Abstract
BackgroundNo accurate evaluation of smoking and water pollution on bladder cancer has been conducted in the Lebanese population. Our aim is to examine the significance of smoking and one of the main water pollutants Trihalomethanes (THM) on bladder cancer risk.MethodsPopulation Attributable Fraction (PAF) was used to quantify the contribution of the risk factors smoking and THMs on bladder cancer in Lebanon. To calculate PAF for each risk factor, we used the proportion of the population exposed and the relative risk for each risk factor. Relative risks for each risk factor were obtained from published meta-analyses. The population at risk values were obtained from a report on chronic disease risk factor surveillance in Lebanon which was conducted by the World Health Organization between 2008 and 2009 and a national study by Semerjian et al. that conducted a multipathway exposure assessment of selected public drinking waters of Lebanon for the risk factors smoking and THMs, respectively.ResultsBladder cancer cases that were the result of smoking in Lebanon among males and females are 33.4 and 18.6%, respectively. Cases attributed to mid-term exposure to THM contamination of drinking water is estimated at 8.6%.ConclusionThis paper further highlights the negative impact of smoking on bladder cancer risk and adds an overlooked and often underestimated risk that THMs have on this type of cancer. Thus, it is imperative that a national based study which assesses THM exposure by gender and smoking status be implemented to determine the real risk behind this byproduct.
Highlights
No accurate evaluation of smoking and water pollution on bladder cancer has been conducted in the Lebanese population
We applied the formula for females and found that bladder cancer cases that were the result of smoking among females were 18.6% of cases for all age groups if we consider the smokers percentage in 2009 and its implication by 2018
To calculate the percentage of bladder cancer cases attributed to mid-term exposure to THM contamination of drinking water we used the value of 94.7% for the Pe and value of 1.1 for relative risk (RR) since exposure to THM in Lebanon is midterm exposure
Summary
No accurate evaluation of smoking and water pollution on bladder cancer has been conducted in the Lebanese population. Our aim is to examine the significance of smoking and one of the main water pollutants Trihalomethanes (THM) on bladder cancer risk. Incidence rates vary from 10 to 30 cases/100,000 for men and 1–6 cases/100,000 in women [2]. The International Agency for Research on Cancer (IARC) identified smoking as one of the causes of bladder cancer in both men and women [4]. Some reported a modest association via the ingestion route [14], the main discrepancies in results were related to those reporting an association between THMs exposure through shower, swimming pools and inhalation and bladder cancer risk [15, 16]. The IARC classified THMs as Group 3 carcinogens concluding that there was inadequate evidence for their carcinogenicity to humans from the ecological and death certificate studies
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