Non-hodgkin's lymphoma and agricultural use of the insecticide lindane

Correlation between Lindane Use and the Incidence of Thyroid Cancer in the United States: An Ecological Study

The increasing rate of thyroid cancer may be attributable to endocrine disruptive chemicals. Lindane is a persistent organochlorine pesticide with endocrine disruptive properties that has been classified as carcinogenic to humans. The aim of this ecological study was to evaluate potential correlation between lindane exposure and thyroid cancer incidence in the United States (US). Data on statewide age-adjusted thyroid cancer incidence rate (per 100,000 people) was obtained from the Centers for Disease Control and Prevention for all US states for 2019. Lindane use estimates per cropland (kg/acres cropland) were then overlaid on the map of age-adjusted thyroid cancer incidence rate using ArcGIS. The trend of lindane use in the US between 1992 and 2007 was calculated using the Mann Kendall correlation test. The correlation between statewide lindane use and age-adjusted thyroid cancer incidence rates was calculated using Spearman correlation. Lindane use in the US decreased significantly between 1992 and 2007 (T = -0.617; p < 0.001). There was no statistically significant correlation between lindane use in 1992 and thyroid cancer incidence rate for any of the years between 1999 and 2019. Our results suggest that restrictions clearly seem to be effective in reducing lindane use, however, more research is needed for individual pesticides and thyroid cancer.

A systematic review and meta-analysis of occupational exposures and risk of follicular lymphoma

BACKGROUND

The etiology of follicular lymphoma (FL), a common non-Hodgkin lymphoma subtype, is largely unknown.

OBJECTIVE

We performed a systematic review and meta-analysis of observational studies examining the relationship between occupational exposures and FL risk.

METHODS

We searched Ovid MEDLINE, Ovid EMBASE, and Web of Science for eligible observational studies examining job titles or occupational exposures prior to January 1, 2020. We performed a narrative synthesis and used random-effects models to generate meta-estimates of relative risk (RR) with 95% confidence intervals (95%CI) for exposures reported by three or more studies.

RESULTS

Fifty-eight studies were eligible. Ten cohort and 37 case-control studies quantified FL risk in relation to any exposure to one or more occupational groups or agents. Eight cohort and 19 case-control studies examined dose-response relationships. We found evidence of a positive association with increasing plasma concentration of dichlorodiphenyldichloroethylene (DDE; meta-RR = 1.51, 95%CI = 0.99, 2.31; I² = 0.0%) and polychlorinated biphenyls (PCBs; meta-RR = 1.47, 95%CI = 0.97, 2.24; I² = 8.6%). We observed a positive association with exposure to any solvent (meta-RR = 1.16, 95%CI = 1.00, 1.34; I² = 0.0%) and chlorinated solvents (meta-RR = 1.35, 95%CI = 1.09, 1.68; I² = 0.0%). Single studies reported a significant positive dose-response association for exposure to any pesticide, hexachlorobenzene, any organophosphate, diazinon, metolachlor, carbaryl, lindane, trichloroethylene, oils/greases, and extremely low-frequency magnetic fields. Job title-only analyses suggested increased risk for medical doctors and spray painters, and decreased risk for bakers and teachers. Overall, studies demonstrated low risk of bias, but most studies examined small numbers of exposed cases.

CONCLUSIONS

Current evidence indicates a positive association between FL and occupational exposure to DDE, PCBs, any solvent and chlorinated solvents. Our findings may help guide policies and practices on the safe use of solvents and inform models of lymphomagenesis. Future studies with larger sample sizes and comprehensive quantitative exposure measures may elucidate other avoidable carcinogenic exposures.

Insecticide use and risk of non-Hodgkin lymphoma subtypes: A subset meta-analysis of the North American Pooled Project

Insecticide use has been linked to increased risk of non-Hodgkin lymphoma (NHL), however, findings of epidemiologic studies have been inconsistent, particularly for NHL subtypes. We analyzed 1690 NHL cases and 5131 controls in the North American Pooled Project (NAPP) to investigate self-reported insecticide use and risk of NHL overall and by subtypes: follicular lymphoma (FL), diffuse large B-cell lymphoma (DLBCL) and small lymphocytic lymphoma (SLL). Odds ratios (OR) and 95% confidence intervals for each insecticide were estimated using logistic regression. Subtype-specific associations were evaluated using ASSET (Association analysis for SubSETs). Increased risks of multiple NHL subtypes were observed for lindane (OR = 1.60, 1.20-2.10: FL, DLCBL, SLL), chlordane (OR = 1.59, 1.17-2.16: FL, SLL) and DDT (OR = 1.36, 1.06-1.73: DLBCL, SLL). Positive trends were observed, within the subsets with identified associations, for increasing categories of exposure duration for lindane (P_trend = 1.7 × 10^-4 ), chlordane (P_trend = 1.0 × 10^-3 ) and DDT (P_trend = 4.2 × 10^-3 ), however, the exposure-response relationship was nonlinear. Ever use of pyrethrum was associated with an increased risk of FL (OR = 3.65, 1.45-9.15), and the relationship with duration of use appeared monotonic (OR for >10 years: OR = 5.38, 1.75-16.53; P_trend = 3.6 × 10^-3 ). Our analysis identified several novel associations between insecticide use and specific NHL subtypes, suggesting possible etiologic heterogeneity in the context of pesticide exposure.

Geographic distribution and environmental risk factors of lymphoma in dogs under primary-care in the UK

OBJECTIVES

To integrate external data sources with VetCompass postcode data to explore the spatial distribution and examine potential associations with environmental risk factors in dogs diagnosed with lymphoma at primary care veterinary practices.

MATERIALS AND METHODS

Cases of lymphoma were identified from electronic patient records of 455,553 dogs under primary veterinary care during 2013 in the UK. Cases were defined as either laboratory-confirmed or non-laboratory-confirmed. Disease maps at the postcode-district level were used to define the geographic distribution of lymphoma incidence and spatial clustering was explored. Environmental risk factors from external data sources were transferred to a compatible format and logistic regression modelling was used to examine associations between environmental herbicide, fungicide and radon concentrations with lymphoma.

RESULTS

From the denominator population of 455,553 dogs, 279 lymphoma cases (187 with laboratory confirmation and 93 without) were identified. Heterogeneous geographic variation was observed with weak evidence of clustering around London and the south-west of England. Herbicide and fungicide exposures were weakly associated with a diagnosis of lymphoma in the univariable analysis. After accounting for the age at diagnosis and breed in the multivariable analysis, herbicide exposure was associated with a diagnosis of lymphoma.

CLINICAL SIGNIFICANCE

The heterogeneous distribution of lymphoma in UK dogs provides further evidence for geographic variation of lymphoma, perhaps in part associated with underlying environmental risk factors. The results suggest an association between environmental herbicide and canine lymphoma.

Electrocatalysis of Lindane Using Antimony Oxide Nanoparticles Based-SWCNT/PANI Nanocomposites

This work describes the chemical synthesis of antimony oxide nanoparticles (AONPs), polyaniline (PANI), acid functionalized single-walled carbon nanotubes (fSWCNTs), and the nanocomposite (AONP-PANI-SWCNT) as catalyst for the trace detection of lindane. Successful synthesis of the nanomaterials was confirmed by Fourier transform infrared (FT-IR) spectroscopy, ultraviolet-visible (UV-Vis) spectroscopy, x-ray diffraction (XRD) spectroscopy, and scanning electron microscopy (SEM). Cyclic voltammetry (CV) and electrochemical impedance spectroscopy (EIS) were used for investigating the electrochemical behavior of the modified electrodes in the ferrocyanide/ferricyanide ([Fe(CN)₆]⁴⁻/[Fe(CN)₆]³⁻) redox probe. GCE-AONP-PANI-SWCNT exhibited faster electron transport properties as well as higher electroactivity as compared to bare-GCE, GCE-AONPs, GCE-PANI, and GCE-SWCNT electrodes. Electrocatalytic studies further showed that GCE-AONP-PANI-SWCNT modified electrode was stable (after 20 scans) with only a small current drop in lindane (0.57%). The GCE-AONP-PANI-SWCNT electrode with low detection limit of 2.01 nM performed better toward the detection of lindane as compared to other studies in literature. The GCE-AONP-PANI-SWCNT electrode is highly selective toward the detection of lindane in the presence of various organic and inorganic interfering species. Real sample analysis of river water and tap water samples using the developed sensor gave satisfactory percentage recoveries therefore confirming the potential of the proposed sensor for practical application.

Ranking occupational contexts associated with risk of non-Hodgkin lymphoma

BACKGROUND

Risk factors associated with non-Hodgkin lymphoma (NHL) remain unknown, but certain occupational contexts (OCs) have been implicated. The objective of this study was to inventory, from the accumulated knowledge, associations between OCs and NHL risk.

METHODS

Literature was used to identify the NHL-associated OCs. For each context, items were ranked both by scientific interest and the association strength.

RESULTS

Three ranked lists of OCs related to NHL were constructed. We found that NHL was associated with 31 occupational activities, 91 occupational exposures, and 35 occupational activity-exposure combinations. Among them, 5 activities, 2 exposures, and 3 combinations, involving agricultural or industrial sector and solvents or pesticides, were highlighted with the highest publications number and the strongest association with NHL risk.

CONCLUSION

These results could be useful in both providing a ranked inventory of OCs associated with NHL risk and highlighting "hot" occupational activities and exposures. Am. J. Ind. Med. 59:561-574, 2016. © 2016 Wiley Periodicals, Inc.

Exposure to organochlorine pesticides and non-Hodgkin lymphoma: a meta-analysis of observational studies

Growing evidence indicates that exposure to organochlorine pesticides (OCPs) could increase non-Hodgkin lymphoma (NHL) risk. However, results from epidemiological studies investigating this association remain controversial. We thus conducted a meta-analysis to quantitatively evaluate the association between OCP exposure and NHL risk. Relevant publications were searched in PubMed, Web of Science, and Embase and identified according to the inclusion criteria. Thirteen studies (6 nested case-control, 1 case-cohort, and 6 case-control) were selected for this meta-analysis. We used odds ratios (ORs) with 95% confidence intervals (CIs) to estimate the relationship between OCPs exposure and NHL risk. The summary OR for included studies was 1.40 (95% CI 1.27 to 1.56). No overall significant heterogeneity in the OR was observed (Ph = 0.253, I(2) = 12.6%). Furthermore, OR estimates in subgroup analyses were discussed, and strong associations were observed for dichlorodiphenyldichloroethylene (DDE, OR = 1.38, 95% CI 1.14 to 1.66), hexachlorocyclohexane (HCH, OR = 1.42, 95% CI 1.08 to 1.87), chlordane (OR = 1.93, 95% CI 1.51 to 2.48), and hexachlorobenzene (HCB, OR = 1.54, 95% CI 1.20 to 1.99). This meta-analysis had suggested that total OCPs of interest was significantly positively associated with NHL risk.

Study of the genotoxic and cytotoxic effects of the α-, β-, and γ- Hexachlorocyclohexane isomers in human lymphocyte cells using the cytokinesis-block micronucleus assay

The genotoxic potential of hexachlorocyclohexane (HCH) isomers (α-, β-, and γ-) which are organochlorine pesticides was tested in peripheral blood lymphocyte cultures from two donors by using the cytokinesis-block micronucleus assay. Micronucleus (MN) frequency, binucleated cells with micronucleus (BNMN), and cytokinesis-blocked proliferation index (CBPI) were determined as genotoxic and cytotoxic endpoints. At the concentration ranges tested (12.5-100 μg.L ^-1), all HCH isomers induced dose-dependent cytotoxic effects, γ-HCH being the most toxic. This isomer was also able to induce significant increase in MN frequency and BNMN cells indicating a genotoxic potential at 50 and 100 μg.L ^-1. The genotoxic test of β-HCH showed a positive induction of MN and BNMN cells at the highest concentration of 100 μg.L ^-1 and a significant cytotoxicity at 50 μg.L ^-1. Under the experimental condition used, α-HCH was unable to induce any significant increase in MN frequency confirming that α-HCH is a non-genotoxic agent.

Non-hodgkin lymphoma risk and insecticide, fungicide and fumigant use in the agricultural health study

Farming and pesticide use have previously been linked to non-Hodgkin lymphoma (NHL), chronic lymphocytic leukemia (CLL) and multiple myeloma (MM). We evaluated agricultural use of specific insecticides, fungicides, and fumigants and risk of NHL and NHL-subtypes (including CLL and MM) in a U.S.-based prospective cohort of farmers and commercial pesticide applicators. A total of 523 cases occurred among 54,306 pesticide applicators from enrollment (1993-97) through December 31, 2011 in Iowa, and December 31, 2010 in North Carolina. Information on pesticide use, other agricultural exposures and other factors was obtained from questionnaires at enrollment and at follow-up approximately five years later (1999-2005). Information from questionnaires, monitoring, and the literature were used to create lifetime-days and intensity-weighted lifetime days of pesticide use, taking into account exposure-modifying factors. Poisson and polytomous models were used to calculate relative risks (RR) and 95% confidence intervals (CI) to evaluate associations between 26 pesticides and NHL and five NHL-subtypes, while adjusting for potential confounding factors. For total NHL, statistically significant positive exposure-response trends were seen with lindane and DDT. Terbufos was associated with total NHL in ever/never comparisons only. In subtype analyses, terbufos and DDT were associated with small cell lymphoma/chronic lymphocytic leukemia/marginal cell lymphoma, lindane and diazinon with follicular lymphoma, and permethrin with MM. However, tests of homogeneity did not show significant differences in exposure-response among NHL-subtypes for any pesticide. Because 26 pesticides were evaluated for their association with NHL and its subtypes, some chance finding could have occurred. Our results showed pesticides from different chemical and functional classes were associated with an excess risk of NHL and NHL subtypes, but not all members of any single class of pesticides were associated with an elevated risk of NHL or NHL subtypes. These findings are among the first to suggest links between DDT, lindane, permethrin, diazinon and terbufos with NHL subtypes.

Non-Hodgkin lymphoma and occupational exposure to agricultural pesticide chemical groups and active ingredients: a systematic review and meta-analysis

This paper describes results from a systematic review and a series of meta-analyses of nearly three decades worth of epidemiologic research on the relationship between non-Hodgkin lymphoma (NHL) and occupational exposure to agricultural pesticide active ingredients and chemical groups. Estimates of associations of NHL with 21 pesticide chemical groups and 80 active ingredients were extracted from 44 papers, all of which reported results from analyses of studies conducted in high-income countries. Random effects meta-analyses showed that phenoxy herbicides, carbamate insecticides, organophosphorus insecticides and the active ingredient lindane, an organochlorine insecticide, were positively associated with NHL. In a handful of papers, associations between pesticides and NHL subtypes were reported; B cell lymphoma was positively associated with phenoxy herbicides and the organophosphorus herbicide glyphosate. Diffuse large B-cell lymphoma was positively associated with phenoxy herbicide exposure. Despite compelling evidence that NHL is associated with certain chemicals, this review indicates the need for investigations of a larger variety of pesticides in more geographic areas, especially in low- and middle-income countries, which, despite producing a large portion of the world's agriculture, were missing in the literature that were reviewed.

Chlorobenzenes, lindane and dieldrin induce apoptotic alterations in human peripheral blood lymphocytes (in vitro study)

In this study, we have assessed apoptotic effect of 1,2,4-trichlorobenzene, hexachlorobenzene, lindane and dieldrin on human peripheral blood lymphocytes. We observed an increase in ROS formation and a decrease in mitochondrial transmembrane potential in the cells incubated with low concentrations of all compounds studied, in particular lindane and dieldrin. ROS formation and changes in mitochondrial transmembrane potential may have influenced caspase-3 activation, a crucial enzyme in the apoptotic process. Moreover, chlorobenzenes, and in particular lindane and dieldrin changed cells' membrane permeability and induced phosphatidylserine translocation, which confirmed that they are capable of inducing apoptosis in human lymphocytes. Apoptotic changes in human lymphocytes provoked by biologically relevant concentrations of these substances suggest that they may disturb function of immunological system especially among people occupationally exposed to their action.

Bioaccessibility of pesticides and polychlorinated biphenyls from house dust: in-vitro methods and human exposure assessment

Semi-volatile chemicals like pesticides and polychlorinated biphenyls (PCB) tend to accumulate in house dust. This may result in residues of some parts per million (p.p.m.), closely associated with health impairments and diseases like cancer. To explain these associations, we must establish whether a relevant absorption from house dust into human organisms occurs, and most crucially the release of chemicals, that is, their bioaccessibility. Digestive as well as dermal bioaccessibilities were examined using in-vitro methods. On average, the digestive bioaccessibility was ~40% for the pesticides and ~60% for the PCB. The dermal penetration availability reached ~60% for the pesticides and ~70% for the PCB (percentages of the concentrations in the dust). Based on the bioaccessibility, an estimate of internal exposure was calculated and expressed as percentages of acceptable or tolerable daily intake (ADI/TDI) values. Exposure via the respiratory tract proved to be very low. Exposure via the digestive tract had maximum values of 4% for pesticides and 12% for PCB. Dermal exposure was much higher. Even for average concentrations in house dust (≈0.5 p.p.m.), children exposed to DDT and PCB showed up to 300% of the ADI/TDI values, and adults about 60%. With high concentrations of contaminants in house dust, the maximum doses absorbed through the skin reached 5000%.

Biochemical effects induced by the hexachlorocyclohexanes

The hexachlorocyclohexanes (HCHs) are synthetic compounds that have been widely used for the control of pests. The most common HCH isomers are the α-, β-, δ-, and γ-HCH. Although the have the same chlorine substitution pattern, the spatial orientation of chlorine atoms is different on each one of them, resulting in unique structures that have distinct molecular properties. Humans are exposed to individual HCH isomers through various routes, including ingestion of contaminated water or food, absorbed through the skin or by inhalation, and because of their liposolubility, these chemicals are mostly stored in fat-containing tissues. The isomer-specific spectrum of biochemical actions for these compounds has been wee characterized for different endpoints such as enzyme activation, calcium homeostasis, gap junctional intercellular communication, endocrine disruption, and cancer, among others. The interaction with the GABA reception has been one of the most extensively studied properties of the HCHs. For instance, γ-HCH acts as a GABAA channel blocker, whereas α- and δ-HCH potentiate currents , all working as allosteric modulators of the receptor. The changes in calcium homeostasis elicited by HCHs are both isomer and cell type specific. For example, in neurons, both the δ- and γ-isomers of HCH stimulate Ca²+ influx through different voltage-gated Ca²+ channels. In human neutrophils, α-,δ-, and γ-HCH, but not β-HCH, increase intracellular Ca²+ concentrations. This isomer-dependent behavior is also similar to that observed for phospholipase A2 activation and also correlates with oxidative stress generation. On the other hand, there are several lines of evidence suggesting that HCHs alter genomic integrity, and, therefore, these compounds have been classified as possibly carcinogenic to humans . Finally, HCHs have been reported to be endocrine disrupters. In fact, γ- and β-HCH have been shown to have weak estrogenic activity, and together with the α- and the δ-isomer, also interfere with steroidogenesis. In short, the HCH isomers are good examples of structurally related chemicals, for which the geometrical patterns present in each one of the different conformers create structures that possess specific mechanisms of action and toxicological properties.

Occupational exposure to pesticides and lymphoid neoplasms among men: results of a French case-control study

OBJECTIVES

Investigating the relationship between occupational exposure to pesticides and the risk of lymphoid neoplasms (LNs) in men.

METHODS

A hospital-based case-control study was conducted in six centres in France between 2000 and 2004. The cases were incident cases with a diagnosis of LN aged 18-75 years. During the same period, controls of the same age and sex as the cases were recruited in the same hospital, mainly in the orthopaedic and rheumatological departments. Exposures to pesticides were evaluated through specific interviews and case-by-case expert reviews. Four hundred and ninety-one cases (244 cases of non-Hodgkin's lymphoma (NHL), 87 of Hodgkin's lymphoma (HL), 104 of lymphoproliferative syndromes (LPSs) and 56 of multiple myeloma (MM) cases) and 456 controls were included in the analyses. The odds ratios (ORs) and 95% CI were estimated using unconditional logistic regressions.

RESULTS

Positive associations between HL and occupational exposure to triazole fungicides and urea herbicides were observed (OR = 8.4 (2.2 to 32.4), 10.8 (2.4 to 48.1), respectively). Exposure to insecticides, fungicides and herbicides were linked to a threefold increase in MM risk (OR = 2.8 (1.2 to 6.5), 3.2 (1.4 to 7.2), 2.9 (1.3 to 6.5)). For LPS subtypes, associations restricted to hairy-cell leukaemia (HCL) were evidenced for exposure to organochlorine insecticides, phenoxy herbicides and triazine herbicides (OR = 4.9 (1.1 to 21.2), 4.1 (1.1 to 15.5), 5.1 (1.4 to 19.3)), although based on small numbers. Lastly, despite the increased ORs for organochlorine and organophosphate insecticides, carbamate fungicides and triazine herbicides, no significant associations were evidenced for NHL.

CONCLUSIONS

The results, based on case-by-case expert review of occupation-specific questionnaires, support the hypothesis that occupational pesticide exposures may be involved in HL, MM and HCL and do not rule out a role in NHL. The analyses identified specific pesticides that deserve further investigation and the findings were consistent with those of previous studies.

Occupational risk factors for non-Hodgkin's lymphoma: a population-based case-control study in Northern Germany

OBJECTIVES

To identify occupational factors associated with non-Hodgkin's lymphoma (NHL).

METHODS

A population-based case-control study was conducted in which incident cases of high-malignancy NHL (NHL(high)), low-malignancy NHL (NHL(low)), and chronic lymphocytic leukemia (CLL) were ascertained during the period 1986-1998 among men and women aged 15-75 years residing in six German counties; controls were drawn from population registries. Occupational histories were collected and agent-specific exposures were estimated via a job-exposure-matrix. Odds ratios were estimated by conditional logistic regression.

RESULTS

A total of 858 cases were included in these analyses. Agricultural workers [odds ratio (OR) = 2.67, 95% confidence interval (CI): 0.99, 7.21) and farmers (OR = 1.98, 95% CI: 0.98, 3.98] had elevated risk of NHL(high). Risk of NHL(low) was elevated among agricultural workers (OR = 2.46, 95% CI: 1.17, 5.16), and among blacksmiths, toolmakers, and machine tool operators (OR = 3.12, 95% CI: 1.31, 7.47). Workers in sales and construction had elevated risks of NHL(high) and NHL(low). Exposure to arsenic compounds, chlorophenols, diesel fuel, herbicides, nitrites/nitrates/nitrosamines, and organic dusts were associated with NHL(high) and NHL(low), while exhibiting little association with CLL. A positive monotonic trend in NHL(low) risk across tertiles of cumulative diesel fuel exposure was observed [P-value for test of linear trend (P) = 0.03].

CONCLUSIONS

These findings provide insights into several potential occupational risk factors for NHL and suggest some specific occupational agents for further investigation.

The non-Hodgkin lymphomas: a review of the epidemiologic literature

The non-Hodgkin lymphomas (NHL) are a heterogeneous group of B-cell and T-cell neoplasms that arise primarily in the lymph nodes. NHL incidence rates in the US doubled between about 1970 and 1990, and stabilized during the 1990s. NHL accounts for approximately 3.4% of cancer deaths in the US. Although some of the observed patterns in NHL have been related to HIV/AIDS, these conditions cannot fully explain the magnitude of the changes; neither do changes in classification systems nor improved diagnostic capabilities. Studies of occupational and environmental exposures (e.g., pesticides, solvents) have produced no consistent pattern of significant positive associations. Inverse associations with ultraviolet radiation exposure and alcohol and fish intake, and positive associations with meat and saturated fat intake have been reported in several studies; additional studies are needed to confirm or refute these associations. Family history of NHL or other hematolympho-proliferative cancers and personal history of several autoimmune disorders are associated with increased risk of NHL, but are not likely to account for a large proportion of cases. HIV and other infectious agents, such as human herpesvirus 8 and Epstein-Barr, appear to be associated with differing types of NHL, such as some B-cell lymphomas. Future epidemiologic studies should evaluate associations by NHL type, enhance exposure information collected, and elucidate factors that may identify susceptible (or resistant) subpopulations because of genetic, immunologic or other characteristics. The extent to which the etiology of NHL types may differ is important to resolve in ongoing and future studies.

Occupational exposure to organochlorine insecticides and cancer incidence in the Agricultural Health Study

Organochlorine (OC) insecticides have been regulated as possible human carcinogens primarily on the basis of animal studies. However, the epidemiologic evidence is inconsistent. We investigated the relationship between cancer incidence and OC insecticide use among pesticide applicators enrolled in the Agricultural Health Study, a prospective cohort study of 57,311 licensed applicators in Iowa and North Carolina enrolled between 1993 and 1997. Information on ever use of 7 OC insecticides (aldrin, chlordane, DDT, dieldrin, heptachlor, lindane, toxaphene) was collected from a self-administered questionnaire at enrollment. Lifetime exposure-days to OC insecticides were calculated using additional data from a take-home questionnaire completed by 25,291 participants (44% of total). We found no clear evidence of an association between use of OC insecticides and incident cancers (N = 1,150) ascertained through December, 2002. When we focused on individual insecticides and structurally similar groups (aldrin and dieldrin; chlordane and heptachlor), significantly increased relative risks of some cancers were observed for use of some chemicals (rectal cancer and chlordane, lung cancer and dieldrin, non-Hodgkin lymphoma (NHL) and lindane, melanoma and toxaphene, leukemia and chlordane/heptachlor). Some significant decreased relative risks were also observed (colon cancer and aldrin; overall cancer and heptachlor). In conclusion, we did not observe any clear relationship between cancer risk and the use of OC insecticides. Our chemical-specific findings are based on small numbers and multiple comparisons, and should be interpreted with caution; however, some observed associations (lindane and NHL, chlordane/heptachlor and leukemia) are supported by previous evidence.

Non-Hodgkin lymphoma and pesticide exposure: 25 years of research

Over the past 40 years, a substantial rise in the incidence of non-Hodgkin lymphoma (NHL) has been observed. Epidemiologic studies aimed at understanding this rise have revealed some association with occupational exposure. NHL is common among farmers, where pesticides have been described as the culprit. The association between pesticides and NHL has been demonstrated mainly in case-control studies, while retrospective cohorts have been less convincing. Pesticides including chlorphenol and phenoxyacetic acid herbicides, organochlorines, and organophosphate insecticides, carbamates, and fungicides have been associated with NHL. Although the causality has not been clearly proven, both genotoxic and nongenotoxic mechanisms for lymphomagenesis have been proposed. The leveling-off of NHL incidence in certain countries may be the result of a favorable change in pesticide usage patterns. Future studies, such as the Agricultural Health Study, may clarify the uncertainties regarding this issue.

Risk of non-Hodgkin's lymphoma and exposure to hexachlorocyclohexane, a nested case-control study

Organochlorines have been linked with non-Hodgkin's lymphoma (NHL) in epidemiological studies. We elucidate the importance of hexachlorocyclohexane (HCH), an organochlorine insecticide, in the aetiology of NHL among individuals with dermal exposure to HCH. This is a case-control study nested in a cohort of sheep owners, collected from records on sheep dipping. The number of dipped sheep was used as surrogate for exposure. No other insecticide was used in sheep dip in Iceland during the study period. Cases (n=45) were identified by record linkage with the national cancer registry (through 1962-2003) and controls (n=221) were selected at random from the cohort. In logistic regression analysis the odds ratio for NHL was 3.86 (95% CI 1.59-8.53), adjusted for age, for individuals who had 100 sheep or more as compared to those who had less than 100 sheep. The results indicate that HCH may be linked to the development of NHL.

The epidemiology of pesticide exposure and cancer: A review

Cancer is a multifactorial disease with contributions from genetic, environmental, and lifestyle factors. Pesticide exposure is recognized as an important environmental risk factor associated with cancer development. The epidemiology of pesticide exposure and cancer in humans has been studied globally in various settings. Insecticides, herbicides, and fungicides are associated with hemopoetic cancers, and cancers of the prostate, pancreas, liver, and other body systems. The involvement of pesticides in breast cancer has not yet been determined. In developing countries, sufficient epidemiologic research and evidence is lacking to link pesticide exposure with cancer development. Agricultural and industrial workers are high-risk groups for developing cancer following pesticide exposure. Children of farm workers can be exposed to pesticides through their parents. Maternal exposure to pesticides can pose a health risk to the fetus and the newborn. The organophosphates are most the commonly used compounds, but the organochlorines are still permitted for limited use in developing countries. Pesticide exposure, independently or in synergism with modifiable risk factors, is associated with several types of cancer.

Pesticide product use and risk of non-Hodgkin lymphoma in women

A population-based, incidence case-control study was conducted among women in upstate New York to determine whether pesticide exposure is associated with an increase in risk of non-Hodgkin lymphoma (NHL) among women. The study involved 376 cases of NHL identified through the State Cancer Registry and 463 controls selected from the Medicare beneficiary files and state driver's license records. Information about history of farm work, history of other jobs associated with pesticide exposure, use of common household pesticide products, and potential confounding variables was obtained by telephone interview. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using an unconditional logistic regression model. The risk of NHL was doubled (OR = 2.12; 95% CI, 1.21-3.71) among women who worked for at least 10 years at a farm where pesticides were reportedly used. When both farming and other types of jobs associated with pesticide exposure were combined, there was a progressive increase in risk of NHL with increasing duration of such work (p = 0.005). Overall cumulative frequency of use of household pesticide products was positively associated with risk of NHL (p = 0.004), which was most pronounced when they were applied by subjects themselves. When exposure was analyzed by type of products used, a significant association was observed for mothballs. The associations with both occupational and household pesticides were particularly elevated if exposure started in 1950-1969 and for high-grade NHL. Although the results of this case-control study suggest that exposure to pesticide products may be associated with an increased risk of NHL among women, methodologic limitations related to selection and recall bias suggest caution in inferring causation.

Exposure of women to organochlorine pesticides in Southern Spain

Organochlorine pesticides are lipophilic compounds that persist in the environment. Because of their lipid solubility and resistance to metabolism, some of these chemicals accumulate in human tissues. The largest area of intensive greenhouse agriculture in Europe is near the Mediterranean coast of Southern Spain, where this type of farming has greatly expanded since the 1960s. We determined and compared the levels of 15 organochlorine pesticides in the adipose tissue and blood of 200 women living in Southern Spain. Aldrin, dieldrin, endrin, lindane, methoxychlor, endosulfans, and DDT and its metabolites were identified. Detectable concentrations of p,p'-DDE were found in 100% of adipose tissue and serum samples. Among the remaining DDTs, p,p'-DDT was the most common, being detected in 39% of adipose tissue and 76.5% of serum samples, followed by endosulfans I and II, which also were found in both adipose tissue and serum samples but at lower concentrations. Endosulfans were followed in frequency by lindane, aldrin, and dieldrin. Endrin and methoxychlor were present at a much lower frequency compared to those of the other organochlorines. Serum concentrations of p,p'-DDE o,p'-DDD, and endosulfan -I, -sulfate, -lactone, and -diol were significantly correlated with their adipose tissue concentrations. No significant relationships were found between the serum and adipose tissue concentrations of the remaining nine compounds determined, raising doubts about the equivalent use of fat/serum samples for the exposure assessment of some pesticides in epidemiological studies. The results suggested that women of reproductive age in Southern Spain have been and are currently exposed to organochlorine pesticides. Because many of these chemicals can mobilize during pregnancy and lactation, further research is warranted to interpret the health consequences for the children of such exposure.

Adipose tissue levels of organochlorine pesticides and polychlorinated biphenyls and risk of non-Hodgkin's lymphoma

In this nested case-control study we examined the relationship between non-Hodgkin's lymphoma (NHL) and organochlorine pesticide exposure. We used a data set originally collected between 1969 and 1983 in the U.S. Environmental Protection Agency National Human Adipose Tissue Survey. Adipose samples were randomly collected from cadavers and surgical patients, and levels of organochlorine pesticide residues were determined. From the original study population, 175 NHL cases were identified and matched to 481 controls; 173 controls were selected from accident victims, and 308 from cases with a diagnosis of myocardial infarction. Cases and controls were mainly from cadavers (> 96%) and were matched on sex, age, region of residence within the United States, and race/ethnicity. Conditional logistic regression showed the organochlorine pesticide residue heptachlor epoxide to be significantly associated with NHL [compared with the lowest quartile: third quartile odds ratio (OR) = 1.82, 95% confidence interval (CI), 1.01-3.28; fourth quartile OR = 3.41, 95% CI, 1.89-6.16]. The highest quartile level of dieldrin was also associated with elevated NHL risk (OR = 2.70; 95% CI, 1.58-4.61), as were higher levels of oxychlordane, p,p'-DDE [p,p'-1,1-dichloro-2,2-bis(p-chlorophenyl)ethylene], and ss-benzene hexachloride (ORs = 1.79, 1.99, and 2.47, respectively). The p-values for trends for these associations were significant. In models containing pairs of pesticides, only heptachlor epoxide and dieldrin remained significantly associated with risk of NHL. Limitations of this study include collection of samples after diagnosis and a lack of information on variables affecting organochlorine levels such as diet, occupation, and body mass index. Given the persistence of pesticides in the environment, these findings are still relevant today.

Residential proximity to industrial plants and non-Hodgkin lymphoma

BACKGROUND

A U.S. analysis suggested a relation between self-reported residential proximity to industrial plants and non-Hodgkin lymphoma (NHL) risk.

METHODS

Using lifetime residential histories collected from a population-based sample of 1499 Canadians with newly diagnosed, histologically confirmed NHL and 5039 population controls, we evaluated the association of residential proximity to 7 types of major heavy industry with NHL risk.

RESULTS

Overall, having lived within 0.8 km or within 3.2 km of an industrial plant was not associated with increased NHL risk. For the follicular subtype of NHL, an odds ratio (OR) of 1.48 (95% confidence interval [CI] = 1.10-1.99) was observed for women who had lived within 3.2 km (83 cases/689 controls). ORs for NHL were elevated for proximity within 3.2 km of copper smelters (OR = 5.1; CI = 1.5-17.7; 7 cases, 4 controls) and within 0.8 km of sulfite pulp mills (OR = 3.7; CI = 1.5-9.4; 9 cases, 10 controls).

CONCLUSIONS

We have identified possible associations between NHL and proximity to industrial plants, which could be the result of chance or other factors associated with proximity. Studies are needed to confirm these associations and to determine whether residential proximity can result in meaningful exposure.

Non-Hodgkin's lymphoma, leukemia, and exposures in agriculture: results from the Italian multicenter case-control study

BACKGROUND

The etiology of non-Hodgkin's lymphoma (NHL) and leukemia is still largely unknown, but exposure to chemicals, in particular pesticides, has been suggested to be a risk factor.

METHODS

A large population-based case-control study was conducted in Italy with the aim of investigating the associations between pesticide exposure and NHL, and solvents and leukemia. Data presented in this article refer to 1,575 interviewed cases and 1,232 controls in the nine agricultural study areas.

RESULTS

Exposure to nitro-derivatives and phenylimides among fungicides, hydrocarbon derivatives and insecticide oils among insecticides, and the herbicide amides are the chemical classes observed to be associated with the pathologies under investigation.

CONCLUSIONS

The results of the case-control study suggest an increased risk for NHL and leukemia, and some chemical classes of pesticides, although few are statistically significant and some are based on few exposed cases. The results also show that men and women experience both similar and different risks for the same environmental agricultural exposures. Am. J. Ind. Med. 44:627-636, 2003.

Integrative assessment of multiple pesticides as risk factors for non-Hodgkin's lymphoma among men

BACKGROUND

An increased rate of non-Hodgkin's lymphoma (NHL) has been repeatedly observed among farmers, but identification of specific exposures that explain this observation has proven difficult.

METHODS

During the 1980s, the National Cancer Institute conducted three case-control studies of NHL in the midwestern United States. These pooled data were used to examine pesticide exposures in farming as risk factors for NHL in men. The large sample size (n = 3417) allowed analysis of 47 pesticides simultaneously, controlling for potential confounding by other pesticides in the model, and adjusting the estimates based on a prespecified variance to make them more stable.

RESULTS

Reported use of several individual pesticides was associated with increased NHL incidence, including organophosphate insecticides coumaphos, diazinon, and fonofos, insecticides chlordane, dieldrin, and copper acetoarsenite, and herbicides atrazine, glyphosate, and sodium chlorate. A subanalysis of these "potentially carcinogenic" pesticides suggested a positive trend of risk with exposure to increasing numbers.

CONCLUSION

Consideration of multiple exposures is important in accurately estimating specific effects and in evaluating realistic exposure scenarios.

Cancer incidence among a cohort of female farm residents in New York State

A retrospective cohort study of cancer incidence among 6,310 female farm residents who were New York Farm Bureau members, or members' spouses or relatives, was conducted from 1980 through 1993. Similar to the previous findings for New York State male farmers, the female farm resident cohort experienced significantly lower cancer rates for all cancers combined, and for lung cancer, compared with rural nonfarm female residents. In addition, significantly low rates for colorectal cancer and ovarian cancer were found among the female cohort members. Nonsignificant excesses were found for thyroid and liver cancers. The findings suggest that female farm residents in this cohort might have experienced some of the same cancer-protective factors as male farmers.

Review of 2,4-dichlorophenoxyacetic acid (2,4-D) epidemiology and toxicology

The scientific evidence in humans and animals relevant to cancer risks, neurologic disease, reproductive risks, and immunotoxicity of 2,4-D was reviewed. Despite several thorough in vitro and in vivo animal studies, no experimental evidence exists supporting the theory that 2,4-D or any of its salts and esters damages DNA under physiologic conditions. Studies in rodents demonstrate a lack of oncogenic or carcinogenic effects following a lifetime dietary administration of 2,4-D. Epidemiologic studies provide scant evidence that exposure to 2,4-D is associated with soft tissue sarcoma, non-Hodgkin's lymphoma, Hodgkin's disease, or any other cancer. Overall, the available evidence from epidemiologic studies is not adequate to conclude that any form of cancer is causally associated with 2,4-D exposure. There is no human evidence of adverse reproductive outcomes related to 2,4-D. The available data from animal studies of acute, subchronic, and chronic exposure to 2,4-D, its salts, and esters show an unequivocal lack of systemic toxicity at doses that do not exceed renal clearance mechanisms. There is no evidence that 2,4-D in any of its forms activates or transforms the immune system in animals at any dose. At high doses, 2,4-D damages the liver and kidney and irritates mucous membranes. Although myotonia and alterations in gait and behavioral indices are observed after overwhelming doses of 2,4-D, alterations in the neurologic system of experimental animals are not observed with the administration of doses in the microgram/kg/day range. It is unlikely that 2,4-D has any neurotoxic potential at doses below those required to induce systemic toxicity.

Risk factors for non-Hodgkin's lymphoma according to family history of haematolymphoproliferative malignancies

BACKGROUND

Aetiological profiles of non-Hodgkin's lymphoma (NHL) may differ depending upon whether the disease is inheritance-related or sporadic. Because familial risk (a probable surrogate of inheritance-relatedness) of NHL is influenced by haematolymphoproliferative malignancies (HLPM), we evaluated whether non-familial risk factors differ between NHL with and without a family history of HLPM, using the Selected Cancers Study data.

METHODS

Cases were 1511 men aged 31-59 and diagnosed with NHL during 1984-1988. Controls were men without NHL, frequency-matched to cases by age range and cancer registry (n = 1910). These groups were compared: cases with a family history of HLPM and without, and controls without such a family history.

RESULTS

Polytomous logistic regression analyses showed that the odds ratio (OR) estimates of homosexual behaviour were 18.2 (95% confidence interval (CI) : 4.8-69.4) and 5.6 (95% CI : 3.3-9.5) for NHL with and without a family history of HLPM, respectively. The corresponding estimates were 3.9 (95% CI : 1.7-8.9) and 2.2 (95% CI : 1.5-3.1) for history of enlarged lymph nodes. Variables only related to NHL with a family history were use of heroin (OR = 15.6, 95% CI : 3.4-70.4), exposure to a chlorinated hydrocarbon pesticide (OR = 2.3, 95% CI : 1.0-5.0), occupational exposure to plywood, fibreboard or particleboard (OR = 2.0, 95% CI : 1.2-3.4) and history of liver diseases (other than hepatitis or cirrhosis) (OR = 6.5, 95% CI : 1.2-36.2). The association between homosexual behaviour and NHL among men with a family history was stronger for those aged 31-44, especially for B-cell type of the disease.

CONCLUSIONS

This study suggests differences in the risk factor profiles between NHL with and without a family history of HLPM. The higher risks of NHL for homosexual behaviour and heroin use, surrogates of HIV infection, in men with a family history of HLPM imply that genetic susceptibility may be influential on the occurrence of HIV-related NHL.

Agricultural exposure to carbamate pesticides and risk of non-Hodgkin lymphoma

Recent epidemiological studies have suggested an increased risk of non-Hodgkin lymphoma (NHL) from carbamate insecticide use among farmers. To further explore the possible relationships, we conducted a pooled analysis of three population-based case-control studies conducted in four midwestern states in the United States. A total of 985 white male subjects and 2895 control subjects were included in this analysis. Unconditional logistic regression was used to estimate the association and control for confounding. Compared with nonfarmers, farmers who had ever used carbamate pesticides had a 30% to 50% increased risk of NHL, whereas farmers without carbamate pesticide use showed no increased risk. Analyses for individual carbamate pesticides found a more consistent association with Sevin but not carbofuran, butylate, or S-ethyl dipropylthiocarbamate plus protectant. Among farmers using Sevin, the risk of NHL was limited to those who personally handled the product, those who first used the product for > or = 20 years before their disease diagnosis, and those who used the product for a longer period. These associations persisted after adjusting for other major classes of pesticides. These results suggest an increased risk of NHL associated with carbamate pesticide use, particularly Sevin. Further investigation of the association is warranted.

Epidemiology of lymphomas

Non-Hodgkin lymphoma (NHL) is the fifth most common cancer in the US, with about 55,000 new cases estimated for the year 2000. According to the new Surveillance, Epidemiology, and End Results (SEER) data from 1973 to 1997, the age-adjusted incidence rates rose by about 80%, with an annual percentage increase of nearly 3%, which is faster than for the majority of cancers. The increasing incidence of NHL is largely unexplained. AIDS-related NHL accounts for some but not all of the increase. The American Cancer Society predicts about 7,400 new cases of Hodgkin Disease (HD) in the year 2000 in the US. The incidence of HD is consistently lower than that of NHL, and has decreased about 16% since the 1970s. Only a small portion of the decrease in HD incidence can be explained by misdiagnosis of HD as NHL. Further research is needed on the cofactors that predispose AIDS cases to lymphoma, as well as other possible causes of NHL such as immunosuppression, genetics, viruses, medical conditions, pesticides, solvents, hair dyes, and diet. Further evaluation of the role of viruses, occupational exposures, and genetics in the etiology of HD should prove valuable.

Cancer in veterinarians

OBJECTIVES

Veterinarians come into contact with several potentially carcinogenic exposures in the course of their occupation. These exposures include radiation, anaesthetic gases, pesticides (particularly insecticides), and zoonotic organisms. This review aims to summarise what is known about the carcinogenic risks in this profession.

METHODS

The levels of exposure to potential carcinogens in the veterinary profession are examined and evidence is reviewed for carcinogenesis of these substances in humans at doses similar to those experienced by veterinarians. The few published studies of cancer in veterinarians are also summarised.

RESULTS

Veterinarians have considerable potential for exposure to several known and potential carcinogens. Risks may be posed by work in clinics with poorly maintained x ray equipment, by use of insecticides, and from contact with carcinogenic zoonotic organisms. The few studies available suggest that veterinarians have increased mortality from lymphohaematopoietic cancers, melanoma, and possibly colon cancer.

CONCLUSIONS

The exposures examined in this review are not unique to the veterinary profession, and, as a consequence, information gathered on the carcinogenic risks of these exposures has implications for many other occupations such as veterinary nurses, animal handlers, and some farmers, as well as dentists, radiographers, and anaesthetists.

Agricultural use of DDT and risk of non-Hodgkin's lymphoma: pooled analysis of three case-control studies in the United States

OBJECTIVES

The objective of this pooled analysis was to examine whether exposure to DDT was associated with the risk of non-Hodgkin's lymphoma among male farmers.

METHODS

Data from three case-control studies from four midwestern states in the United States (Nebraska, Iowa, Minnesota, Kansas) were pooled to carry out analyses of 993 cases and 2918 controls. Information on use of agricultural pesticides and other risk factors was based on interviews. Non-farmers (people who had never lived or worked on a farm) were used as a reference category.

RESULTS

There were 161 cases and 340 controls who reported use of DDT on animals or crops, or on both, yielding an odds ratio (OR) of 1.2 (95% confidence intervals (95% CI) 1.0 to 1.6). Farmers who had used DDT for > or = 15 years had an OR of 1.5 (95% CI 1.0 to 2.3). Adjustment for respondent status and use of other pesticides resulted in slightly reduced ORs. Analyses by the number of days of use a year was limited to the Nebraska data. The most notable increase was found among farmers who used DDT for > or = 5 days a year (OR 2.6, 95% CI 1.1 to 5.9); however, additional adjustment for use of organophosphates, phenoxyacetic acids, and the individual pesticides lindane, malathion, and atrazine reduced the ORs to 1.0, 0.9, 1.1, 1.6, and 1.9 respectively.

CONCLUSIONS

No strong consistent evidence was found for an association between exposure to DDT and risk of non-Hodgkin's lymphoma. It seems that the excess risk initially found may be explained by use of other pesticides.