The use of asbestos-cement pipe for public water supply and the incidence of cancer in selected communities in Utah

Our plain-English summary of The use of asbestos-cement pipe for public water supply and the incidence of cancer in selected communities in Utah, by T.D. Sadler, W.N. Rom, J.L. Lyon, et al (Journal of Community Health, 1984).

The study

• Authors: T.D. Sadler, W.N. Rom, J.L. Lyon, J.O. Mason
• Journal: Journal of Community Health
• Published: 1984;9(4):285-93
• Cited by: 13 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 000570).

Abstract

We tested the hypothesis that there is an association between the use of asbestos-cement piping for drinking water supplies and the incidence of gastrointestinal and kidney cancer. Cancer incidence in 14 Utah communities that had used predominantly asbestos-cement piping for transporting their drinking water supplies for 20 years or more were compared to 27 Utah communities that had never used asbestos-cement piping. Cancer incidence was tabulated for 11 cancer sites for the years 1967-1976. Increased Standard Incidence Ratios (SIRs) were found for cancer of the kidney in men (SIR 192) and leukemia (a control site) in women (SIR 203). No increased SIRs were found for the opposite sex at these sites or for the other gastrointestinal sites singly or in combination. There was no increase in age-adjusted cancer incidence for the 11 sites in 4 of the 14 study communities that had used asbestos-cement piping for 30 years or more. Limitations of the study were that the water supplies were nonaggressive, and leaching from the pipes was minimal if at all. Furthermore, the latent period for observation was very short, suggesting that these results should be considered preliminary.

In plain English

The authors compared cancer rates in 14 Utah communities whose drinking water had run mainly through asbestos-cement pipe for 20 years or more with 27 that used none. Using Utah Cancer Registry records for 1967 to 1976 on residents aged 35 and older, they examined 11 cancer sites. In the pipe communities, kidney cancer in men was significantly higher than expected (31 observed, 16.2 expected). Women had 11 against 9.9 expected, which the authors did not consider elevated. Leukemia, a comparison cancer with no or only a weak link to asbestos, was significantly higher in women. Colon cancer was lower than expected. The gastrointestinal sites combined, including peritoneum, showed 261 cases against 273 expected. In four communities with 30 or more years of pipe use, no site showed a significant increase. Water tested in five study communities had no detectable asbestos. The authors concluded there was no consistent difference in cancer incidence. They cautioned that too little time may have passed since pipe installation for cancers to develop, that the water leached little if any asbestos, and that the population was small.

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: Epidemiologic comparison of cancer incidence between communities with and without asbestos-cement water pipe. The control communities' rates were used as the standard to calculate standard incidence ratios (SIRs), and the Mantel-Haenszel chi-square test was used, controlling for sex and age.
• Who was studied: Residents aged 35 and older of 14 Utah study communities (73,966 people in 1970) and 27 Utah control communities (134,497 people). Control communities used no asbestos-cement pipe, had less than a 200 percent population increase from 1960 to 1975, and had fewer than 50,000 people in 1975. Cancer cases came from the Utah Cancer Registry for 1967 to 1976.
• Exposure: Drinking water carried in asbestos-cement pipe. In the study communities this was the predominant pipe in the main distribution lines and had been in use for 20 or more years before 1978 (30 years or more in four communities). The article does not state the asbestos fiber type in the pipes. In water samples from five study communities, taken before and after transport through the pipe, asbestos was below the limit of detection.
• Main results:
  • Kidney cancer in men in the study communities: 31 cases observed against about 16 expected (16.2 in the table), SIR 192, p less than 0.01. The excess was mainly in the older age groups.
  • Kidney cancer in women in the study communities: 11 observed and 9.9 expected (SIR 111). The authors described this as not elevated, and the table does not mark it as significant.
  • Leukemia, included as a control site because of no or only a weak association with asbestos, was raised in women in the study communities: SIR 203, p less than 0.01 (43 observed, 21.2 expected). The excess was almost entirely in the three older age groups.
  • Gallbladder cancer in women in the study communities was described as suggestive but not significant: 13 observed, 6 expected, SIR 215, p = 0.053.
  • Colon cancer was significantly lower than expected in the study communities: SIR 79 for both sexes combined and SIR 67 for women.
  • All gastrointestinal sites combined (stomach, small intestine, colon, rectum, peritoneum) in the study communities: 261 cases observed, 273 expected, SIR 96.
  • In the four communities with 30 or more years of pipe use, no cancer site showed a statistically significant increase by sex or age. The eight combined sites showed a significant negative association: 72 observed, 90.4 expected, p = 0.05.
• The authors' conclusion: The authors concluded that, over the 10-year period, there was no consistent difference in gastrointestinal and kidney cancer incidence between the 14 communities with asbestos-cement pipes and the 27 without. They judged that the small increases for kidney cancer (men only) and leukemia (women only) would be unlikely to support an association.
• Limitations the authors state:
  • The authors called the short latency period the most serious limitation: cases were ascertained as little as 9 years after exposure began.
  • Water in the study communities was predominantly nonaggressive and would leach only minimal amounts of asbestos from the pipes.
  • The study population was relatively small.
  • 168 statistical calculations were made, so several might be expected to be positive by chance alone.
  • Occupation, diet, smoking habits and length of residence were not systematically controlled.
  • The authors lacked information on the precise length or percentage of asbestos-cement pipe, and asbestos levels were not measured in the control communities.
  • Installation dates were estimates by the water systems managers.

Topics

Medical terms in this study, explained in our Lexicon: Asbestos-Cement Pipe, Asbestos-Cement.

Related studies

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• Epidemiology study of the use of asbestos-cement pipe for the distribution of drinking water in Escambia County, Florida — J.R. Millette, G.F. Craun, et al. (1983)
• Degradation of asbestos - Reinforced water supply cement pipes after a long-term operation — J. Zavašnik, A. Šestan, et al. (2022)
• Evaluation of the Webler-Brown model for estimating tetrachloroethylene exposure from vinyl-lined asbestos-cement pipes — L.A. Spence, A. Aschengrau, et al. (2008)
• Is there a risk to health in using asbestos--cement pipes for the carriage of drinking water? — S.F. McCullagh (1980)
• Asbestos in drinking water and cancer incidence in the San Francisco Bay area — M.S. Kanarek, P.M. Conforti, et al. (1980)

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