Epidemiological association between chlorinated water and overall risk of cancer: A systematic review

Review objective The review objective is to synthesise the best available evidence on exposure to chlorinated water and risk of cancer. Risks associated with colorectal or bladder cancers have already been established and therefore will not be considered in this systematic review. Inclusion criteria Types of participants This review will consider studies that include males and females of all ages. Types of intervention(s)/phenomena of interest This review will consider studies that evaluate exposure to chlorine disinfection by-products by drinking (ingesting), bathing, showering, swimming, cooking, cleaning and dishwashing (dermal and inhalation) and identify incidence and mortality outcomes of cancer (excluding colorectal and bladder) compared with exposure without chemical disinfection (chlorine) or alternative disinfection processes. Types of outcomes This review will consider studies that include the following outcome measures. Incidence, mortality and specifically measures of risk between exposure and outcome of cancers with the exception of bowel and bladder. For example the following cancers have been associated with chlorine disinfection by products, kidney/adrenal, liver, thyroid, pituitary, lymphoma and leukaemia, pancreatic, gastrointestinal (other than colorectal), testicular, breast and lung cancer. These and any other cancers identified as relevant eg. skin cancers will be included.