Journal of Preventive Medicine

Extended Abstract
Introduction
In September 2015, the United Nations adopted the “Sustainable Development Goals” as a common agenda for all countries to achieve sustainable development. Among the 17 ideals proposed for sustainable development, the sixth ideal is dedicated to providing clean water and improving the environment. Therefore, access to safe water is one of the challenges that the world community is facing [1]. Among the types of pollutants in water sources, heavy metals are very worrying due to their non-biodegradability, their ability to accumulate in the food chain, and their acute and chronic adverse effects on human health. Research shows that more than 90% of cancers are caused by external environmental factors [2] that directly or indirectly affect DNA. Molecular epidemiologic research has confirmed that environmental factors are the main causes of human cancer and the degree of influence of these factors also depends on the individual’s genetic characteristics and susceptibility [3]. With the development of industrialization and urbanization, the contamination of media with heavy metals has brought a serious threat to human health [3]. Humans are exposed to heavy metals through the environmental media of water, air, and food. People may be exposed to heavy metals from the mentioned routes during their life, and heavy metals received through drinking pose the greatest threat to people’s health [5]. The relationship between exposure to heavy metals and the incidence and mortality of cancer has been confirmed [7] and drinking water is considered one of the main routes of exposure to heavy metals [8]. Therefore, this study was conducted to assess the risk of exposure to heavy metals in drinking water in Bandar Abbas.
Methods
This study was conducted in Bandar Abbas, which is one of the southern cities of Iran. To cover all the studied areas based on the city map, the sampling points were chosen uniformly throughout Bandar Abbas. The number of sampling points from the urban water distribution network of Bandar Abbas was determined to be 12. The samples were collected from the water distribution network. Sampling was done using pre-washed polyethylene bottles with distilled water and nitric acid. After sampling, to protect the samples, nitric acid was added to the samples and kept at a temperature of less than 4°C until analysis. In this step, for every 100 ml of sample, 1 ml of nitric acid was added to reduce the pH to less than 3. A total of 42 samples were taken. The samples were transported to the laboratory by observing the cold chain for measuring with an ICP-MS device. For preparation, first, the samples were passed through 0.45 µm filter paper and then the pH of the samples was changed to less than 2 using nitric acid. An Agilent Hp4500 Series equipped with a plasma spectrometer made in the United States was used to analyze the concentration of heavy metals. All test results and their averages are reported. To determine the per capita drinking water consumption of Bandar Abbas city, the residents were asked about the type and amount of drinking water consumption using the Persian Cohort Questionnaire. In order to evaluate the health risk caused by exposure to heavy metals through drinking water in Bandar Abbas, the method proposed by the American Environmental Protection Organization was used.
Results
Table 1 shows the results of the average concentration of heavy metals in the drinking water of Bandar Abbas. According to the results and drinking water standard of Iran (SD=1053) and the World Health Organization (WHO) guideline, the average concentration of all heavy metals in the drinking water of Bandar Abbas was lower than the maximum allowed concentration of the mentioned standards.



Figure 1 shows the daily intake of heavy metals for the risk of carcinogenesis in the drinking water of Bandar Abbas. The lower limit of the blue color shows the 10th percentile and the upper limit shows the 90th percentile.



Figure 2 shows the results of the evaluation of carcinogenic risk caused by heavy metals in the drinking water of Bandar Abbas. In the diagrams, the lower limit of the purple color shows the 10th percentile and the upper limit shows the 90th percentile. According to the results, the average carcinogenic risk caused by arsenic for Bandar Abbas was higher than the permissible limit (4-10) set by WHO, and for the rest of the metals, the average carcinogenic risk was lower than the permissible limit (4-10) determined by WHO.



Discussion
According to the results and according to the drinking water standard of Iran and the WHO guidelines, the average concentration of all heavy metals in the drinking water of Bandar Abbas was lower than the maximum allowed concentration of the mentioned standards. In a study conducted on drinking water in Sistan and Balochistan, the average arsenic concentration in this area, like Bandar Abbas city, was lower than the recommended standards, which is consistent with the present study. Also, Rajaei et al. in Zabul showed that the average concentration of arsenic, nickel, and lead is lower than the recommended standards, which is consistent with the present study. According to the results, the average carcinogenic risk caused by arsenic for Bandar Abbas is higher than the standard limit (4-10) set by WHO, and for the rest of the metals, the average carcinogenic risk is lower than the permissible limit (4-10) determined by WHO. Islami et al. in Rafsanjan-Kerman and Tulabi et al. in Bam, Kerman indicated that the risk of carcinogenesis caused by arsenic in drinking water in these cities is higher than the standard set by WHO, which is consistent with the results of the present study. The results of Maleki et al. in Kurdistan, Mirzabigi et al. in Sistan and Baluchistan, respectively, regarding carcinogenic risks caused by nickel and lead in drinking water and also, the results of Dashtizadeh et al. in Zahedan and Shahriari et al. in Zabul regarding the carcinogenic risk caused by cadmium in drinking water in these cities showed that all elements were lower than the standard set by WHO, which is consistent with the results of our study. According to the results, the average concentration of metals measured in Bandar Abbas drinking water and their risk, except for arsenic, was lower than the standard. Although the results of the concentrations and risks do not show a significant threat to the residents, it is suggested that more studies be done, especially on the arsenic concentration, and precautions should be taken into account by the water supply organization and health professionals. 
Ethical Considerations
Compliance with ethical guidelines
This study has ethical approval number IR.HUMS.REC.1398.413 from Hormozgan University of Medical Sciences.
Funding
This article was done with the financial support of Hormozgan University of Medical Sciences.
Authors' contributions
Study design: Hamidreza Ghafari, Vali Alipour, Kavos Dindarlou and Mehdi Fazalzadeh; Sampling, analysis of water samples and data collection: Zohreh Kemari and Hamidreza Ghaffari; Data analysis: Amin Ghanbaranjad and Hamidreza Ghafari; Writing the first draft: Zohra Kemari and Hamidreza Ghaffari. All authors discussed the results and commented on the final version.
Conflicts of interest
The authors declared no conflict of interest.
Acknowledgements
The authors of this article thank and appreciate the financial support of Hormozgan University of Medical Sciences.
 

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