovarian cancer","volume":"115","author":"Leitzmann","year":"2009","journal-title":"Cancer"},{"issue":"4","key":"2026080408085307100_cit52","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1177\/2053369117709225","article-title":"Obesity and ovarian\ncancer risk: A systematic 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