ObjectiveWe reviewed epidemiologic evidence related to occupational pesticide exposures and cancer incidence in the Agricultural Health Study (AHS) cohort.Data sourcesStudies were identified from the AHS publication list available at http://aghealth.nci.nih.gov as well as through a Medline/PubMed database search in March 2009. We also examined citation lists. Findings related to lifetime-days and/or intensity-weighted lifetime-days of pesticide use are the primary focus of this review, because these measures allow for the evaluation of potential exposure–response relationships.Data synthesisWe reviewed 28 studies; most of the 32 pesticides examined were not strongly associated with cancer incidence in pesticide applicators. Increased rate ratios (or odds ratios) and positive exposure–response patterns were reported for 12 pesticides currently registered in Canada and/or the United States (alachlor, aldicarb, carbaryl, chlorpyrifos, diazinon, dicamba, S-ethyl-N,N-dipropylthiocarbamate, imazethapyr, metolachlor, pendimethalin, permethrin, trifluralin). However, estimates of association for specific cancers were often imprecise because of small numbers of exposed cases, and clear monotonic exposure–response patterns were not always apparent. Exposure misclassification is also a concern in the AHS and may limit the analysis of exposure–response patterns. Epidemiologic evidence outside the AHS remains limited with respect to most of the observed associations, but animal toxicity data support the biological plausibility of relationships observed for alachlor, carbaryl, metolachlor, pendimethalin, permethrin, and trifluralin.ConclusionsContinued follow-up is needed to clarify associations reported to date. In particular, further evaluation of registered pesticides is warranted.
Revisão sobre a exposição aos pesticidas e a incidência de câncer em estudo de coorte da saúde dos agricultoresResumo Nós revisamos evidências epidemioló-gicas relacionadas à exposição ocupacional a pesticidas e à incidência de câncer no Estudo da Saú-de Agrícola (AHS). Descobertas relacionadas com a vida-dia e / ou intensidade do tempo de vidadia do uso de agrotóxicos são o foco principal desta revisão, porque estas medidas permitem a avaliação do potencial das relações de exposição-resposta. A maioria dos 32 pesticidas examinados não foram fortemente associados à incidência de cân-cer em aplicadores de pesticidas. Um aumento da taxa e padrões de resposta-exposição positivos foram reportados em 12 pesticidas registrados atualmente nos Estados Unidos e Canadá. A classificação de exposição incorreta também é uma preocupação para o AHS e pode limitar a análise dos padrões de resposta-exposição. É necessário um acompanhamento contínuo para clarificar as associações reportadas até hoje. Em particular, é necessária uma avaliação mais profunda dos pesticidas registrados. Palavras-chave Estudo de saúde agrícola, Cân-cer, Pesticidas, Revisão Abstract We reviewed epidemiologic evidence related to occupational pesticide exposures and cancer incidence in the Agricultural Health Study (AHS) cohort. Studies were identified from the AHS publication list available on a Medline/ PubMed database search in March 2009. Findings related to lifetime-days and/or intensityweighted lifetime-days of pesticide use are the primary focus of this review, because these measures allow for the evaluation of potential exposure-response relationships. Most of the 32 pesticides examined were not strongly associated with cancer incidence in pesticide applicators. Increased rate ratios and positive exposure-response patterns were reported for 12 pesticides currently registered in Canada and/or the United States. Exposure misclassification is also a concern in the AHS and may limit the analysis of exposureresponse patterns. Epidemiologic evidence outside the AHS remains limited with respect to most of the observed associations, but animal toxicity data support the biological plausibility of relationships observed six pesticides. Continued follow-up is needed to clarify associations reported to date. In particular, further evaluation of registered pesticides is warranted.
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