Non-cancer health effects of pesticides: systematic review and implications for family doctors.
OBJECTIVE
To investigate whether there are associations between exposure to pesticides and 4 chronic non-cancer health effects: dermatologic, neurologic, reproductive, and genotoxic effects.


METHODS
We searched PreMedline, MEDLINE, and LILACS using the key word pesticide combined with the term for the specific health effect being searched. Reviewers scanned the references of all articles for additional relevant studies.


METHODS
Studies since 1992 were assessed using structured inclusion and quality-of-methods criteria. Studies scoring <4 on a 7-point global methodologic quality scale were excluded. In total, 124 studies were included. These studies had a mean quality score of 4.88 out of 7.


RESULTS
Strong evidence of association with pesticide exposure was found for all neurologic outcomes, genotoxicity, and 4 of 6 reproductive effects: birth defects, fetal death, altered growth, and other outcomes. Exposure to pesticides generally doubled the level of genetic damage as measured by chromosome aberrations in lymphocytes. Only a few high-quality studies focused on the dermatologic effects of pesticides. In some of these studies, rates of dermatitis were higher among those who had had high exposure to pesticides on the job.


CONCLUSIONS
Evidence from research on humans consistently points to positive associations between pesticide exposure and 3 of the 4 non-cancer health outcomes studied. Physicians have a dual role in educating individual patients about the risks of exposure and in reducing exposure in the community by advocating for restrictions on use of pesticides.
Sanborn
M
M
Chesley Medical Clinic, Box 459, Chesley, ON. msanborn@sbghc.on.ca
Kerr
K J
KJ
Sanin
L H
LH
Cole
D C
DC
Bassil
K L
KL
Vakil
C
C
D000328:Adult; D002648:Child; D004249:DNA Damage; D002658:Developmental Disabilities / Q000139:chemically induced; D004781:Environmental Exposure / Q000009:adverse effects*; D005194:Family Practice; D005260:Female; D005313:Fetal Death / Q000139:chemically induced; D006801:Humans; D007246:Infertility / Q000139:chemically induced; D008297:Male; D009422:Nervous System Diseases / Q000139:chemically induced; D010573:Pesticide Residues / Q000009:adverse effects*; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000139:chemically induced; D012871:Skin Diseases / Q000139:chemically induced
D010573:Pesticide Residues