Humans have long recognized the hazards of microbial contamination of drinking water. Only since the 1960s, however, have epidemiologic studies systematically examined whether naturally occurring and/or manmade pollutants in drinking water affect cancer risk. Ironically, some of the measures taken to reduce microbial hazards have increased exposure to other contaminants. This chapter begins by discussing three waterborne exposures that affect large numbers of people and have been studied most extensively: inorganic arsenic, disinfection byproducts, and nitrate. Of these, only arsenic and its compounds are currently designated as carcinogenic to humans. It then discusses the evidence concerning two emerging issues: the carcinogenicity of toxins from cyanobacteria, an ancient and ubiquitous family of prokaryotic organisms formerly known as blue-green algae, now affected by climate change, and the methods of studying cancer in local communities where the water supply has been contaminated by industrial chemicals. Methodologic challenges complicate studies of these issues.
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