title: Non-hodgkin lymphoma risk and insecticide, fungicide and fumigant use in the agricultural health study.
abstract: 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.
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, United States of America.
authors.forename: Michael C R
authors.initials: MC
authors.lastname: Alavanja
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, United States of America.
authors.forename: Jonathan N
authors.initials: JN
authors.lastname: Hofmann
authors.affiliation: College of Public Health, University of Iowa, Iowa City, Iowa, United States of America.
authors.forename: Charles F
authors.initials: CF
authors.lastname: Lynch
authors.affiliation: National Institute for Occupational Safety and Health, Cincinnati, Ohio, United States of America.
authors.forename: Cynthia J
authors.initials: CJ
authors.lastname: Hines
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, United States of America.
authors.forename: Kathryn H
authors.initials: KH
authors.lastname: Barry
authors.affiliation: IMS, Inc, Calverton, Maryland, United States of America.
authors.forename: Joseph
authors.initials: J
authors.lastname: Barker
authors.affiliation: IMS, Inc, Calverton, Maryland, United States of America.
authors.forename: Dennis W
authors.initials: DW
authors.lastname: Buckman
authors.affiliation: National Exposure Research Laboratory, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina, United States of America.
authors.forename: Kent
authors.initials: K
authors.lastname: Thomas
authors.affiliation: Epidemiology Branch, National Institute for Environmental Health Sciences, Research Triangle Park, North Carolina, United States of America.
authors.forename: Dale P
authors.initials: DP
authors.lastname: Sandler
authors.affiliation: Epidemiology Branch, National Institute for Environmental Health Sciences, Research Triangle Park, North Carolina, United States of America.
authors.forename: Jane A
authors.initials: JA
authors.lastname: Hoppin
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, United States of America.
authors.forename: Stella
authors.initials: S
authors.lastname: Koutros
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, United States of America.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Andreotti
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, United States of America.
authors.forename: Jay H
authors.initials: JH
authors.lastname: Lubin
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, United States of America.
authors.forename: Aaron
authors.initials: A
authors.lastname: Blair
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, United States of America.
authors.forename: Laura E
authors.initials: LE
authors.lastname: Beane Freeman
mesh_terms: D000328:Adult; D000368:Aged; D000382:Agricultural Workers' Diseases / Q000139:chemically induced / Q000453:epidemiology*; D000383:Agriculture; D005659:Fungicides, Industrial / Q000633:toxicity; D006801:Humans; D006843:Hydrocarbons, Chlorinated / Q000633:toxicity; D007306:Insecticides / Q000633:toxicity; D007484:Iowa; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000139:chemically induced / Q000453:epidemiology* / Q000473:pathology; D008228:Lymphoma, Non-Hodgkin / Q000139:chemically induced / Q000453:epidemiology* / Q000473:pathology; D008875:Middle Aged; D009101:Multiple Myeloma / Q000139:chemically induced / Q000453:epidemiology* / Q000473:pathology; D009657:North Carolina; D012307:Risk Factors
chemical_list: D005659:Fungicides, Industrial; D006843:Hydrocarbons, Chlorinated; D007306:Insecticides; C007792:Fumigant 93