Nitrate and Nitrite Level of Drinking Water and the Risk of Upper Gastrointestinal Cancers in Urban Areas of Golestan Province, Northeast of Iran

Document Type: Original Article


1 Associate Professor of Internal Medicine and Subspecialist in Liver and Gostrointestinal Diseases, Gorgan School of Medicine, Golestan University of Medical Sciences, Golestan, Iran.

2 General Practitioner, Golestan University of Medical Sciences, Golestan, Iran.

3 Assistant Professor of Community Medicine, Gorgan School of Medicine, Golestan University of Medical Sciences, Golestan, Iran.

4 Instructor of Biostatistics, Gorgan Paramedical School, Golestan University of Medical Sciences, Golestan, Iran.


Background & Aims: Esophageal and gastric cancers are among prevalent cancers in the world and it is believed that nitrate and nitrite contaminations of drinking water are important factors in increasing the risk of these cancers. This study was designed to determine the correlations between these factors and upper gastrointestinal cancers. Methods: In this ecologic study, mean concentrations of nitrite and nitrate of drinking waters in Golestan urban areas were obtained during 2004-2005. All patients with esophageal and gastric cancers during this period who resided in urban areas were recruited to estimate the incidence rate and Age Standardized Rate (ASR) of these cancers. The province was divided into three regions of low, intermediate and high incidence based on 33% and 66% quartiles of both cancers. Spearman Correlation Coefficient and regression line were used to analyze dataResults: Based on the results, nitrite and nitrate concentration of drinking waters in all three regions were in the standard range. There was a significant positive correlation between nitrate increase and esophageal cancer incidence (R=0.624 P=0.013). There was no correlation between levels of nitrite in drinking water and the risk of esophageal and stomach cancer. Conclusions: It seems that there is an increased risk of esophageal cancer correlated with higher nitrate levels in drinking water. But nitrite level of drinking water has no impact on the esophageal and gastric cancer, from the ecological point of view. Further studies on food resources and drinking water of urban and rural areas are recommended to determine the effects of these factors on the upper gastrointestinal cancers.