Cancer risk assessment from exposure to trihalomethanes in tap water and swimming pool water

We investigated the concentration of trihalomethanes （THMs） in tap water and swimming pool water in the area of the Nakhon Path- om Municipality during the period April 2005-March 2006. The concentrations of total THMs, chloroform, bromodichloromethane, dibromochloromethane and bromoform in tap water were 12.70-41.74, 6.72-29.19, 1.12-11.75, 0.63-3.55 and 0.08-3.40 μg/L, respectively, whereas those in swimming pool water were 26.15-65.09, 9.50-36.97, 8.90-18.01, 5.19-22.78 and ND-6.56 μg/L, respectively. It implied that the concentration of THMs in swimming pool water was higher than those in tap water, particularly, brominated-THMs. Both tap water and swimming pool water contained concentrations of total THMs below the standards of the World Health Organization （WHO）, European Union （EU） and the United States Environmental Protection Agency （USEPA） phase Ⅰ, but 1 out of 60 tap water samples and 60 out of 72 swimming pool water samples contained those over the Standard of the USEPA phase Ⅱ. From the two cases of cancer risk assessment including Case Ⅰ Non-Swimmer and Case Ⅱ Swimmer, assessment of cancer risk of nonswimmers from exposure to THMs at the highest and the average concentrations was 4.43×10^-5 and 2.19×10^-5, respectively, which can be classified as acceptable risk according to the Standard of USEPA. Assessment of cancer risk of swimmers from exposure to THMs at the highest and the average concentrations was 1.47×10^-3 and 7.99×10^-4, respectively, which can be classified as unacceptable risk and needs to be improved. Risk of THMs exposure from swimming was 93.9%-94.2% of the total risk. Cancer risk of THMs concluded from various routes in descending order was： skin exposure while swimming, gastro-intestinal exposure from tap water intake, and skin exposure to tap water and gastro-intestinal exposure while swimming. Cancer risk from skin exposure while swimming was 94.18% of the total cancer risk.

Carcinogen-Macromolecular Adducts As Biomarkers in Human Cancer Risk Assessment

Substantial data have been generated during the past 5 years in both experimental systems and human populations which shed light on the potential role of carcinogen-macromolecular adducts in human cancer risk assessment. The use of DNA and protein adducts is based on the fundamental concept in chemical carcinogenesis that most genotoxins are metabolized to electrophilic 'ultimate' carcinogens that are capable of forming covalent adducts with cellular macromolecules. This report examines the relative usefulness and limitations of using DNA and protein adducts and related techniques for assessing human exposure to genotoxic carcinogens. Data discussed in this report clearly demonstrate that these biomarkers not only allow early detection of potential cancer hazard in humans, but they can also significantly increase the power of conventional cancer epidemiological studies in determining true causal relationships. In addition, such biomarkers can improve extrapolation of cancer risks from laboratory animals to humans or from one human population to another.

Assessment of Dose and Lifetime Risk of Exposure Induced Cancer in Adult Common Computed Tomography Scans in Douala-Cameroon

Background: Among medical technologies that use ionizing radiation, CT is currently the radio diagnostic technic that can deliver the highest radiation to the Patient compared with other conventional procedures. In developing countries, the uses and risks of CT have not been well characterized. Objective: To estimate the lifetime attributable risk (LAR) incidence and mortality for cancer for each procedure for adult’s patients who had Computed Tomography examinations in 10 imaging centers in the city of Douala-Cameroon so as to provide a reference data. Materials and Methods: We conducted a cross-sectional study describing radiation dose associated with the 8 most common types of diagnostic CT studies performed on 1287 consecutive adult patients at 10 Douala radiology department. We estimated lifetime attributable risks of cancer by study type from these measured doses. Estimation of LAR for cancer incidence and mortality was based on the effective dose, patient’s sex and age at exposure using the BIER VII preferred models. Results: Mean effective dose from CT scans examinations varied from: 0.30 and 8.81 mSv. The highest doses were observed for lumbar spine CT (8.81 mSv), followed by abdomen-pelvis procedure (6.46 mSv), chest-abdomen-pelvic CT (6.61 mSv), chest CT (3.90 mSv), cervical Spine CT (3.05 mSv), head CT (1.7 mSv) and lower for sinus CT (0.30 mSv). The LAR values of all cancer from patients’ CT scans obtained vary from 67.13 excess per 100,000 (about 1 in 1489) and 0.45 excess per 100,000 (about 1 in 222,222). All cancer risk was high for lumbar spine CT in women 20 years old (67.13 excess deaths in 100,000 scans) followed by chest-abdomen-pelvic CT (50.36 excess deaths in 100,000 scans) and abdomen-pelvic CT (49.22 excess deaths in 100,000 scans) for the same age group. The LAR of incidence and mortality values were higher from female’s patients than males and higher for younger than older patients. Conclusion: This study was set out to estimate the LAR values associated with adult common CT scans procedures. The data indicates, LAR risks related to induced cancer from CT exposures were estimated to be low. This risk can be relatively significant for younger age group compared to older age group. The LAR values obtained will help to better evaluate radiation exposure risk, before ordering a CT scans examinations.

Seasonal variation effects on the formation of trihalomethane during chlorination of water from Yangtze River and associated cancer risk assessment

For the system of water samples collected from Yangtze River,the effects of seasonal variation and Fe（III） concentrations on the formation and distribution of trihalomethanes （THMs） during chlorination have been investigated.The corresponding lifetime cancer risk of the formed THMs to human beings was estimated using the parameters and procedure issued by the US EPA.The results indicated that the average concentration of THMs （100.81 μg/L） in spring was significantly higher than that in other seasons,which was related to the higher bromide ion concentration resulted from the intrusion of tidal saltwater.The total cancer risk in spring reached 8.23 × 10 ？5 and 8.86 × 10 ？5 for males and females,respectively,which were about two times of those in summer under the experimental conditions.Furthermore,it was found that the presence of Fe（III） resulted in the increased level of THMs and greater cancer risk from exposure to humans.Under weak basic conditions,about 10% of the increment of THMs from the water samples in spring was found in the presence of 0.5 mg/L Fe（III） compared with the situation without Fe（III）.More attention should be given to the effect of the coexistence of Fe（III） and bromide ions on the risk assessment of human intake of THMs from drinking water should be paid more attention,especially in the coastland and estuaries.

How to select elderly colorectal cancer patients for surgery: a pilot study in an Italian academic medical center

Objective: Cancer is one of the most common diagnoses in elderly patients. Of all types of abdominal cancer, colorectal cancer(CRC) is undoubtedly the most frequent. Median age at diagnosis is approximately 70 years old worldwide. Due to the multiple comorbidities affecting elderly people, frailty evaluation is very important in order to avoid over- or undertreatment. This pilot study was designed to investigate the variables capable of predicting the long-term risk of mortality and living situation after surgery for CRC.Methods: Patients with 70 years old and older undergoing elective surgery for CRC were prospectively enrolled in the study. The patients were preoperatively screened using 11 internationally-validated-frailty-assessment tests. The endpoints of the study were long-term mortality and living situation. The data were analyzed using univariate Cox proportional-hazard regression analysis to verify the predictive value of score indices in order to identify possible risk factors.Results: Forty-six patients were studied. The median follow-up time after surgery was 4.6 years(range, 2.9-5.7 years) and no patients were lost to follow-up. The overall mortality rate was 39%. Four of the patients who survived(4/28, 14%) lost their functional autonomy. The preoperative impaired Timed Up and Go(TUG), Eastern Cooperative Group Performance Status(ECOG PS), Instrumental Activities of Daily Living(IADLs), Vulnerable Elders Survey(VES-13) scoring systems were significantly associated with increased long term mortality risk.Conclusion: Simplified frailty-assessing tools should be routinely used in elderly cancer patients before treatment in order to stratify patient risk. The TUG, ECOG-PS, IADLs and VES-13 scoring systems are potentially able to predict long-term mortality and disability. Additional studies will be needed to confirm the preliminary data in order to improve management strategies for oncogeriatric surgical patients.