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Discover Applied Sciences
Review
Mapping andvisualizing theglobal research landscapes ondrinking
water andcancer
ShaherZyoud1· Sa’edH.Zyoud2,3
Received: 7 August 2024 / Accepted: 7 October 2024
© The Author(s) 2024 OPEN
Abstract
A growing body of epidemiologic research has examined the potential associations between contaminants in drink-
ing water and various cancers, with a special emphasis on sources of particular concern, including arsenic, asbestos,
radon, agricultural chemicals, and byproducts of hazardous waste sites. Given the potential public health implications,
a bibliometric analysis of the literature in this eld is warranted. This analysis aims to systematically map the progres-
sion of research on the relationship between drinking water contaminants and cancer. By identifying emerging trends
and knowledge gaps, this analysis can inform future research directions and prioritize areas with the greatest potential
for public health impact. In this study, we employed a bibliometric approach to analyze research on drinking water and
cancer. We searched for articles in all languages published between 1939 and 2023 using the Scopus database. To ensure
the precision of our search, we validated a search strategy using relevant keywords related to drinking water and cancer.
The data analysis included bibliometric indicators such as the analysis of citation patterns, publication trends, and the
identication of the most productive countries and institutions in this eld. Finally, we used VOSviewer software (ver-
sion 1.6.20) to visualize the data through network and co-occurrence analysis. This visualization helped us identify key
research clusters and emerging topics within the eld. A comprehensive search of the Scopus database from 1939 to
2023 yielded 11,703 articles related to drinking water and cancer. By focusing on journal articles and excluding errata
and retracted documents, the data set was rened to 10,751 publications. The majority (91.06%) of these were original
research articles (n = 9790), while reviews accounted for 6.49% (n = 698). The United States was the country that contrib-
uted the most articles in this eld, contributing 3,268 articles (30.4%), followed by China (n = 1496; 13.9%), Japan (n = 1358;
12.6%), and India (n = 758; 7.1%). Recent research (post-2015) focuses on assessing carcinogenic pollutant risks, mainly
in groundwater. In contrast, earlier studies often used animal and human models to explore the carcinogenic eects of
various chemicals found in drinking water. This study oers insight into the current research on the link between con-
taminants in drinking water and cancer. Most of this research focuses on high-income countries, highlighting the need
for more studies in low- and middle-income regions. To advance our understanding and develop eective strategies,
further research is essential. This includes improving methods for detecting and measuring emerging contaminants, as
well as evaluating the impact of water treatment and sanitation practices.
Article Highlights
• Cancer and drinking water global knowledge is analyzed using performance analysis and visualization mapping.
* Shaher Zyoud, shaher.zyoud@ptuk.edu.ps; Sa’ed H. Zyoud, saedzyoud@yahoo.com | 1Department ofBuilding Engineering &
Environment, Department ofCivil Engineering & Sustainable Structures, Palestine Technical University (Kadoorie), Jaa Street, P.O. Box:
7, Tulkarem, Palestine. 2Department ofClinical andCommunity Pharmacy, College ofMedicine andHealth Sciences, An-Najah National
University, Nablus44839, Palestine. 3Clinical Research Centre, An-Najah National University Hospital, Nablus44839, Palestine.
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• More research is required to eectively detect emerging contaminants and investigate water treatment and sanita-
tion impacts.
• Most cancer-drinking water research originates in developed countries, stressing the signicance of collaboration
and investments.
Keywords Health risks· Drinking water· Cancer· Visualization analysis· Emerging contaminants
1 Introduction
Dierent chemicals are introduced into our water supplies by human activities. These substances may enter the system
through inltration during transit, treatment byproducts, or contamination at the source [1]. Depending on where they
originate, these possible carcinogens (agents that cause cancer) in our drinking water can take many dierent forms
and at dierent concentrations [1]. Hazardous waste, radon, asbestos, arsenic, and agricultural chemicals can contami-
nate source water. Arsenic is the most carcinogenic; it has been associated with cancers of the liver, lungs, bladder, and
kidneys [2]. One of the most important steps in preventing infectious diseases is chlorine disinfection, which can also
produce disinfection by products (DBPs) that may be carcinogenic [3]. There is evidence that prolonged exposure to
water contaminants, even at levels found in drinking water, can increase the risk of disease [4]. Access to clean water is
perhaps the most important public health intervention [5].
DBPs in drinking water have been associated with an increased risk of bladder, colon, and rectal cancers, according to
epidemiological studies (evidence based on disease patterns) [6–8]. An increased risk of bladder and rectal cancers has
also been associated with long-term exposure to chlorinated surface water, which is a source of DBPs [9]. Furthermore,
proximal colon cancer in men has been associated with an elevated risk of colorectal cancer in association with high
levels of trihalomethanes (a kind of DBPs) in drinking water [10]. Similarly, exposure to trihalomethanes and nitrate has
been associated with a greater risk of colorectal cancer, possibly due to inammatory processes [11].
Bibliometrics is a scientic method that employs mathematical and statistical techniques to quantitatively analyze
a knowledge system. It is used to analyze, compare, and quantify the literature to better understand the evolution and
patterns of scientic research[12–14]. Although numerous bibliometric studies have examined research productivity in
the environmental eld [15–19], including studies on drinking water [20–24] and cancer [25–30], there has yet to be an
evaluation of research output on the relationship between drinking water and cancer. This study conducts a bibliometric
analysis of the literature in this eld to better understand the progression of the literature on the relationship between
drinking water and cancer. The purpose of this project is to identify specic areas of interest that could be useful for
future research. This study evaluated data that will help ll research gaps in this area. The current bibliometric analysis
is extremely valuable for researchers studying the link between drinking water and cancer. It is a concise reference tool
for interdisciplinary researchers, providing an overview of recent scientic evaluations on this topic.
2 Methods
2.1 Study design
Performance analysis and bibliometric methods were applied to conduct a descriptive cross-sectional assessment of
published works associated with cancer and drinking water. Over a decade, bibliometric analyses have emerged as the
focus of several scholarly works, covering a broad spectrum of scientic topics [31–35]. Unlike systematic reviews, which
address specic research issues based on a limited selection of research works [36], and scoping reviews, which aim to
outline the scope and features of research evidence [37], bibliometric methods deliver an eective resource to capture
an overview of both national and international contributions to the literature in a specic eld. Bibliometric methods,
in addition, oer signicant data to identify research gaps and guide future investigations toward potential domains of
attention [38].
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2.2 Database used
A comprehensive bibliometric analysis implies the application of multiple databases of literature for extensive docu-
ment analysis. However, when confronted with a large body of literature on the topic in question, this approach could
be impractical. In view of the challenging task of applying bibliometric metrics and mapping literature within multiple
databases (e.g., overlapping or repetitive publications), bibliometric studies typically employ a single database [39]
to avoid compromising the reliability of the research results [40]. The present analysis covers a significant amount
of literature (10,751 documents), justifying the application of a single database. A survey of the literature revealed
that the Scopus database is one of the most comprehensive literature databases in the context of data size and the
affordability of analytical and sorting capabilities [41, 42]. It offers extensive coverage, including all PubMed content,
as well as twofold the number of indexed sources and journals as of Web of Science. It offers comprehensive author
and institution profiles compiled using advanced profiling algorithms, ensuring excellent precision and reliability
[43]. Consequently, Scopus was suggested by the investigators of the present analysis for fulfilling the research
objectives. Scopus’s robust search functions are extremely advantageous, facilitating the design of comprehensive
and complex queries for searching [44]. This includes using Boolean operators (e.g., AND, OR, and NOT) to combine
search terms in appropriate search queries, field specific search (e.g., title, abstract, author name, source title, or
keywords), wildcard and truncation for flexible keyword variations, proximity search to finds terms that are within a
certain distance from each other, phrase search, and citation search [45].
2.3 Search strategy
A comprehensive search of the Scopus database identified relevant research on cancer and drinking water. The
search process was not restricted to a particular starting time but was restricted to covering all data and research
works available until the end of 2023. This time frame allowed the identification of major shifts, progress, or declines
in research outputs and impact over time, thus facilitating an overview of emerging trends and advancements. This
ensures that the results of the analysis are timely and pertinent. To eliminate possible biases triggered by continuous
database updates, all relevant search operations and data retrieved were compiled in a single session, April 8, 2024.
This analysis applied an explicit and rigorous search strategy that incorporated advanced search tools, addressing an
extensive array of concepts and terms related to drinking water and cancer. The data of this analysis were acquired
by applying the following consecutive steps:
Step 1: To successfully identify pertinent search terms, a literature review was performed on the association between
drinking water and cancer, focusing specically on systematic reviews and meta-analyses [46–48].
Step 2: Cancer-related terms were retrieved via PubMed’s Medical Subject Headings (MeSH) along with previous
research [29, 49]. Drinking water terms were drawn from an array of bibliometric analyses, each exploring a specic topic
and context within the broader issue of drinking water [21, 24, 50–52].
Step 3: The search query was limited to terms related to cancer and drinking water in the titles and abstracts of docu-
ments. It was only applied to journals as a source, and it discarded errata and retracted documents from the journal’s
output. The concluding search query was as follows: (( TITLE-ABS(Drinking Water OR Potable Water OR Bottled Water)
AND TITLE-ABS ( cancer OR carcinoma OR malignancies OR malignant OR malignancy OR neoplasia OR neoplasm OR
tumour OR tumor) OR TITLE-ABS ( carcinogen* OR tumorigenesis OR tumorigeneses OR oncogenesis OR oncogeneses)
OR TITLE-ABS ( oncology)) AND PUBYEAR < 2024 AND PUBYEAR > 1938 AND PUBYEAR < 2024 AND (LIMIT-TO (SRCTYPE,"j"))
AND (EXCLUDE (DOCTYPE,"er") OR EXCLUDE (DOCTYPE,"tb"))).
Step 4: The search query was scrutinized by applying two techniques. First, two external colleagues in the eld of
bibliometric science examined the titles and abstracts of the 100 most cited documents, delivered as an Endnote folder
(Endnote ™; version: 20, Clarivate Analytics, New York, NY, USA). Second, the lead investigator veried the titles and
abstracts of publications in even numbers (110, 120, 130, 140, etc.) to verify content credibility.
2.4 Bibliometric andperformance analysis
In the present analysis, the basic bibliometric metrics that were investigated were classied into four major groups, either
quantitative or qualitative indicators:
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a) Research Evolution: This category explored publication years, evolution patterns with time, and citation counts.
b) Origin of the published works: This category analyzed the productive countries and origins that contributed to
research related to cancer and drinking water.
c) Research productivity: This category recognized the major institutions and funding agencies active in the eld under
investigation.
d) Impact of research: This category investigated the signicance of highly cited research works, the Hirsch index (h
index), and renowned journals, including their impact factors.
2.5 Visualization analysis
VOSviewer software, developed by the Center for Science and Technology Studies at Leiden University in the Neth-
erlands, is applied to develop network maps and knowledge structures that reveal global collaboration, intellectual
links between sources, and research-driving themes [53, 54]. VOSviewer provides a two-dimensional bibliometric
map that reveals collaboration among countries, institutions, authors, etc. [54]. The distance between two countries
on the map, for example, represents the extent of association, with shorter distances implying close scientific col-
laboration. VOSviewer categorizes countries into distinct clusters based on frequent collaboration within each group.
Co-citation analysis, which explores shared citations among sources, is utilized to determine associations between
different publications and acquire a better understanding of intellectual associations between major journals. The
evidence of a similarity between B and C journals, for example, could come from an article in journal A citing works
from both journals B and C. The greater the association, the more documents in other journals that cite both B and
C journals [55]. Co-citation links between two journals display their relationship based on their proximity on the
visualization map [54]. VOSviewer aggregates sources into distinct clusters, each exhibiting a closely related field.
Such an analysis enables researchers to recognize fundamental journals in the field under investigation [56]. Using
keyword co-occurrence analysis, VOSviewer depicted each term by a frame. The size of the frame is correlated with
the total number of published works corresponding to that term [57]. To highlight topics of interest, the relevant
terms of the titles and abstracts were selected. This analysis showed the extent to which two terms occurred simul-
taneously in different published works, proving the level of similarity [58]. The co-occurrence analysis utilized the
value of a relevance score. This score omits general terms and only considers terms that have higher relevance scores,
which consistently underscores significant topics [54]. Figure1 summarizes the methodological strategy, detailing
the inclusion criteria and analysis techniques.
3 Results
3.1 Volume ofpublished works oncancer anddrinking water
The earliest document indexed in the Scopus database on the topic under investigation dates back to 1939. From 1939
to the end of 2023, 11,703 documents of dierent types were identied in the Scopus database on cancer and drink-
ing water-related research. When considering the content published in journals as the primary source only, omitting
errors and retracted documents, 10,751 documents were identied. These were divided into articles (9790 documents;
91.06%), reviews (698 documents; 6.49%), and conference papers (184 documents; 1.71%). Other less-represented types
(79 documents; 0.73%) involved letters, notes, short surveys, editorials, and data papers.
3.2 Evolution andproductivity trends
Figure2 shows the evolution of published works on cancer and drinking water over eight decades. Productivity rates
began modestly, specically in the rst three decades. However, the number of published works has grown substantially
over the last ve years. The graph reveals an exponential increase in research related to cancer and drinking water, with a
determination coecient R2 = 0.891. There was a strong positive correlation between the annual publication count and
the corresponding year of publication (P < 0.001).
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Fig. 1 The roadmap outlines the entire analysis procedure of knowledge on drinking water-cancer, including data collection, bibliometric
analysis, visualization mapping, and major outcomes
Fig. 2 The evolution of cancer
and drinking water-related
publications y = 2E-70e0.0827x
R² = 0.891
0
200
400
600
800
1000
1200
# of documents
Year
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3.3 Performance ofglobal regions andcountries
Figure3 reveals a detailed visualization of the global output of cancer and drinking water research, with participation
from 143 countries of various capacities. The Asiatic region is the most prolic region at the regional level, yielding 4713
documents (43.8% of the total). This region is followed by North America (3612 documents; 33.6%), Western Europe
(2165 documents; 20.1%), the Middle East (810 documents; 7.5%), Eastern Europe (580 documents; 5.4%), Africa (530
documents; 4.9%), Latin America (465 documents; 4.3%), and the Pacic region (221 documents; 2.1%). Africa has the
most contributing countries at 30, with Nigeria leading (152 documents). The Asiatic region is second with 27 countries,
led by China (1496 documents). Eastern Europe features 22, with the Russian Federation in the core (181 documents),
Latin America (20) with Brazil at the forefront (188 documents), Western Europe (20) with Germany leading (399 docu-
ments), the Middle East (16) with Iran in the core (306 documents), and the Pacic region (6) with Australia leading in
this regard (185 documents). Finally, North America features 2 contributing countries, with the United States as the most
inuential (3268 documents).
Fig. 3 Nation–level production on cancer-drinking water research; a worldwide perspective of research productivity at the country (or
region) level. The size of the black circles represents the output of each country (or region) (i.e., the larger the circle is, the greater the perfor-
mance of the country or a region with respect to the number of publications). The colors further indicate the productivity of each country,
using a range of shades to dierentiate countries based on their productivity levels. The global map was created using Statplanet Interac-
tive Mapping and Visualization Software, www. stats ilk. com, free license
Table 1 The top 10 most productive countries on research related to cancer and drinking water
Rank Country/Territory # of documents % # collabo-
rated coun-
tries
# of documents from
collaboration (%) Most collabo-
rated country # of documents with
most collaborated coun-
try (%)
1st United States 3268 30.4 92 925 (28.3) China 158 (4.8)
2nd China 1496 13.9 58 358 (23.9) United States 158 (10.6)
3rd Japan 1358 12.6 56 257 (18.9) United States 111(8.2)
4th India 758 7.1 60 184 (24.3) United States 54 (7.1)
5th Germany 399 3.7 63 161(40.3) United States 54 (13.5)
6th United Kingdom 380 3.5 63 209 (55.0) United States 73 (19.2)
7th Canada 344 3.2 46 170 (49.4) United States 89 (25.9)
8th Iran 306 2.8 45 90 (29.4) United States 21 (6.9)
9th Italy 266 2.5 62 128 (48.1) United States 40 (15.0)
10th Taiwan 237 2.2 22 43 (18.1) United States 29 (12.2)
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Table1 presents the top ten countries sorted by their research productivity at the country level. The United States
dominates the list, accounting for approximately one-third of all publications on cancer and drinking water. China and
Japan follow at a distance. The top ten most productive countries collectively contributed 7935 documents, which is
73.8% of the total. This figure underscores the crucial role these countries undertake in producing the bulk of global
knowledge in this regard. The findings demonstrate incompatible collaboration trends among the most productive
countries, as well as between these countries and those not in the top ten list. Collaboration rates surpass 40% for
the United Kingdom, Canada, Italy, and Germany, while for other countries, the rates range from 18.1% to 29.4%.
There is an overlap in research output across countries, developing when researchers from different countries work
jointly on research projects or when specific research is assigned to several countries.
Figure4 shows the scale of global research collaboration between countries, highlighting countries that have
contributed more than 100 documents on cancer and drinking water research. The map shows 25 countries organ-
ized into three major clusters. Cluster 1, in red, is made up primarily of Asian countries; cluster 2, in green, comprises
primarily Western European countries; and cluster 3, in blue, consists mainly of Latin American countries. The United
States stands at the center of the map, with the highest number of collaboration links (24 links out of 244 total links)
and the greatest strength of significant links (940 out of 2218).
Fig. 4 Visualization map of international research collaboration with a minimum research output of 100 documents/country. Of the 143
countries, 25 met this threshold. Full counting is employed, where each co-authorship link is assigned equal weight. For each of the 25
countries, the total strength of the co-authorship links with other countries was calculated. The countries with the highest total link strength
were selected. The map categorized the countries that most frequently collaborated into 3 clusters with distinctive colors: Cluster 1 with red
(11 countries; the United States acquired the strongest link strength: 940 out of 2218, and the greatest number of links: 24 out of 244); Clus-
ter 2 with green (9 countries; the United Kingdom acquired the strongest link strength: 271 out of 2218 and the greatest number of links: 23
each out of 244); and Cluster 3 with blue (5 countries; India acquired the strongest link strength: 220 out of 2218 and recorded the greatest
number of links: 24 out of 244). Co-authorship links between the United States and China (link strength: 158), Japan (link strength: 108),
Canada (link strength: 89), the United Kingdom (link strength: 71), and Germany (link strength: 53) were the strongest links at the global
level. The map was created using VOSviewer software version 1.6.20
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3.4 Top institutions/organizations
Table2 lists the 10 most significant institutions out of 24,056 that are actively researching cancer and drinking water.
These institutions collectively produced 1385 documents, accounting for 12.6% of all published works in the field.
The United States Environmental Protection Agency (EPA) was the most prolific organization, with 225 documents
(2.1%). It is followed by the National Institute of Health Sciences, Japan, which has 180 documents (1.7%). Of the ten
most active institutions, six were from the United States, three were from Japan, and two were from China.
3.5 Major funding organizations/agencies
Table3 lists the 10 most significant funding agencies that have contributed to this field. The National Cancer Insti-
tute, the United States (n = 626; 5.8%), the National Natural Science Foundation of China (n = 493; 4.6%), the National
Institutes of Health, the United States (n = 416; 3.9%), and the National Institute of Environmental Health Sciences,
the United States (n = 403; 3.7%), are the leading funding agencies. Collectively, the agencies listed as top funding
supported 2058 research works (19.1% of the total publications). It should be highlighted that the United States has
assumed an essential role in this field, with five of the active funding agencies based in this country. It is followed by
Japan, which has three funding agencies.
Table 2 The top 10 most productive institutions/organizations on research related to cancer and drinking water
Rank Aliation Country # of documents %
1st United States Environmental Protection Agency United States 225 2.1
2nd National Institute of Health Sciences Japan 180 1.7
3rd Chinese Academy of Sciences China 167 1.6
4th Ministry of Education of the People’s Republic of China China 158 1.5
4th National Cancer Institute NCI United States 158 1.5
6th Nagoya City University Medical School Japan 138 1.3
7th University of Nebraska Medical Center United States 137 1.3
8th National Cancer Institute at Frederick United States 121 1.1
9th Osaka Metropolitan University Graduate School of Medicine Japan 98 0.9
10th National Institutes of Health NIH United States 94 0.9
10th US EPA National Health and Environmental Eects Research Laboratory United States 94 0.9
Table 3 The top 10 funding
agencies that support
research related to cancer and
drinking water
Rank Funding sponsor Country # of
docu-
ments
%
1st National Cancer Institute United States 626 5.8
2nd National Natural Science Foundation of China China 493 4.6
3rd National Institutes of Health United States 416 3.9
4th National Institute of Environmental Health Sciences United States 403 3.7
5th Ministry of Education, Culture, Sports, Science and Technology Japan 132 1.2
6th Japan Society for the Promotion of Science Japan 126 1.2
7th U.S. Environmental Protection Agency United States 119 1.1
8th Ministry of Health, Labour and Welfare Japan 118 1.1
9th U.S. Public Health Service United States 79 0.7
10th Department of Science and Technology, Ministry of Science and
Technology, India India 74 0.7
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3.6 Major journals
Table4 shows the top ten journals out of 2481 journals that contributed to cancer and drinking water, sorted by
publication. These journals delivered a total of 1676 documents, which is 15.6% of all contributions in the field. Car-
cinogenesis dominated with 296 documents, accounting for 2.8% of the total. The Cancer Research journal features
254 documents (2.4%), preceding Cancer Letters featuring 192 documents (1.8%), and the Science of the Total Envi-
ronment journal with 157 documents (1.5%). These respected journals span three pertinent fields: carcinogenicity,
toxicology, and environmental sciences. The impact factor and CiteScore metrics highlight the significant influence
of these journals in the field under investigation.
3.7 Analysis ofcitation figures
According to the citation analysis, the retrieved documents acquired an average of 37.7 citations per document,
with an h-index of 223 and a total of 405,258 citations. Of these documents, 859 did not receive citations, while 906
acquired more than 100 citations/document. The numbers of references for these studies fluctuated between 0 and
4728. Table5 lists the 10 most cited documents; eight are reviews, and two are articles [46, 47, 59–66]. The number
of citations for the documents included in the list varied from 984 to 4728 at the time the data were compiled and
analyzed.
3.8 Analysis ofco‑citation figures
Figure5 illustrates the 11 most influential journals that have substantial co-citation links, achieving a minimum cita-
tion threshold of 2000. These journals contribute significantly to sharing knowledge and providing solid insights
into cancer and drinking water. The map organizes these journals into three distinct clusters, each highlighted with
a distinctive color, according to shared attributes (e.g., similar research themes, topics, or methodologies), indicat-
ing that journals within each cluster are related in the academic landscape. The red cluster is composed of five
journals, with Carcinogenesis journal at the center of this cluster. The green cluster, consisting of 4 journals, has the
Environmental Science and Technology journal at its core. The blue cluster features only 2 journals, the core is Muta-
tion Research journal. The map indicates the close association between Water Research and Environmental Science
and Technology, which was recognized as the most substantial link on the map (the thickest line). Moreover, there
Table 4 The journals with the
most publications on cancer
and drinking water
a Impact Factor (IF): This factor is calculated by dividing the number of current-year citations by the num-
ber of source items published in a journal during the previous 2years (these include articles, reviews, and
proceedings papers) (2022 Journal Citation Reports®, Clarivate 2023)
b CiteScore: CiteScore 2022 counts the citations received from 2019 to 2022 for articles, reviews, confer-
ence papers, book chapters, and data papers published from 2019 to 2022 and divides this by the number
of publications published from 2019 to 2022 (CiteScore 2022, Scopus database 2023)
Rank Source # of docu-
ments % IFaCiteScoreb
1st Carcinogenesis 296 2.8 4.7 8.4
2nd Cancer Research 254 2.4 11.2 16.9
3rd Cancer Letters 192 1.8 9.7 16.7
4th Science of the Total Environment 157 1.5 9.8 16.8
5th Journal of the National Cancer Institute 149 1.4 10.3 18.3
6th Environmental Health Perspectives 140 1.3 10.4 15.2
7th Environmental Science and Pollution Research 133 1.2 5.8 7.9
8th Toxicology and Applied Pharmacology 124 1.2 3.8 7.2
9th Chemosphere 118 1.1 8.8 13.3
10th Food and Chemical Toxicology 113 1.1 4.3 11.2
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Table 5 The top 10 documents most cited in cancer and drinking water-related research
Rank Authors Year Title Source title Cited by Document type
1st Järup L 2003 “Hazards of heavy metal contamination” British Medical Bulletin 4728 Review
2nd Richardson S.D. etal 2007 “Occurrence, genotoxicity, and carcinogenicity of regu-
lated and emerging disinfection by-products in drink-
ing water: A review and roadmap for research”
Mutation Research—Reviews in Mutation Research 2631 Review
3rd Smith A.H. etal 2000 “Contamination of drinking-water by arsenic in Bangla-
desh: A public health emergency” Bulletin of the World Health Organization 1682 Article
4th Camargo J.A. and Alonso Á 2006 “Ecological and toxicological eects of inorganic nitrogen
pollution in aquatic ecosystems: A global assessment” Environment International 1557 Review
5th Weber L.W.D. etal 2003 “Hepatotoxicity and mechanism of action of haloalkanes:
Carbon tetrachloride as a toxicological model” Critical Reviews in Toxicology 1439 Review
6th Kim K.-H. etal 2017 “Exposure to pesticides and the associated human health
eects” Science of the Total Environment 1199 Review
7th Sunderland E.M. etal 2019 “A review of the pathways of human exposure to poly-
and peruoroalkyl substances (PFASs) and present
understanding of health eects”
Journal of Exposure Science and Environmental Epide-
miology 1141 Review
8th Fendorf S. etal 2010 “Spatial and temporal variations of groundwater arsenic
in South and Southeast Asia” Science 995 Review
9th Naujokas M.F. etal 2013 “The broad scope of health eects from chronic arsenic
exposure: Update on a worldwide public health prob-
lem”
Environmental Health Perspectives 993 Review
10th Hughes M.F. etal 2011 “Arsenic exposure and toxicology: A historical perspec-
tive” Toxicological Sciences 984 Article
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was a significant association between Carcinogenesis and Cancer Research. The map reveals a dominant position of
journals with emphasis on water, environmental, carcinogenicity, and toxicology research.
3.9 Keyword co‑occurrence analysis
VOSviewer was applied to perform a co-occurrence analysis of the titles and abstracts of documents related to cancer
and drinking water. The main research themes are displayed in Fig.6. Diverse research themes have been displayed
employing network visualization, which maps the co-occurrence of terms more than 200 times. Of the 162,034 terms,
166 satised the threshold, based on a relevance score of 60%, which omits the general terms, and were assigned to two
major groups (Fig.6). Each of the clusters is distinguished by a distinctive color: red for cluster 1 and green for cluster 2,
which indicate terms relevant to specic research topics. Cluster 1 focused mainly on drinking water quality and health
risk assessment, which involved evaluating dierent contaminants and their associated health hazards. This involves
accomplishing risk assessments, monitoring initiatives, and imposing regulations that preserve safety and quality. It
investigates the prevalence, occurrence, and impacts of chemical contaminants in drinking water sources, focusing
primarily on heavy metals, DBPs, and other hazardous substances. Cluster 2 is devoted to experimental research that
involves animal and human models to explore the carcinogenic repercussions of many dierent chemicals and substances
that exist in drinking water. It addresses the molecular and cellular mechanisms that explain carcinogenesis, targeting
modications in gene expression, proliferation of cells, and responses to inammation. The terms in each cluster revealed
substantial associations that demonstrated the consistency of the research within these themes.
3.10 Research trends
The terms prevalent in research on cancer and drinking water over time were additionally recognized in the titles and
abstracts through keyword co-occurrence analysis (Fig.7). In particular, studies exploring risk assessments, focusing on
both carcinogenic and noncarcinogenic contaminants, using hazard quotients and other indices to quantify and prior-
itize risk levels, and examining groundwater samples for hazardous substances impacting public health have emerged
in recent years since earlier research focused on experimental models.
Fig. 5 Network visualization map. The minimum number of citations of a source was set as 2000. Full counting is employed, where each
co-citation link is assigned equal weight. Of the 76,012 sources, 11 met the threshold. For each of the 11 sources, the total strength of the
co-citation links with other sources was calculated. The sources with the highest total link strength were selected. The map categorized the
most co-cited sources into 3 clusters with distinctive colors: Cluster 1 with red (5 sources); Cluster 2 with green (4 sources); and Cluster 3
with blue (2 sources). The map was created using VOSviewer software version 1.6.20
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4 Discussion
In this paper, a bibliometric analysis of the scientic literature on drinking water and its possible association with cancer
is presented. Our research focused on studies that examined the relationship between the development of cancer and
dierent toxic substances and compounds, such as heavy metals, that are present in drinking water. Although previous
bibliometric reviews have examined specic water contaminants such as lead, arsenic, or Cryptosporidium [21, 22, 52,
67, 68], no research has examined the total cancer risk associated with the exposure of drinking water to dangerous ele -
ments. Furthermore, the specic link between water quality and cancer has not been examined in bibliometric analyses
of water that have been performed thus far, instead of focusing on general water quality or water treatment technologies
[20–22, 24, 52, 69]. Here, we seek to close this gap by undertaking an extensive analysis of drinking water-related cancer
research covering a wide range of potential cancer-causing agents.
The development of drinking water quality and the productivity of cancer research over time have been inuenced by
several factors, including population growth, industrialization, water scarcity, policy changes, and technological advances.
Proactive strategic planning, investments in infrastructure and research, and the implementation of regulatory measures
have all been necessary to address these issues. Furthermore, advances in science and technology have signicantly
impacted the productivity of cancer research and the trajectory of drinking water quality. Cancer continues to be the
leading cause of global mortality and morbidity, with its incidence estimated to increase by 50% over the next two dec-
ades. Finding associated environmental risk factors is crucial, as evidenced by daily increases in most cancer types [6,
70]. DBPs in drinking water have been linked by epidemiological evidence to a number of cancers, including those of the
gastrointestinal tract, kidney, bladder, breast, liver, and thyroid [3, 6, 71]. Consequently, several factors have aided in the
growth of the research trajectory: (1) Proactive strategic planning is necessary in light of global water scarcity caused by
population growth, industrial pollution, and climate change [72]. (2) Investments in infrastructure, research, and human
Fig. 6 Network visualization map of term co-occurrence within title-abstract. Two hundred occurrences of a term were set as the minimum
number (Binary counting: involves assessing the presence or absence of a term in the titles and abstracts of documents, with the frequency
of occurrences within a document being disregarded). A total of 166 terms out of the 162,034 terms met the set threshold considering a
relevance score of 60%. Terms are categorized into 2 major clusters: Cluster 1, red (85 items); and Cluster 2, green (81 items). The map was
created using VOSviewer software version 1.6.20
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resources are essential for creative water quality management [72]. (3) Concerns about wastewater production and the
availability of clean drinking water have increased due to increasing industrialization and population density [73]. (4)
The world’s need for water has increased dramatically due to the rapid growth of the industrial sector and population
[74]. (5) The growing shortage of fresh water, exacerbated by pollution and depletion, has become a worldwide concern
that aects more than 1.2 billion people [75, 76].
The number of related research publications has increased due to the growing global concern about water quality and
its possible link to cancer. There are countries with distinct research priorities, such as the United States, China, Japan,
and India. These include examining the sources of drinking water and learning how dierent pollutants are geographi-
cally distributed within water bodies and how these elements aect dierent types of cancer. Converting these research
results into useful public health interventions and policies is the ultimate objective [77]. The development of eective
preventive measures, improved international collaboration, and development grounded in scientic evidence have been
identied as research priorities for future investigations [78]. Key factors explaining the high number of publications: (1)
Research on drinking water is increasing signicantly in low- and lower-middle-income countries. In particular, in regard
to published research on this subject, India has outdone the United States [23]. (2) Countries such as China have seen
a nationwide spatial association between water quality and cancer, highlighting the importance of surface water qual-
ity in cancer incidence, and studies in China have focused on bladder and breast cancer, while India has seen research
on esophageal cancer [28, 79]. (3) The patterns of collaboration currently in place indicate that established publishing
giants such as the United States and the UK, which are known for producing large volumes of publications, are the main
focus of partnerships [23].
The topic of ‘Assessing Drinking Water Quality and Health Risks from Contaminants’ was one of the main hot topics
in the current study. The well-being of the general population is critically dependent on the safety of drinking water, as
current studies show a relationship between water quality and the development of cancer risk. Examining the types of
contaminants, their concentrations, and duration of exposure as well as performing health risk analyses to investigate
the presence of pollutants and their possible cancer-causing ability constitute the main areas of focus [80, 81]. Monitor-
ing activities include periodic studies for toxins, including pharmaceuticals and industrial chemicals, heavy metals (lead,
Fig. 7 Overlay visualization map of term co-occurrence within the title-abstract. Two hundred occurrences of a term were set as the mini-
mum number (Binary counting: involves assessing the presence or absence of a term in the titles and abstracts of documents, with the fre-
quency of occurrences within a document being disregarded). A total of 166 terms out of the 162,034 terms met the set threshold consider-
ing a relevance score of 60%. The blue nodes represent earlier occurrences, and the yellow nodes represent later occurrences. The map was
created using VOSviewer software version 1.6.20
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arsenic, chromium), DBPs (chlorine reacting with organic matter to create cancer-causing trihalomethanes) and other
pollutants [82, 83]. Maximum contamination levels (MCLs) are determined by scientic evidence; regulations are then
enforced to ensure that water treatmentfacilities maintain pollution levels below these thresholds [84–86]. Ongoing
studies are beingconducted toassess the frequency and concentration of pollutants in various water supplies. Research
is being conducted to identify high-risk areas and investigate particular health eects, such ascancer, generated by these
pollutants. The ultimate objective is to improve risk assessments and to provide useful data forlegislative development.
All creatures depend on access to drinkable water and sanitation; however, poor socioeconomic conditions and rapid
changes in land use have degraded the quality and availability of water, therefore aecting human health. Ocially, the
United Nations (UN) acknowledges that every human being has many fundamental rights, including the right to safe
drinking water [87]. Global accessibility to safely managed drinking water has continually improved, growing from 625
in 2000 to 74% in 2020. Despite this progress, nearly 2 billion people do not have access to safely managed drinking
water, including 771 million who lack even basic water services [88]. Eorts to ensure water accessibility and quality are
essential for long-term human health [89].
Another subject that has received much attention is “Experimental Research on Carcinogenic Eects of Chemicals in
Drinking Water Using Animal and Human Models". A major focus of environmental health studies is the search for possible
carcinogens in drinking water [90–92]. Using a thorough approach, researchers have examined the carcinogenic eects
of these chemicals by means of animal models and experiments with human subjects [93, 94]. Researchaims to clarify
the exact molecular and cellular pathways by which these chemicalsmight cause cancer. Clarifying the changes in gene
expression caused by these pollutants is highly important. This analytical approach claries possible routes involved in
carcinogenesis, especially by emphasizing genes responsible for programmed cell death, DNA repair mechanisms, and
cellular proliferation. Moreover, scientists have investigated the processes by which toxins induce uncontrollably rapid
cellular division, supporting the development of tumors [95, 96]. Furthermore, there has been a deliberate attempt to
investigate the relationship between environmental toxins and the frequency of chronic inammation, a known precur-
sor of cancer [97, 98]. To study their eects on tumor development, animal models, such as mice and rats, are purposely
exposed to particular chemicals, providing a detailed analysis of these mechanisms. Concurrent with this, there are
epidemiological studies including human populations. These studies track cancer incidence among drinking water with
dierent degrees of pollutants. This complementary approach helps to create links between particular chemicals and
cancer risk, enabling a more complete knowledge of environmental health hazards.
A thematic analysis of highly cited papers in scientic literature on drinking water and its possible connection with
cancer reveals a concentrated study of subtopics closely related to established areas of research. This observation points
to increasing scholarly attention in this eld and more intense interest in recent years. In particular, the most cited paper,
written by Järup L. and published in the British Medical Bulletin in 2003 [61], has almost 4,728 citations. This study high-
lighted how exposure to lead, cadmium, mercury, and arsenic causes major human health hazards related to heavy met-
als. These metals have been well investigated, and international agencies such as the World Health Organization (WHO)
routinely evaluate how they aect human health. Human use of heavy metals goes back millennia. Although several
negative health eects associated with these metals are well known, exposure to these metals continues and may even
increase in some areas of the world, especially in less developed nations. On the other hand, in most developed countries
in recent years, emissions have decreased [99].
The second most frequently cited study [47] was published in Mutation Research—Reviews in Mutation Research.
This review thoroughly evaluated the occurrence, genotoxicity, and carcinogenic potential of DBPs in drinking water. It
investigated comprehensively the formation of DBPs resulting from the interaction of disinfectants—such as chlorine,
ozone, chlorine dioxide, or chloramines—with naturally occurring organic matter, human-made pollutants, bromide,
and iodide during the drinking water disinfection process. That fundamental work covered three decades of research,
encompassing a wider spectrum of DBPs. It specically investigated the occurrence, genotoxic characteristics, and car-
cinogenic potential of 85 DBPs, including 74 newly discovered DBPs based on their presence and possible toxicological
eects, as well as 11 DBPs currently under the U.S. Environmental Protection Agency (EPA) regulation.
5 Strengths andlimitations
This study focused on a unique examination of the research landscape surrounding drinking water and its potential
association with cancer. Recognizing the importance of international collaboration, we observed a notable increase
in the volume of published research on this topic. However, the limitations inherent to the chosen database (Scopus)
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restrict the comprehensiveness of our ndings. Although Scopus oers extensive coverage across disciplines, it excludes
certain peer-reviewed journals, particularly those originating from Asia and Africa, regions where drinking water pollu-
tion poses a signicant public health challenge. These excluded journals are primarily located in India, China, Indonesia,
the Middle East, and other Asian and African nations. Consequently, our analysis omits publications found within these
unindexed journals.
Despite the implementation of a rigorous search strategy, our study shares the inherent limitations of bibliometric
analyses. The possibility of false positives and false negatives cannot be entirely eliminated. Additionally, our reliance on
Scopus data for identifying active research institutions and funding agencies introduces potential biases. Inconsisten-
cies in the way institutions are named across dierent publications can skew the research output and subsequent rank-
ings generated from our analysis. This issue extends to funding agencies, as name changes can inuence their visibility
and evaluation. In particular, our search strategy aimed to minimize false positives by restricting relevant keywords to
abstracts and titles, focusing exclusively on studies directly related to our area of interest (drinking water and cancer).
Although a list of highly cited articles has been compiled, it is crucial to acknowledge the limitations of citation counts
as a sole measure of research impact. Self-citation and other factors can signicantly distort these metrics. It is therefore
possible that our review of highly cited articles may have inadvertently overlooked inuential and established contribu-
tions to the eld.
6 Conclusions
A bibliometric analysis was performed to investigate publication trends in global research on drinking water-related
cancer between 1993 and 2023. This approach examined publication volume, publication types, and prominent research
themes. The analysis revealed that original research articles constituted the dominant type of publication within the
eld. In particular, the number of publications on drinking water-related cancer has increased signicantly over the
past decades. The United States and China emerged as the most prolic contributors to this research area. Two primary
research themes emerged as central areas of investigation: "Assessing Drinking Water Quality and Health Risks from
Contaminants" and "Experimental Research on Carcinogenic Eects of Chemicals in Drinking Water Using Animal and
Human Models." This study has signicant implications for policymakers by pinpointing areas that warrant increased
investment and research funding. By strategically targeting relevant environmental sectors, this knowledge can ultimately
contribute to improving global drinking water safety. To advance our understanding and develop eective strategies,
further research is essential. This includes improving methods for detecting and measuring emerging contaminants, as
well as evaluating the impact of water treatment and sanitation practices.
Acknowledgements The authors would like to thank Palestine Technical University (Kadoorie) and An-Najah National University for all admin-
istrative assistance during the project’s implementation.
Author contributions SH.Z. and S.H.Z. initiated the study, designed, and performed the analysis, interpreted the data, and wrote the main
paper. All authors read and approved the nal manuscript.
Funding Not applicable.
Data availability The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable
request.
Declarations
Ethics approval and consent to participate This analysis is without human involvement. There was no need for ethical approval.
Consent for publication Not applicable.
Competing interests The author declares that they have no competing interests.
Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which
permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to
the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modied the licensed material. You
do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party
material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If
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the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http:// creat iveco
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