{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T20:26:20Z","timestamp":1793132780087,"version":"4.5.0"},"reference-count":32,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2023,8,8]],"date-time":"2023-08-08T00:00:00Z","timestamp":1691452800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004359","name":"Swedish Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004359","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002794","name":"Swedish Cancer Society","doi-asserted-by":"publisher","award":["2020-01630"],"award-info":[{"award-number":["2020-01630"]}],"id":[{"id":"10.13039\/501100002794","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002794","name":"Swedish Cancer Society","doi-asserted-by":"publisher","award":["CAN2018\/584"],"award-info":[{"award-number":["CAN2018\/584"]}],"id":[{"id":"10.13039\/501100002794","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,12,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Colorectal cancer is the third most common malignancy worldwide and is strongly linked to lifestyle and environmental risk factors. Although several drinking-water disinfection by-products are confirmed rodent carcinogens, the evidence in humans for carcinogenicity associated with these by-products, including colorectal cancer, is still inconclusive.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We assessed the association of long-term exposure to trihalomethanes (THMs), the most prevalent disinfection by-products in chlorinated drinking water, with incidence of colorectal cancer in 58\u200a672 men and women in 2 population-based cohorts. Exposure was assessed by combining long-term information of residential history with drinking water\u2013monitoring data. Participants were categorized according to no exposure, low exposure (&amp;lt;15\u00a0\u00b5g\/L), and high exposure (\u226515\u00a0\u00b5g\/L). Incident cases of colorectal cancer were ascertained by use of the Swedish National Cancer Register.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>During an average follow-up of 16.8\u00a0years (988\u200a144 person-years), 1913 cases of colorectal cancer were ascertained (1176 cases in men and 746 in women, respectively). High THM concentrations in drinking water (\u226515\u2009\u00b5g\/L) were associated with increased risk of colorectal cancer in men (hazard ratio = 1.26, 95% confidence interval = 1.05-1.51) compared with no exposure. When subsites were assessed, the association was statistically significant for proximal colon cancer (hazard ratio = 1.59, 95% confidence interval = 1.11 to 2.27) but not for distal colon cancer or rectal cancer. In women, we observed overall no association of THMs with colorectal cancer.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>These results add further evidence that disinfection by-products in drinking water may be a possible risk factor for proximal colon cancer in men. This observation was made at THM concentrations lower than those in most previous studies.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jnci\/djad145","type":"journal-article","created":{"date-parts":[[2023,8,8]],"date-time":"2023-08-08T12:48:42Z","timestamp":1691498922000},"page":"1597-1604","source":"Crossref","is-referenced-by-count":37,"title":["Disinfection by-products in drinking water and risk of colorectal cancer: a population-based cohort study"],"prefix":"10.1093","volume":"115","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7062-5968","authenticated-orcid":false,"given":"Emilie","family":"Helte","sequence":"first","affiliation":[{"name":"Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet , Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melle","family":"S\u00e4ve-S\u00f6derbergh","sequence":"additional","affiliation":[{"name":"Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet , Stockholm, Sweden"},{"name":"Science Division, Swedish Food Agency , Uppsala, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susanna C","family":"Larsson","sequence":"additional","affiliation":[{"name":"Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet , Stockholm, Sweden"},{"name":"Unit of Medical Epidemiology, Department of Surgical Sciences, Uppsala University , Uppsala, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Martling","sequence":"additional","affiliation":[{"name":"Department of Molecular Medicine and Surgery, Karolinska Institutet , Stockholm, Sweden"},{"name":"Department of Pelvic Cancer, GI Oncology and Colorectal Surgery Unit, Karolinska University Hospital , Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agneta","family":"\u00c5kesson","sequence":"additional","affiliation":[{"name":"Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet , Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,8,8]]},"reference":[{"issue":"3","key":"2023120620190284700_djad145-B1","doi-asserted-by":"crossref","first-page":"209","DOI":"10.3322\/caac.21660","article-title":"Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"71","author":"Sung","year":"2021","journal-title":"CA Cancer J Clin"},{"issue":"11","key":"2023120620190284700_djad145-B2","doi-asserted-by":"crossref","first-page":"1350","DOI":"10.1038\/nm.3967","article-title":"The consensus molecular subtypes of colorectal cancer","volume":"21","author":"Guinney","year":"2015","journal-title":"Nat Med"},{"issue":"10","key":"2023120620190284700_djad145-B3","doi-asserted-by":"crossref","first-page":"1995","DOI":"10.1093\/annonc\/mdu275","article-title":"Distal and proximal colon cancers differ in terms of molecular, pathological, and clinical features","volume":"25","author":"Missiaglia","year":"2014","journal-title":"Ann Oncol"},{"issue":"5","key":"2023120620190284700_djad145-B4","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1002\/ijc.10635","article-title":"Are there two sides to colorectal cancer?","volume":"101","author":"Iacopetta","year":"2002","journal-title":"Int J Cancer"},{"issue":"1","key":"2023120620190284700_djad145-B5","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1111\/j.1440-1746.2009.05992.x","article-title":"Sex differences in epidemiological, clinical and pathological characteristics of colorectal cancer","volume":"25","author":"Koo","year":"2010","journal-title":"J Gastroenterol Hepatol"},{"issue":"1-3","key":"2023120620190284700_djad145-B6","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1016\/j.mrrev.2007.09.001","article-title":"Occurrence, genotoxicity, and carcinogenicity of regulated and emerging disinfection by-products in drinking water: a review and roadmap for research","volume":"636","author":"Richardson","year":"2007","journal-title":"Mutat Res"},{"key":"2023120620190284700_djad145-B7","first-page":"1","article-title":"NTP toxicology and carcinogenesis studies of tribromomethane (Bromoform) (CAS No. 75-25-2) in F344\/N Rats and B6C3F1 Mice (gavage studies)","volume":"350","author":"NTP (National Toxicology Program)","year":"1989","journal-title":"Natl Toxicol Program Tech Rep Ser"},{"key":"2023120620190284700_djad145-B8","first-page":"1","article-title":"NTP toxicology and carcinogenesis studies of bromodichloromethane (CAS No. 75-27-4) in F344\/N Rats and B6C3F1 mice (gavage studies)","volume":"321","author":"NTP (National Toxicology Program)","year":"1987","journal-title":"Natl Toxicol Program Tech Rep Ser"},{"issue":"3","key":"2023120620190284700_djad145-B9","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1093\/ije\/dyp371","article-title":"Disinfection by-products in drinking water and colorectal cancer: a meta-analysis","volume":"39","author":"Rahman","year":"2010","journal-title":"Int J Epidemiol"},{"issue":"2","key":"2023120620190284700_djad145-B10","doi-asserted-by":"crossref","DOI":"10.13172\/2053-079X-1-2-943","article-title":"The Swedish mammography cohort and the cohort of Swedish men: study design and characteristics of two population-based longitudinal cohorts","volume":"1","author":"Harris","year":"2013","journal-title":"OA Epidemiol"},{"issue":"2","key":"2023120620190284700_djad145-B11","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1038\/jes.2017.8","article-title":"Drinking water consumption patterns among adults-SMS as a novel tool for collection of repeated self-reported water consumption","volume":"28","author":"Save-Soderbergh","year":"2018","journal-title":"J Expo Sci Environ Epidemiol"},{"key":"2023120620190284700_djad145-B12","author":"Conway"},{"issue":"1","key":"2023120620190284700_djad145-B13","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1080\/02841860802247664","article-title":"The completeness of the Swedish Cancer Register \u2013 a sample survey for year 1998","volume":"48","author":"Barlow","year":"2009","journal-title":"Acta Oncologica"},{"key":"2023120620190284700_djad145-B14","volume-title":"ICD-10 : International Statistical Classification of Diseases and Related Health Problems: Tenth Revision","author":"World Health Organization","year":"2004","edition":"2nd ed"},{"issue":"17","key":"2023120620190284700_djad145-B15","doi-asserted-by":"crossref","first-page":"5167","DOI":"10.3748\/wjg.v21.i17.5167","article-title":"Sex- and gender-specific disparities in colorectal cancer risk","volume":"21","author":"Kim","year":"2015","journal-title":"World J Gastroenterol"},{"issue":"14","key":"2023120620190284700_djad145-B16","doi-asserted-by":"crossref","first-page":"3636","DOI":"10.1002\/cncr.26677","article-title":"Socioeconomic status and the risk of colorectal cancer: an analysis of more than a half million adults in the National Institutes of Health-AARP Diet and Health Study","volume":"118","author":"Doubeni","year":"2012","journal-title":"Cancer"},{"issue":"10","key":"2023120620190284700_djad145-B17","doi-asserted-by":"crossref","first-page":"2406","DOI":"10.1002\/ijc.24191","article-title":"Cigarette smoking and colorectal cancer incidence and mortality: systematic review and meta-analysis","volume":"124","author":"Liang","year":"2009","journal-title":"Int J Cancer"},{"key":"2023120620190284700_djad145-B18","author":"World Cancer Research Fund\/American Institute for Cancer Research","year":"2018"},{"issue":"5","key":"2023120620190284700_djad145-B19","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1089\/dia.2012.0263","article-title":"Diabetes mellitus and the occurrence of colorectal cancer: an updated meta-analysis of cohort studies","volume":"15","author":"Wu","year":"2013","journal-title":"Diabetes Technol Ther"},{"issue":"1","key":"2023120620190284700_djad145-B20","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1289\/EHP155","article-title":"Colorectal cancer and long-term exposure to trihalomethanes in drinking water: a multicenter case-control study in Spain and Italy","volume":"125","author":"Villanueva","year":"2017","journal-title":"Environ Health Perspect"},{"key":"2023120620190284700_djad145-B21","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1186\/1471-2407-14-445","article-title":"Colon and rectal cancer incidence and water trihalomethane concentrations in New South Wales, Australia","volume":"14","author":"Rahman","year":"2014","journal-title":"BMC Cancer"},{"key":"2023120620190284700_djad145-B22","doi-asserted-by":"crossref","first-page":"11786302211064432","DOI":"10.1177\/11786302211064432","article-title":"Drinking water source, chlorinated water, and colorectal cancer: a matched case-control study in Ethiopia","volume":"16","author":"Tafesse","year":"2022","journal-title":"Environ Health Insights"},{"key":"2023120620190284700_djad145-B23","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1016\/j.envint.2019.02.010","article-title":"Ingested nitrate, disinfection by-products, and risk of colon and rectal cancers in the Iowa Women's Health Study cohort","volume":"126","author":"Jones","year":"2019","journal-title":"Environ Int"},{"key":"2023120620190284700_djad145-B24","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1186\/1476-072X-6-18","article-title":"Case control study of the geographic variability of exposure to disinfectant byproducts and risk for rectal cancer","volume":"6","author":"Bove","year":"2007","journal-title":"Int J Health Geogr"},{"key":"2023120620190284700_djad145-B25","first-page":"1","article-title":"Report on the carcinogenesis bioassay of chloroform (CAS No. 67-66-3)","volume":"1976","author":"National Toxicology Program","year":"1976","journal-title":"Natl Cancer Inst Carcinog Tech Rep Ser"},{"key":"2023120620190284700_djad145-B26","first-page":"1","article-title":"NTP toxicology and carcinogenesis studies of chlorodibromomethane (CAS No. 124-48-1) in F344\/N rats and B6C3F1 mice (gavage studies)","volume":"282","author":"National Toxicology Program","year":"1985","journal-title":"Natl Toxicol Program Tech Rep Ser"},{"issue":"12","key":"2023120620190284700_djad145-B27","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1038\/s41575-019-0189-8","article-title":"Global burden of colorectal cancer: emerging trends, risk factors and prevention strategies","volume":"16","author":"Keum","year":"2019","journal-title":"Nat Rev Gastroenterol Hepatol"},{"issue":"5","key":"2023120620190284700_djad145-B28","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1136\/oem.2010.062703","article-title":"Water disinfection by-products and bladder cancer: is there a European specificity? A pooled and meta-analysis of European case\u2013control studies","volume":"68","author":"Costet","year":"2011","journal-title":"Occup Environ Med"},{"issue":"5","key":"2023120620190284700_djad145-B29","doi-asserted-by":"crossref","first-page":"703","DOI":"10.1097\/EDE.0000000000000647","article-title":"Ingested nitrate, disinfection by-products, and kidney cancer risk in older women","volume":"28","author":"Jones","year":"2017","journal-title":"Epidemiology"},{"issue":"2","key":"2023120620190284700_djad145-B30","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1002\/ijc.31055","article-title":"Ingested nitrate and nitrite, disinfection by-products, and pancreatic cancer risk in postmenopausal women","volume":"142","author":"Quist","year":"2018","journal-title":"Int J Cancer"},{"key":"2023120620190284700_djad145-B31","volume-title":"Report on Carcinogens","author":"NTP (National Toxicology Program)","year":"2021","edition":"15th ed"},{"key":"2023120620190284700_djad145-B32","author":"Pereira"}],"container-title":["JNCI: Journal of the National Cancer Institute"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jnci\/advance-article-pdf\/doi\/10.1093\/jnci\/djad145\/51301154\/djad145.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jnci\/article-pdf\/115\/12\/1597\/54035685\/djad145.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jnci\/article-pdf\/115\/12\/1597\/54035685\/djad145.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,12,7]],"date-time":"2023-12-07T05:45:33Z","timestamp":1701927933000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jnci\/article\/115\/12\/1597\/7238786"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,8]]},"references-count":32,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2023,8,8]]},"published-print":{"date-parts":[[2023,12,6]]}},"URL":"https:\/\/doi.org\/10.1093\/jnci\/djad145","relation":{},"ISSN":["0027-8874","1460-2105"],"issn-type":[{"value":"0027-8874","type":"print"},{"value":"1460-2105","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,12,1]]},"published":{"date-parts":[[2023,8,8]]}}}