A coalition of 85 international health and environmental organisations has urged the World Health Organization (WHO) to revise its drinking water standards for nitrate, warning that exposure to levels below the existing limit may be associated with colorectal cancer and premature births.

In an open letter sent on Tuesday, the groups called on the United Nations health agency to include nitrate in its forthcoHealth Groups Urge WHO to Tighten Drinking Water Nitrate Limits Over Cancer Risks

ming review of drinking water guidelines. Signatories include Greenpeace International, the World Organization of Family Doctors (WONCA) and the European Environmental Bureau.

The organisations argue that the WHO’s current nitrate limit is based on standards established decades ago and does not adequately reflect more recent scientific evidence about the potential effects of long-term exposure.

Nitrates and nitrites are naturally occurring compounds found in soil, water and food. However, human activities, including the use of agricultural fertilisers, manure runoff and poorly maintained septic systems, can increase nitrate concentrations in water supplies.

The current WHO guideline sets the maximum acceptable nitrate concentration at 50 milligrams per litre (mg/L), equivalent to 11.3 mg/L when measured as nitrate-nitrogen. The standard dates back to 1958 and was originally designed to prevent methaemoglobinaemia, commonly known as blue-baby syndrome. The condition reduces the blood’s ability to carry oxygen and can be fatal in infants.

The organisations say the existing threshold does not account for epidemiological research linking prolonged exposure to lower nitrate concentrations with other health risks, particularly bowel cancer and adverse pregnancy outcomes.

“Studies now link nitrate in drinking water, at levels well below the current WHO limit, to bowel cancer and premature birth,” said Pratyush Kumar, chair of WONCA, in a joint statement.

Amanda Larsson, Greenpeace’s global project lead for agriculture, said access to safe drinking water should be treated as a basic guarantee rather than a privilege.

The coalition also cited a report commissioned by the Danish government last year, which concluded that the existing international standard was insufficient to protect public health. The expert panel recommended reducing the nitrate limit to 6.0 mg/L.

Denmark has committed to adopting the lower threshold, although it has not announced a timetable for implementation. The organisations said this creates a growing difference between international guidance and national drinking water policies.

Most governments use WHO recommendations as the basis for their own drinking water standards, making changes to the agency’s guidelines important for wider regulatory reform, the letter said.

The appeal was issued on World One Health Day, which highlights the links between human, animal and environmental health.

The signatories also called on governments to reduce pollution from intensive livestock farming and support producers in adopting more environmentally sustainable agricultural practices.

They said stronger protections against nitrate contamination were needed to safeguard drinking water supplies and reduce potential health risks, particularly for children and pregnant women.

A breast biopsy can bring days of uncertainty, fear and difficult memories, particularly for women with a family history of cancer. For Euronews reporter Monica Pinna, a week-long wait for test results became a personal experience of the emotional strain involved in investigating a possible diagnosis, as well as the inequalities affecting breast cancer screening and care across Europe.

Pinna had delayed a routine breast examination for around two years before attending an appointment in France. Her mammogram appeared normal, but an ultrasound revealed a suspicious area that required a biopsy. She underwent the procedure two days later and waited seven days for the results.

During that period, she recalled relatives who had survived breast cancer and others who had died from the disease. Although the uncertainty disrupted her work and daily life, the doctor eventually confirmed that there was no cancer.

Her experience highlighted a wider problem: access to early detection and timely diagnosis varies considerably between European countries.

When breast cancer is detected before it spreads, five-year survival rates approach 100%, compared with 38% for women diagnosed at an advanced stage, according to figures cited in the report. The European Commission has allocated around €80 million through its Europe’s Beating Cancer Plan to strengthen screening, but access remains uneven.

Differences in screening arrangements, appointment availability, out-of-pocket costs and public awareness all affect women’s chances of receiving an early diagnosis. Research by the European Union and the Organisation for Economic Co-operation and Development (OECD) has also identified social inequalities as a factor.

The time between screening and diagnosis varies across the continent. A study cited in the report found median waiting times ranging from eight days in Denmark to 32 days in Romania.

Maria Assunta, who lives in Sardinia, experienced a considerably longer process. At 46, a routine ultrasound identified a four-centimetre lump. She waited a month for a biopsy and another three weeks to receive her diagnosis. She is now in follow-up care, with examinations every six months, and describes the treatment she received as excellent.

Participation in organised screening programmes also remains inconsistent. In France, fewer than half of eligible women take part. Although screening rates increased in nine EU countries with available data compared with 2019, progress has stalled in many others.

Around 360,000 women in the EU are diagnosed with breast cancer each year, including approximately 61,000 in France. Estimates suggest that one in 11 women will develop the disease during their lifetime.

Access to psychological support is another concern. The OECD’s 2026 European Cancer Inequalities Report found that only 16 EU countries include psychological care in their cancer treatment pathways, alongside Norway and Iceland.

In Italy, a 2024 study of around 3,000 cancer patients found that only 20% had received psychological support. The Italian Federation of Voluntary Associations in Oncology estimates that specialised psycho-oncology services are available in only around 20% of hospitals.

Cancer survivors and medical volunteers have established initiatives to help address these gaps, offering activities such as yoga, Qigong and emotional support. However, provision remains limited and often depends on voluntary organisations.

Pinna’s experience ended with an all-clear, but she said it had changed her approach to screening. She hopes sharing her story will encourage women to attend regular examinations, while calling for faster diagnosis, wider access to treatment and psychological support across Europe.

Pilot fatigue remains a significant aviation safety concern, with a new survey finding that many pilots continue flying while exhausted rather than declaring themselves unfit for duty because of concerns about their employers’ reactions.

The European Cockpit Association (ECA) said fear of career consequences, reluctance to draw attention to fatigue and concerns about inconveniencing employers were among the main barriers preventing pilots from reporting that they were too tired to fly.

The survey, conducted by aviation consultancy Baines Simmons, collected responses from 7,200 pilots across 32 countries. More than half of respondents said they had flown while tired, while over 76% reported experiencing at least one microsleep on the flight deck during the previous four weeks.

Microsleeps are brief, involuntary episodes of sleep that can occur when a person is severely fatigued. Other warning signs include head nodding, difficulty keeping the eyes open and reduced alertness, all of which can compromise a pilot’s ability to respond to changing conditions during a flight.

More than half of the pilots surveyed said that, at least once in the previous three months, they had operated a flight before later realising they should have declared themselves unfit for duty because of fatigue.

Concern about management’s reaction was the most frequently reported barrier, cited by 47% of respondents. Another 44% said they did not want to draw attention to themselves, while 35% were reluctant to inconvenience their employer.

“When pilots fear career consequences, fatigue goes unreported and the risk returns to the cockpit,” said Captain Coen George, an ECA board director.

Fatigue can result from insufficient sleep, long or demanding duty periods and inadequate recovery time between assignments. The report also highlighted cumulative fatigue, which builds up over successive duties and can be harder for pilots to recognise before their performance is affected.

Despite widespread awareness of the risks, confidence in reporting procedures remains low. Although 82% of respondents knew how to submit a fatigue report, only 12% said they trusted the reporting system. Just 11% said fatigue reports had resulted in operational changes intended to improve safety.

Half of those surveyed described fatigue risks at their airlines as poorly managed or not managed at all.

The findings echo concerns raised by the European Union Aviation Safety Agency (EASA), which identified aircrew fatigue as a prominent safety issue in a report published in June 2026.

EASA linked fatigue to several operational and employment-related factors, including flight scheduling, short-notice roster changes and the use of commanders’ discretion to extend duty periods beyond planned limits.

The agency called for targeted safety initiatives to improve reporting and awareness, alongside workplace cultures that allow personnel to declare themselves too tired to work without fear of reprimand.

The ECA survey suggests that improving formal reporting procedures alone may not be sufficient. Building trust in those systems and ensuring that fatigue reports lead to meaningful operational changes remain important challenges for airlines seeking to protect flight safety.