Cancer incidence following exposure to drinking water with asbestos leachate

Our plain-English summary of Cancer incidence following exposure to drinking water with asbestos leachate, by H.L. Howe, P.E. Wolfgang, W.S. Burnett, et al (Public Health Reports, 1989).

The study

• Authors: H.L. Howe, P.E. Wolfgang, W.S. Burnett, P.C. Nasca, L. Youngblood
• Journal: Public Health Reports
• Published: 1989;104(3):251-6
• Cited by: 19 articles, as counted by NIH iCite
• Read it: PubMed · Free full text
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 000095).

Abstract

In November 1985, the New York State Department of Health was altered to extraordinary concentrations of asbestos leachate in the drinking water in the Town of Woodstock. Concentrations of 3.2 million fibers per liter (MFL) to 304.5 MFL were found, depending on location. An investigation of cancer incidence in the area was conducted for the period 1973-83 using the State Cancer Registry to compute standardized incidence ratios. No evidence was found of elevated cancer incidence at sites associated with asbestos exposure. A statistically non-significant excess of kidney cancer was seen among men, but not women. Colon cancer among men was significantly low, but incidence among women was similar to that expected. Lung cancer incidence was lower than expected for both sexes. Ovarian cancer rates were not different from expected rates. At sites not previously related to asbestos exposure, cancer of the oral cavity was significantly high, with most affected persons having a history of cigarette smoking. Surveillance of the community is continuing because of an insufficient latent period for some exposed groups.

In plain English

The authors studied cancer in part of Woodstock, New York. In 1985, asbestos was found in public drinking water carried through deteriorating asbestos-cement pipe. Samples held 3.2 to 304.5 million fibers per liter, including chrysotile and crocidolite. Using the State Cancer Registry, the authors compared cancers diagnosed in 1973-83 among the area's 2,679 residents (1980 census) with numbers expected from upstate New York rates. They counted 127 cancers, a standardized incidence ratio of 0.9 (95 percent confidence interval 0.8, 1.1). No mesotheliomas were detected, and no cancer site previously linked to asbestos showed a statistically significant excess. Kidney cancer in men was above expected (ratio 3.0, 95 percent confidence interval 1.0 to 6.9), a difference the authors called not statistically significant. Colon cancer in men was significantly low, and lung cancer was lower than expected in both sexes. Oral cancer was significantly high in men, most of whom had smoked. The authors noted that the design cannot show cause, that exposure may have been misclassified, and that some findings could be chance. Surveillance continued because some residents may not yet have had enough time for cancer to appear.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Ecological study of cancer incidence using state cancer registry data and standardized incidence ratios, with exposure defined by area of residence at diagnosis
• Who was studied: Residents of four census block groups covering the water district in the Town of Woodstock, New York: 2,679 people (1,235 men, 1,444 women) by the 1980 Census. Cancers diagnosed in 1973-83 were compared with expected numbers based on New York State rates excluding New York City.
• Exposure: Asbestos leachate in public drinking water from deteriorating asbestos-cement pipe. Five residential samples taken in 1985 contained 3.2 to 304.5 million fibers per liter, and chrysotile and crocidolite were present. Potential exposure began in the mid-1950s for one housing development and in the mid-1960s for the rest of the system. The duration of exposure could not be determined.
• Main results:
  • Total cancers observed in the study area: 127, standardized incidence ratio 0.9 (95 percent CI 0.8, 1.1)
  • The authors found no evidence of elevated cancer risk at any site previously associated with asbestos exposure
  • No mesotheliomas were detected
  • Kidney cancer showed a nonsignificant excess in men but not in women
  • Kidney cancer SIR: men 3.0 (95 percent CI 1.0, 6.9); women 0.0 (0.0, 3.4)
  • Colon cancer was significantly low among men, while incidence among women was similar to expected
  • Colon cancer SIR: men 0.1 (95 percent CI 0.0, 0.7); women 1.1 (0.5, 2.0)
  • Lung cancer was lower than expected in both sexes. SIR: men 0.4 (95 percent CI 0.2, 0.9); women 0.5 (0.1, 1.4)
  • Ovarian cancer SIR in women: 1.0 (95 percent CI 0.2, 2.9), not different from expected
  • Oral cavity cancer, a site not previously related to asbestos, was significantly high in men, most of whom had a history of cigarette smoking
  • Buccal (oral) cancer SIR: men 3.0 (95 percent CI 1.2, 6.1); women 0.0 (0.0, 3.0)
• The authors' conclusion: The authors reported that the Department of Health was continuing surveillance of the community through a registry of exposed residents. They said the follow-up would reduce the chance that the negative findings resulted from insufficient latency among those exposed.
• Limitations the authors state:
  • Because of the ecological design, the data cannot support a causal relationship between exposure and cancer incidence
  • Exposure may have been misclassified because of population migration and the lack of individual historical exposure data
  • About half of the households in the water district were not connected to the public water supply, and the people in those households could not be identified
  • Because many statistical tests were run, the oral cancer excess and the lung and colon deficits in men could be chance findings
  • Statistical power to detect a 50 percent increase was low for each sex-specific cancer site
  • The time between the start of exposure and the study period may have been too short, with at least 10 years elapsed for residents
  • The duration of exposure could not be determined

Topics

Medical terms in this study, explained in our Lexicon: Cancer Registry, Standardized Incidence Ratio (SIR), Asbestos Exposure, Colorectal Cancer, Lung Cancer, Ovarian Cancer.

Related studies

• Cancer incidence and asbestos in drinking water, Town of Woodstock, New York, 1980-1998 — M.L. Browne, D. Varadarajulu, et al. (2005)
• Asbestos in drinking water and cancer incidence in the San Francisco Bay area — M.S. Kanarek, P.M. Conforti, et al. (1980)
• Cancer incidence in relation to asbestos in drinking water in the Puget Sound region — L. Polissar, R.K. Severson, et al. (1982)
• The San Francisco Bay epidemiology studies on asbestos in drinking water and cancer incidence: relationship to studies in other locations and pointers for further research — M.S. Kanarek (1983)
• "Asbestos in drinking water and cancer incidence in the San Francisco Bay area" — I.T. Higgins (1981)
• Drinking water and cancer — K.P. Cantor (1997)

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