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Long-term Behavioral and Reproductive Consequences of Embryonic Exposure to Low-dose Toxicants
Published on: March 6, 2018
Drinking Water Contaminant Exposures and Risk of Uterine Cancer
Maya Spaur1, Lydia Marcus Post1,2, Laura E Beane Freeman1
1Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland.
JAMA Network Open
|July 22, 2026
Summary
Drinking water disinfection byproducts, specifically total trihalomethanes (THMs), are linked to increased uterine cancer risk, particularly endometrioid tumors. This finding highlights potential environmental factors in gynecologic cancer development.
Area of Science:
- Environmental Health
- Epidemiology
- Toxicology
Background:
- Drinking water contaminants, such as disinfection byproducts, are potential carcinogens and endocrine disruptors.
- Few epidemiological studies have investigated the link between drinking water contaminants and uterine cancer risk.
Purpose of the Study:
- To examine the prospective association between exposure to multiple regulated drinking water contaminants and the risk of developing uterine cancer.
- To investigate specific associations with endometrioid and nonendometrioid uterine tumors.
Main Methods:
- A prospective cohort study of 53,100 female California educators (California Teachers Study) was conducted from 1995-2020.
- Mean concentrations of trihalomethanes (THMs), haloacetic acids (HAAs), nitrate, arsenic, and uranium were calculated and linked to residential addresses.
- Cox models were used to analyze associations between contaminant exposures and uterine cancer incidence, adjusting for confounders.
Main Results:
- Higher levels of total THMs were associated with an increased risk of uterine cancer (HR 1.18) and endometrioid tumors (HR 1.23).
- Specific THMs like chloroform and the sum of 5 HAAs (associated with nonendometrioid tumors) also showed positive associations.
- No significant associations were found for nitrate, arsenic, or uranium exposure.
Conclusions:
- Drinking water total trihalomethanes are associated with an elevated risk of uterine cancer, especially endometrioid tumors.
- These findings align with previous research and suggest that drinking water contaminants may be modifiable risk factors for uterine cancer.
- Further research is warranted to explore drinking water contaminants as potential risk factors for this common gynecologic cancer.
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