title: Occupational exposure to pesticides and bladder cancer risk.
abstract: In the developed world, occupational exposures are a leading cause of bladder cancer. A few studies have suggested a link between pesticide exposures among agricultural populations and bladder cancer.
  
  
  
  We used data from the Agricultural Health Study, a prospective cohort study which includes 57 310 pesticide applicators with detailed information on pesticide use, to evaluate the association between pesticides and bladder cancer. We used Poisson regression to calculate rate ratios (RRs) and 95% confidence intervals (CIs) to estimate the association between each of 65 pesticides and 321 incident bladder cancer cases which accrued over the course of follow-up (1993-2011), adjusting for lifestyle and demographic and non-pesticide farm-related exposures, including those previously linked to bladder cancer. We conducted additional analyses stratified by smoking status (never, former, current).
  
  
  
  We observed associations with bladder cancer risk for two imidazolinone herbicides, imazethapyr and imazaquin, which are aromatic amines. Ever use of imazaquin (RR = 1.54, 95% CI: 1.05, 2.26) was associated with increased risk whereas the excess risk among users of imazethapyr was evident among never smokers (RR in highest quartile vs non-exposed = 3.03, 95% CI: 1.46, 6.29, P-interaction = 0.005). We also observed increased risks overall and among never smokers for use of several chlorinated pesticides including chlorophenoxy herbicides and organochlorine insecticides.
  
  
  
  Several associations between specific pesticides and bladder cancer risk were observed, many of which were stronger among never smokers, suggesting that possible risk factors for bladder cancer may be more readily detectable in those unexposed to potent risk factors like tobacco smoke.
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA, KoutrosS@mail.nih.gov.
authors.forename: Stella
authors.initials: S
authors.lastname: Koutros
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Debra T
authors.initials: DT
authors.lastname: Silverman
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Michael Cr
authors.initials: MC
authors.lastname: Alavanja
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Andreotti
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Catherine C
authors.initials: CC
authors.lastname: Lerro
authors.affiliation: Seattle Children's Hospital Research Institute, University of Washington School of Medicine, Department of Pediatrics, Seattle, WA, USA.
authors.forename: Sonya
authors.initials: S
authors.lastname: Heltshe
authors.affiliation: College of Public Health, University of Iowa, Iowa City, IA, USA and.
authors.forename: Charles F
authors.initials: CF
authors.lastname: Lynch
authors.affiliation: Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, USA.
authors.forename: Dale P
authors.initials: DP
authors.lastname: Sandler
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Aaron
authors.initials: A
authors.lastname: Blair
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Laura E
authors.initials: LE
authors.lastname: Beane Freeman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000072480:Farms; D006801:Humans; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure / Q000009:adverse effects*; D010575:Pesticides / Q000009:adverse effects* / Q000145:classification; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D001749:Urinary Bladder Neoplasms / Q000139:chemically induced / Q000453:epidemiology*
chemical_list: D010575:Pesticides
keywords: Pesticides; bladder cancer; epidemiology