title: Pesticide exposure and lymphohaematopoietic cancers: a case-control study in an agricultural region (Larissa, Thessaly, Greece).
abstract: BACKGROUND
  The causality of lymphohaematopoietic cancers (LHC) is multifactorial and studies investigating the association between chemical exposure and LHC have produced variable results. The aim of this study was to investigate the relationships between exposure to pesticides and LHC in an agricultural region of Greece.
  
  
  METHODS
  A structured questionnaire was employed in a hospital-based case control study to gather information on demographics, occupation, exposure to pesticides, agricultural practices, family and medical history and smoking. To control for confounders, backward conditional and multinomial logistic regression analyses were used. To assess the dose-response relationship between exposure and disease, the chi-square test for trend was used.
  
  
  RESULTS
  Three hundred and fifty-four (354) histologically confirmed LHC cases diagnosed from 2004 to 2006 and 455 sex- and age-matched controls were included in the study. Pesticide exposure was associated with total LHC cases (OR 1.46, 95% CI 1.05-2.04), myelodysplastic syndrome (MDS) (OR 1.87, 95% CI 1.00-3.51) and leukaemia (OR 2.14, 95% CI 1.09-4.20). A dose-response pattern was observed for total LHC cases (P = 0.004), MDS (P = 0.024) and leukaemia (P = 0.002). Pesticide exposure was independently associated with total LHC cases (OR 1.41, 95% CI 1.00 - 2.00) and leukaemia (OR 2.05, 95% CI 1.02-4.12) after controlling for age, smoking and family history (cancers, LHC and immunological disorders). Smoking during application of pesticides was strongly associated with total LHC cases (OR 3.29, 95% CI 1.81-5.98), MDS (OR 3.67, 95% CI 1.18-12.11), leukaemia (OR 10.15, 95% CI 2.15-65.69) and lymphoma (OR 2.72, 95% CI 1.02-8.00). This association was even stronger for total LHC cases (OR 18.18, 95% CI 2.38-381.17) when eating simultaneously with pesticide application.
  
  
  CONCLUSIONS
  Lymphohaematopoietic cancers were associated with pesticide exposure after controlling for confounders. Smoking and eating during pesticide application were identified as modifying factors increasing the risk for LHC. The poor pesticide work practices identified during this study underline the need for educational campaigns for farmers.
authors.affiliation: Department of Hygiene and Epidemiology, Medical Faculty, University of Thessaly, Larissa, Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Kokouva
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Bitsolas
authors.forename: Georgios M
authors.initials: GM
authors.lastname: Hadjigeorgiou
authors.forename: George
authors.initials: G
authors.lastname: Rachiotis
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Papadoulis
authors.forename: Christos
authors.initials: C
authors.lastname: Hadjichristodoulou
mesh_terms: D000368:Aged; D000382:Agricultural Workers' Diseases / Q000453:epidemiology* / Q000209:etiology; D000383:Agriculture; D000428:Alcohol Drinking / Q000453:epidemiology; D016022:Case-Control Studies; D015986:Confounding Factors, Epidemiologic; D005260:Female; D006115:Greece / Q000453:epidemiology; D019337:Hematologic Neoplasms / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure / Q000009:adverse effects* / Q000706:statistics & numerical data; D010575:Pesticides / Q000009:adverse effects*; D012907:Smoking / Q000453:epidemiology; D011795:Surveys and Questionnaires
chemical_list: D010575:Pesticides