Reporter Volume 25, No.11 November 11, 1993

By  LOIS BAKER
News Bureau Staff
Men who drink large quantities of fluids every day have a greater
chance of developing bladder cancer than men who consume few
beverages, and chlorinated tap water may be a contributing factor, a
UB research group has found.   
	Results of the study, published in Archives of Environmental
Health, show a two to four times greater bladder-cancer risk in males
who drank more than 14 cups of fluid per day compared to males who
drank less than seven cups daily.  
	Breaking down consumption into tap and non-tap sources of
liquid, the results suggest that tap water is an independent risk
factor for bladder cancer, with the association being strongest among
those who had never smoked cigarettes.
	The study, led by John E. Vena, UB associate professor of
social and preventive medicine, supports findings from previous
research conducted in the United States, Denmark and Germany that
showed a relationship between bladder cancer and fluid intake, and
another study showing a tap water-bladder cancer association. 
	Vena's group compared the fluid consumption of 351 white men
with confirmed cases of bladder cancer, diagnosed between 1979-1985,
with the fluid intake of 855 men without cancer.  All study subjects
were 35-90 years old and lived in Erie, Niagara and Monroe counties in
Western New York.  Information on liquid consumption was derived from
data collected by personal interviews for the Western New York Diet
Study.
	Total fluid consumption included all alcoholic beverages,
bottled beverages, soda, milk, coffee, tea, juices and water.
Beverages from tap water were defined as coffee, hot and cold tea, 75
percent of frozen reconstituted orange juice, 37.5 percent of all
other juices, and water taken directly from the tap. Tap-water
beverages were broken down further into those made with boiled versus
unheated water.
	Researchers also compared fluid intake and cancer risk in
smokers and non-smokers, and conducted separate analyses for subjects
over and under 65 years of age.
	The results of the study showed no association between any
alcoholic beverages or bottled beverages and the risk of bladder
cancer. However, there was a strong link between total fluid intake
and the risk of bladder cancer, with the risk increasing as
consumption increased in both age groups.
	 The strongest effect appeared in the younger age group. Men
under 65 who drank the most liquids--14 to 49 cups a day--were six
times more likely to develop bladder cancer than those who consumed
seven or fewer cups a day. In the over-65 age group, the risk at the
highest consumption levels was about three times greater than at the
lowest  levels.
	Drinking tap water was strongly associated with bladder-cancer
risk in both age groups.  	Vena said the connection between
bladder cancer and fluid consumption could be related to the tap-water
component and reactions between the chlorine used to disinfect the
water and carcinogenic compounds found in surface water. 
	"Hypotheses that bladder-cancer risk is associated with
long-term ingestion of chlorinated surface water are supported by
epidemiologic and experimental studies," he said. "Historically, most
surface waters have been treated with chlorine to control
microbiologic contamination."  	Most of the study group had used
chlorinated public water 90 percent of their lives.
	"Chlorine reacts with a host of cancer precursor chemicals,
including manmade chemicals from industrial and municipal waste water
or runoff and naturally occurring organic substances to produce
chlorinated organic compounds," Vena said. "Trihalomethanes are the
most commonly occurring organics found in drinking water, and appear
in the highest concentrations.  These compounds are toxic and
carcinogenic to animals in high doses."
	The Great Lakes Basin, one of the largest fresh sources of
drinking water in the world and the source of tap water in this study,
has been plagued with excess nutrients and toxic chemical pollution,
he noted. "Eighteen possible, probable or definite human carcinogens
have been identified in varying concentrations in the finished
drinking water taken from Lake Ontario," he said. 
	 The results of this study stress the urgent need for further
investigation, and for support for the Niagara River Remedial Action
Plan  and the recommendations of the International Joint Commission,
Vena stated. Both urge eliminating the discharge of persistent toxic
chemicals into the Great Lakes ecosystem. 
	Besides Vena, UB study researchers include Saxon Graham, Jo
Freudenheim, James Marshall, Maria Zielezny, and Mya Swanson, all of
the Department of Social and Preventive Medicine, and Gerald Sufrin,
chair of the Department of Urology.