INTRODUCTION:

“Clean water is a key factor for economic growth. Deteriorating water quality is stalling economic growth, worsening health conditions, reducing food production, and exacerbating poverty in many countries.” said World Bank Group President David Malpass in the press release ‘Worsening Water Quality Reducing Economic Growth by a Third in Some Countries: World Bank.’

He further added, “Their governments must take urgent actions to help tackle water pollution so that countries can grow faster in equitable and environmentally sustainable ways.”¹

As we are moving towards the Sustainable developmental Goal 6 in another 5 years progress report for the year 2020, 74% of the global population used safely managed drinking water services, 60% in rural and 86% in urban. The number of people without accessible safe drinking water remained at 2 billion, of which 1.2 billion had access to basic services, 282 million had limited services, 367 million had unimproved sources, and 122 million drank water from the ground surface². This study reviews the levels of carcinogenic compounds in the groundwater from previous studies and aims to find the association between the levels and increase in cancer cases in the respective districts as per TNCRP report 2021³.

MATERIALS AND METHODS:

Information sources:

In accordance with PRISMA guidelines, the following electronic databases were searched from 2005 until 2020: PubMed, Wiley online library, Elsevier science direct, SpringerLink and ResearchGate. Among, 209 articles collected, 49 full text articles relevant to the district were independently assessed. After assessing for eligibility with inclusion and exclusion criteria, removing duplicates and others, a total of 9 articles fulfilling the inclusion criteria were included in the study. The search strategy for the databases below is shown in Figure 1.

Figure 1: Flow diagram showing the number of studies identified screened assessed for eligibility excluded and included in systematic review.

Search strategy: The search strategies included Boolean operators for the following combinations of keywords: ‘Thamirabharani’ or ‘Cancer’ or ‘Environmental toxicity’ or ‘carcinogens’ or ‘heavy metal intoxication’ or ‘toxic pollutants’ or ‘heavy metal status’ or ‘Industrial contaminants’ or ‘Occupational exposure’ or ‘water pollution’ or ‘soil pollution’ or ‘industrial effluents.’

Study location: Thamirabharani is a perennial river in Tamil Nadu state, India that flows through the districts of Tirunelveli and Thoothukudi. Agriculture, hand-woven clothes and household industries contribute to the economic growth of the city. Thoothukudi is known by the name 'Pearl city'. The major industries are salt pans, shipping, fishing, agricultural, power and chemical industries.

Inclusion criteria:

We included studies conducted in Thamirabharani river, Tirunelveli, Thoothukudi and Kanyalumari districts. Only those articles that are available electronically were considered. Original studies that were published in English with available full-text were included. Studies that used standardized methods of measurements and validation tools were included in the study. Studies that have been carried out with appropriate statistical analysis had included in the study.

Exclusion criteria:

Exposure to toxic substances occurred due to accidental spillage were excluded from the study. Studies undertaken by Tamil Nadu Pollution Control Board were excluded.

Data extraction and synthesis:

For studies that met the eligibility criteria, the following data was collected: Citation (author/year), study area, study duration, number and type of samples (air/water/soil) collected, carcinogens found in the samples, method of testing samples and test result values. The values were compared with standardized normal limits set by WHO/BIS/CEQG for drinking water source, air and soil. Quality assessment was carried out using Newcastle Ottawa Scale.

Methodology:

Based on the study conducted in Noyyal river basin⁴. We used IARC lists of classification of carcinogens, Volumes 1-133, to enumerate the group of carcinogens along with the cancer site⁵. Carcinogens exceeding the standard limit were checked for its carcinogenic potential and cancer sites showing sufficient and limited evidences in humans by IARC lists of classification of carcinogens and by cancer site respectively⁶. The percentages of all types of cancer cases reported in Tirunelveli, Thoothukudi and Kanyakumari was calculated using Tamil Nadu Cancer Registry Project report 2021 data, published by the Cancer Institute, Adyar and the state health department³. The percentages obtained were then used to find the association between the excessive presence of carcinogens and their contribution to the increased prevalence of cancer. Tamil Nadu average count for each district were calculated by adding number of cancer cases of specific type in all the districts divided by 38 (total 38 districts in Tamil Nadu state).

RESULT:

Table 1: Review of articles on the presence of carcinogenic agents in the Thambirabharani river basin, its method of assessment and the results obtained.

Author

Year

Place of

Study

Study Duration

Sample Size Sample Site

Methods of

Measurements

Carcinogen

Results

Normal Permissible Limit (PL)

L Prabudoss Kumar et al;

2019

Tamirabharani⁷

Jan – Mar 2017

water and sediment samples 11 different locations at Tamirabharani

Standard analytic method

Lead

Water- 0.01-0.03g/l

Sediment-

0.26 to 0.74µg/g

WHO-0.01mg/l

Divya Sapphire M et al; 2016

Tamirabharani⁸

pre-monsoon post-monsoon summer

Water samples at Thalaianai Cheranmadevi

Atomic Absorption Spectrophotometer (AAS)

Lead (mg/l)

Cadmium

Chromium

Thalaianai – BDL

Cheranmadevi:

Lead-0.23

Cadmium-1.70

Chromium- 1.00

WHO (2013)

0.01

0.05

0.003

Mathivanan V

et al 2013

Tamirabharani⁹

Jan 2013 – June 2013

Water samples at Naranammal Puram (Station 1) and Sutthamalli (Station II)

BIS IS-10500: 2012 method

Nitrate(mg/l)

Nitrite

Phosphate

Station I: 4 – 9.29

Station II: 5 – 10.5

Station I: 4 – 9.29

Station II: 5 – 10.5

Station I: 0.18 – 2.81

Station II: 0.6 – 4.89

45mg/l

0.1mg/l

S.S. Nawab Ali et al 2021

Tirunelveli¹⁰

40 water samples at Karayar

Papanasam

Settimedu

Harikesavanallur

Pathamadai

Atomic Absorption Spectrometer Perkin Elmer AA200

Chromium

Cadmium

Lead

Karayar-0.04-0.06

Papanasam-0.04-0.08

Settimedu-0.02-0.04

Harikesavanallur-0.02

Pathamadai-0.02-0.06

Karayar-0.01-0.06

Papanasam-0.01-0.04

Settimedu-0.02-0.04

Harikesavanallur-0.02-0.05

Pathamadai-0.02-0.03

Karayar-0.04-0.05

Papanasam-0.02-0.04

Settimedu-0.02-0.05

Harikesavanallur-0.02-0.08

Pathamadai-0.01-0.03

WHO

0.003

0.05

0.01

S. Sivakumar Karthikeyan et al; 2021

Tuticorin¹¹

pre and post-monsoon seasons in the year 2017

groundwater samples at 40 locations in Tuticorin industrial block

Atomic Absorption Spectrophotometer – Perkin Elmer AA 200

Chromium

Nickel

Cobalt

Lead

Pre-monsoon: 0.001 to 0.184mg/l

Post-monsoon: 0.038 to 0.845mg/l

Pre-monsoon:

0.015 to 0.757mg/l

Post-monsoon 0.014 to 0.266mg/l

Pre-monsoon:

0.104 to 2.429mg/l

Post-monsoon: 0.005 to 0.193mg/l

Pre-monsoon:

0.171 to 2.221mg/l

Post-monsoon: 0.004 to 0.810mg/l

WHO (2012)

0.05

0.02

0.05mg/l

0.01

A.Kayalvizhi et al; 2019

Tuticorin¹²

7 groundwater samples from Meelavitan, SIPCOT,

Sterlite, Muthiapuram, Periyanayaga Puram, Siluvaipatti, Mapilaiurani Shanmugapuram

ArcGIS 9.2 software

Arsenic

(mg/l)

Lead

Chromium

Cadmium

Nickel

Chromium:

0.0015-0.08

Nickel:

0.000082-0.011

Arsenic:

0.00087-0.0837

Cadmium:

0.000012-0.0021

Lead:

0.00045-0.018

WHO (2012)

0.05

0.02

0.01

0.003

0.01

C. Puthiyasekar et al; 2010

Thoothukudi and Tirunelveli¹³

July 2006 to June 2007

July 2007 to May 2008

Bore water SIPCOT 1 and 2

Kamarajar College

Paniammai Velankanni Church

Karaisuthu Uvari

Athankarai Palli

Atomic Absorption Spectrometry (VARIAN 240 FS)

Cadmium

(mg/kg)

Lead

July 2006 to June 2007

Lead: BDL to 0.16

Cadmium: BDL to 0.06

July 2007 to May 2008

Lead: 0.01 to 0.21

Cadmium: 0.01-0.23

WHO

0.01mg/kg

0.003mg/kg

Sajimol Sundar et al; 2021

Kanyakumari ¹⁴

late summer of 2018

64 samples along the sediments of Kanyakumari beach

Niton FXL, 950 energy dispersive X-ray fluorescence (XRF).

Cadmium

Lead

Nickel

Cobalt Chromium

4±1mg/kg

31±43mg/kg

267±154mg/kg

42±30 mg/kg

167±302mg/kg

J. Malathi et al; 2005

Kanyakumari¹⁵

55 sand samples at Agastheeswaram taluk

NaI(TI) gamma ray spectrometer

²³²Th activity

32.18-32147.22Bq/kg

4786.78 µSv/year

Table 1 shows the review of articles on method of measurement of particular carcinogen and the results obtained at particular site as given by Prabudoss Kumar L et al, Divya Sapphire M et al, Nawab Ali SS et al, Sivakumar Karthikeyan S et al, Kayalvizhi A et al, Puthiyasekar C et al, Sajimol Sundar et al and Malathi J et al

Table 2: Quality Assessment: Newcastle Ottawa scale

Aauthor and Year	Selection				Comparability	Outcome
Aauthor and Year	Representativeness of the samples	Sample size	Non- respondent	Ascertainment of the exposure	Comparability	Assessment of the outcome	Statistical test
Prabudoss L Kumar et al⁷	*	*	-	*	*	**	-
Divya Sapphire et al⁸	*	*	-	*	*	**	*
Mathivanan V et al⁹	*	*	-	*	*	**	-
Nawab Ali SS et al¹⁰	*	*	-	*	*	**	*
Sivakumar KS et al¹¹	*	*	-	*	*	**	*
.Kayalvizhi A et al¹²	*	*	-	*	*	**	*
Puthiyasekar C et al¹³	*	*	-	*	*	**	-
Sajimol et al¹⁴	*	*	-	*	*	**	*
Malathi J et al¹⁵	*	*	-	*	*	**	*

Table 3: Percentage of cancer cases and its association with carcinogen levels in the Thamirabharani river.

DDistrict	Carcinogens⁵	Mean range obtained^*	Normal value^† ^{[WHO, 2013]}	Cancer site⁶	Percentage of cancer cases³
Tirunelveli	Cadmium	0.02-0.08	0.003	Lung, Prostate and Kidney	Stomach – 5% Lung – 4.6% Prostate – 2.1% Nasal cavity– 4.3% Kidney - 3.9%
	Chromium	0.01-0.06	0.05	Nasal cavity and paranasal cavity and Lung
	Lead	0.01-0.08	0.01	Stomach
	Nitrite	4-10.5	0.1	Stomach
	Nitrate	4-10.5	45	Stomach
	Phosphate	0.18 – 4.89	-	Stomach
Thoothukudi	Cadmium	0.000012-0.0021	0.003	Lung, Prostate and Kidney	Nasal cavity– 1.6% Prostate – 1.25% Kidney – 2.5% Lung – 2.8% Stomach – 2.7% Bladder – 1.6% Skin – 2% Liver – 2%
	Chromium	0.001-0.845	0.05	Nasal cavity and paranasal cavity and Lung
	Lead	0.00045-2.221	0.01	Stomach
	Cobalt	0.005-2.429	0.05	Lung
	Nickel	0.000082-0.757	0.02	Nasal cavity and paranasal cavity and Lung
	Arsenic	0.00087- 0.0837	0.01	Bladder, Lung, Skin, Prostate, Kidney and Liver
Kanyakumari	Cadmium	4±1mg/kg	-	Lung, Prostate and Kidney	Stomach – 2% Lung – 3.8% Prostate – 3.5% Nasal cavity– 3.3% Kidney - 1.7% Liver – 4% Gall bladder – 3.1% Pancreas – 5% Leukemia – 2.4%
	Chromium	167±302mg/kg	-	Nasal cavity and paranasal cavity and Lung
	Lead	31±43mg/kg	-	Stomach
	Cobalt	42±30 mg/kg	-	Lung
	Nickel	267±154mg/kg	-	Nasal cavity and paranasal cavity and Lung
	²³²Th activity	32.18-32147.22Bq/kg	4786.78 µSv/year	Liver, Bile duct, Gall bladder, Pancreas, Prostate and Leukemia

Source:

^*Mean value of carcinogens was the cumulated score of different studies described in the Table 1; Units – mg/l.

^†Mean score was compared with WHO 2013 standard limits for drinking water; Units – mg/l.

DISCUSSION:

Due to rapid urbanization, the nation’s economy grows tremendously building up various large scale industries, small scale industries, and foundries, developing infrastructures that are essential for transport, education and health care sectors. The other aspect of urbanization comes along with deleterious effect on environment affecting air, water and soil quality, getting into the food chain ultimately increasing health risk of population. Groundwater is a vital source of water meeting up with basic domestic needs, agricultural requirements and renders industrial development in the sustainability and functioning of ecosystems.

‘Tirunelveli Corporation councilors urged district Mayor to take immediate action in order to save Thamirabharani river from getting polluted by the outflow of sewage while being pumped from the underground drainage system to the Ramaiyanpatti garbage yard due to the breaches in the pipeline at various places.’ reported recently in the ‘The Hindu’ newspaper. By facing direct discharges of domestic waste, sewage, and solid waste along its banks, the Thamirabarani River and its tributaries have become heavily polluted²³.Deterioration of water quality and ingestion heavy metals and other carcinogenic compounds into the groundwater system leads to various communicable and non-communicable disease including cancers. This might be one of the leading causes of sudden increase in the spurts of cancer cases in the state.

According to^6-9 study showed that Cheranmahadevi and papanasam is highly polluted with lead, chromium, cadmium, nitrite and phosphate beyond WHO standard limit. Agriculture, beedi industries and metal industries serve as a major source of income for people residing in Cheranmahadevi. Estimation of groundwater samples for heavy metal contaminatio in Tuticorin and found arsenic exceeding the WHO standard limit in 35 samples and lead in 9 samples. The studies reported high concentration of chromium was due to heavy vehicle workshops, nickel due to sewage waters, lead was mainly due to petroleum products used in fisheries boat and cobalt due to electroplating, smelting and fertilizer industrial effluent^11,12. Sajimol Sundar et al 2012 study in Kanyakumari show that the concentration of cadmium in sediment sample collected exceeds the detection limit in 42 sites; lead exceeds the detection limit 47 sites; nickel in 7 sites exceeds the detection limit; cobalt in 37 sites; chromium in 46 sites and arsenic exceeds at 12 sites. The study stated that the problem of metal contamination is increasing along the coastal regions due to increasing population and over extraction of groundwater for domestic, agricultural and industrial activities¹⁴.

As mentioned in Table 4, Literatures suggest that deficiencies of micronutrients leads to increased uptake of these heavy metals and meeting up with the needs gradual decreased the levels of toxic substances. High risk population such as those who are close by to industries, sewage yard, agricultural lands, with evident oral lesions (as mentioned in table 4), young children, pregnant women, very old age people, those who consume alcohol and tobacco products are more susceptible to mutagenesis. They are advised to consult physician and check for serum concentration levels for carcinogens and complete vitamin profile. Thus dietary modifications are recommended for individuals as preventive or therapeutic measures in reversing the abnormal levels of carcinogens in the body (Toxicology profiles, ASTDR)¹⁶.

In an attempt to reduce the environmental pollution precautionary measures for industrial sectors which produce Cadmium, chromium VI, cobalt, nickel and lead as by products are recommended to follow zero waste strategy, Reverse Osmosis and use of magnetic nano particles filtration; Agricultural sector where arsenic, nitrite/nitrate, phosphates, cadmium and chromium VI used are recommended to follow phytoremediation methods such as to use plant species like Saccharomyces sp., Parthenium hysterophorus L Asteraceae, Sonneratia caseolaris^24-27 to absorb heavy metals and reduce the toxicity. Food Safety Department should ensure that foods such as fruits, vegetables, nuts and species are not contaminated with either fertilizers or pesticides. Entomology/Toxicology Department of Agriculture should monitor the overuse of fertilizers and pesticides by farmers; it is necessary to provide farmers with information about eco-friendly fertilizers²⁸. Municipal/Corporation/Domestic waste can be managed by installing Mini sewage treatment plants, Material recycling, and thermal treatment like incineration, biogas generation, composting and more importantly environmental education^29-32.

As sample sites are limited to a few zones and areas, the study may not generalize to the entire district but in contrast only district-level cancer prevalence data are available, with no information on zone-level or taluk-level cancer prevalence. With the available and limited source of data, we could find a positive association between carcinogen levels and cancer prevalence.

CONCLUSION:

The present systematic review shows that excessive presence of carcinogens can have a carcinogenic impact on the general population. It's high time we raise our voices for ourselves and bring it to the attention of the Tamil Nadu Government and authorities concerned so that they can respond on an emergency basis and save millions of lives.

CONFLICT OF INTEREST:

The authors have no conflicts of interest regarding this investigation.

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Received on 17.11.2023 Modified on 08.01.2024

Res. J. Humanities and Social Sciences. 2024;15(1)24-30.

DOI: 10.52711/2321-5828.2024.00005

Carcinogens	Micronutrients^17-21	Recommended Diet
Cadmium	Iron and zinc	Greens, Nuts and Seeds, Liver, Fish, Meat and dairy products
Chromium VI	Calcium and magnesium	Broccoli, Cabbage, Lady’s finger, Bananas, Oranges and dairy products
Nickel	Iron and magnesium	Greens, Beans, Peas, Bananas, Nuts and Seeds, Liver and dairy products
Lead	Iron, calcium, zinc and vitamin C	Nuts and Seeds, Oranges, Grapes, Watermelon, Indian Gooseberry²², Greens, Tomato, Potato, Broccoli, Cabbage, Lady’s finger, Fish, Meat, Liver and dairy products
Arsenic	Vitamin A, B9, E and selenium	Papaya, Watermelon, Wheat germ, Nuts and Seeds, Carrots, Greens, Sweet potato, Broccoli, Pumpkin, Cauliflower, Spinach, Chick peas, Peas, Brown rice, Eggs, Chicken, liver, Fish and dairy products
Cobalt	Iron and Glutathione	Greens, Nuts and Seeds, Avocado, Broccoli, Okra, Almonds, Liver, Fish, Meat and dairy products
Nitrite/nitrates/phosphates	Include all vitamins and mineral rich foods	Greens, Mushrooms, Peanuts, Soya bean, Cereals, Legumes including all the above mentioned items.