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The
blue green algae or cyanobacteria represent a diverse group of organisms
that produce potent natural toxins. There have been case reports of severe
morbidity and mortality in domestic animals through drinking water contaminated
by these toxins. Microcystins, in particular, have been associated with
acute liver damage and possibly liver cancer in laboratory animals. Although,
there has been little epidemiological research on toxin effects in humans,
a study by Yu (1995) found an association between primary liver cancer
and surface water. Surface water drinking supplies are particularly vulnerable
to the growth of these organisms; current US drinking water treatment
practices do not monitor or actively treat for blue green algal toxins
including the microcystins.
After a monitoring survey in Florida found organisms and microcystins (among
other cyanobacterial toxins) in surface water drinking sources, a pilot
ecological study was performed using a Geographic Information System (GIS)
to evaluate the risk of primary hepatocellular carcinoma (HCC) and proximity
to a surface water treatment plant at cancer diagnosis. The study linked
all HCC cancers diagnosed in Florida from 1981 to 1998 with environmental
databases. A significantly increased risk for HCC with residence within
the service area of a surface water treatment plant was found compared
to persons living in areas contiguous to the surface water treatment plants.
However,
this increased risk was not seen in comparison to persons living in randomly
selected ground water treatment service areas or compared to the Florida
cumulative incidence rate for the study period, using various comparison
and GIS methodologies. Furthermore, these findings must be interpreted
in light of significant issues of latency, high population mobility, and
the lack of individual exposure information. Nevertheless, the issue of
acute and chronic human health effects associated with the consumption
of surface waters possibly contaminated by blue green algal toxins merits
further investigation.
Primary
hepatocellular carcinoma (HCC), a malignant epithelial tumor, is the most
prevalent type of liver cancer in the world. It is one of the three leading
causes of cancer mortality, accounting for 25 million deaths annually
world wide, with a ratio of mortality to incidence of 0.98:1 (London and
Pisani). HCC is particularly a problem in the developing countries of
the world where 81% of the worlds cases are found ( Parkin and Parkin).
For individuals living in developed countries versus developing countries,
the age-standardized incidence rates are 7.6/100,000 and 17.9/100,000
for males, and 2.6/100,000 and 6.2/100,000 for females, respectively (
Parkin et al., 1999a). Although, the incidence of HCC is relatively low
in the US, it has been increasing (Martin and El). In Florida, since 1981 to 1998,
there was a significant increase in the average annual HCC incidence rate
( Shea et al., 2001)). In particular, the average Florida annual HCC incidence
rates among male and female hispanics and blacks have been consistently
twice the rate of white males and females as standardized rate ratios
(SRRs; Shea et al., 2001).
During
this time period, the incidence rate in hispanic males (3.29/100,000)
approached twice the rate reported in white males (1.82/100,000), while
black males (3.86/100,000) had greater than twice the rate of white males;
in females, the rates in both hispanic and black females (1.23/100,000
and 1.18/100,000, respectively) were approximately twice those of white
females (0.6/100,000). The cyanobacteria or blue green algae are an ancient
and ubiquitous family of organisms, many with photosynthetic abilities
(Chorus; Carmichael; Falconer and NHMRC). The cyanobacteria frequently
are found growing in marine, brackish and fresh waters, including freshwater
surface water drinking sources, such as lakes and drinking water reservoirs.
Similar
to marine algal blooms, such as red tides, cyanobacteria periodically
exhibit significantly increased reproductive rates and total population
biomass known as a bloom. The reasons for these cyanobacteria blooms
are not completely understood, but most cases are related to the addition
of nutrients via runoff ( Philipp; Carmichael and Rapala). Large bloom
events are classified as harmful algal blooms if they cause negative
environmental impacts such as:
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