title: Prostate cancer and toxicity from critical use exemptions of methyl bromide: environmental protection helps protect against human health risks.
abstract: BACKGROUND
  Although ozone-depleting methyl bromide was destined for phase-out by 2005, it is still widely applied as a consequence of various critical-use-exemptions and mandatory international regulations aiming to restrict the spread of pests and alien species (e.g. in globalized transport and storage). The withdrawal of methyl bromide because of its environmental risk could fortuitously help in the containment of its human toxicity.
  
  
  METHODS
  We performed a systematic review of the literature, including in vitro toxicological and epidemiological studies of occupational and community exposure to the halogenated hydrocarbon pesticide methyl bromide. We focused on toxic (especially chronic) or carcinogenic effects from the use of methyl bromide, on biomonitoring data and reference values. Eligible epidemiological studies were subjected to meta-analysis.
  
  
  RESULTS
  Out of the 542 peer reviewed publications between 1990-2011, we found only 91 referring to toxicity of methyl bromide and 29 using the term "carcinogenic", "neoplastic" or "mutagenic". Several studies provide new additional data pertaining to the mechanistic aspects of methyl bromide toxicity. Few studies have performed a detailed exposure assessment including biomonitoring. Three evaluated epidemiological studies assessed a possible association between cancer and methyl bromide. Overall, exposure to methyl bromide is associated with an increased risk of prostate cancer OR, 1.21; 95% CI (0,98-1.49), P = 0.076. Two epidemiological studies have analyzed environmental, non-occupational exposure to methyl bromide providing evidence for its health risk to the general public. None of the epidemiological studies addressed its use as a fumigant in freight containers, although recent field and case reports do refer to its toxic effects associated with its use in shipping and storage.
  
  
  CONCLUSIONS
  Both the epidemiological evidence and toxicological data suggest a possible link between methyl bromide exposure and serious health problems, including prostate cancer risk from occupational and community exposure. The environmental risks of methyl bromide are not in doubt, but also its health risks, especially for genetically predisposed subjects, should not be underestimated.
authors.affiliation: Division of Occupational Toxicology and Immunology, Institute for Occupational and Maritime Medicine (ZfAM), Medical Faculty, University of Hamburg, University Medical Center, Hamburg, Germany. L.Budnik@uke.uni-hamburg.de
authors.forename: Lygia T
authors.initials: LT
authors.lastname: Budnik
authors.forename: Stefan
authors.initials: S
authors.lastname: Kloth
authors.forename: Marcial
authors.initials: M
authors.lastname: Velasco-Garrido
authors.forename: Xaver
authors.initials: X
authors.lastname: Baur
mesh_terms: D003247:Conservation of Natural Resources; D004781:Environmental Exposure; D006801:Humans; D006842:Hydrocarbons, Brominated / Q000633:toxicity*; D008297:Male; D016273:Occupational Exposure; D010575:Pesticides / Q000633:toxicity*; D011471:Prostatic Neoplasms / Q000139:chemically induced* / Q000453:epidemiology; D018570:Risk Assessment
chemical_list: D006842:Hydrocarbons, Brominated; D010575:Pesticides; C005218:methyl bromide