IJE Advance Access originally published online on November 26, 2004
International Journal of Epidemiology 2004 33(6):1209-1216; doi:10.1093/ije/dyh215
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IJE vol.33 no.6 © International Epidemiological Association 2004; all rights reserved.
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Household water source and the risk of childhood brain tumours: results of the SEARCH International Brain Tumor Study
1 Public Health Sciences Division, Fred Hutchinson Cancer Research Center, PO Box 19024, Mail Stop M4-C308, Seattle, WA 98109-1024, USA
2 Epidemiology Department, School of Public Health and Community Medicine, University of Washington, Seattle, WA, USA
3 Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
4 Department of Epidemiology and Biostatistics, University of California San Francisco, CA, USA
5 INSERM, U435, Rennes, France
6 Neuroepidemiology Research Unit, Istituto Nazionale Neurologico ‘C Besta’, Milan, Italy
7 Unidad de Información y Documentacion Medicosanitaria, IEDHC (CSIC-Universitat de Valencia), Valencia, Spain
8 Manitoba Cancer Treatment and Research Foundation, Winnipeg, Canada (deceased)
Correspondence: Dr Mueller, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, PO Box 19024, Mail Stop M4-C308, Seattle, WA 98109–1024, USA. E-mail: bmueller{at}fhcrc.org
Background The period in utero is a time of increased vulnerability. Offspring of pregnant women exposed to carcinogenic substances in drinking water may be more likely to develop cancer. We examined whether household water source and the presence of nitrates or nitrites in residential water were associated with increased risks of childhood brain tumours (CBT).
Methods We used data from a multicentre, case-control study with maternal information on residential water source, and nitrate/nitrite levels of tap water measured by dipstick. Subjects included 836 CBT cases and 1485 controls from five countries.
Results The risks of CBT associated with reliance on well water (versus public water) during pregnancy varied widely, with significantly increased risks noted in two (of seven) regions and a decreased risk observed in one region. CBT risk did not increase with increasing nitrate levels. However, our results based on tap water tested in the pregnancy residences suggest the risk of astrocytoma may be associated with increasing levels of nitrite (odds ratio [OR] = 4.3, 95% CI: 1.4, 12.6 for nitrite levels of 1–<5 mg/l nitrite ion; OR = 5.7, 95% CI: 1.2, 27.2 of nitrite 
5 mg/l).
Conclusions These results should be interpreted with caution because women's recollection of water sources may have contained inaccuracies, and nitrate and nitrite measurements, available for only a portion of subjects, were often obtained years after the pregnancies occurred. However, our results suggest a need for closer evaluation of well water content in some regions and the possibility that a nitrite-related water exposure may be associated with CBT.
Keywords Childhood brain tumours, environmental exposures, drinking water, nitrates, nitrites
Accepted 30 March 2004
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  D. Forman Commentary: Nitrites, nitrates and nitrosation as causes of brain cancer in children: epidemiological challenges Int. J. Epidemiol., December 1, 2004; 33(6): 1216 - 1218. [Full Text] [PDF]
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