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Cancer Risk Among Farmers in the Province of Vercelli

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Cancer Risk Among Farmers in the Province of Vercelli Cancer risk among farmers in the Province of VercelliAnn Ig (Italy) 2014; 26: 255-263 doi:10.7416/ai.2014.1983255 Cancer risk among farmers in the Province of Vercelli (Italy) from 2002 to 2005: an ecological study C. Salerno*, S. Sacco**, M. Panella*, P. Berchialla***, K. Vanhaecht****, L.A. Palin* Key words: Farmers, pesticides, cancer risk, Province of Vercelli, Italy Parole chiave: Coltivatori diretti, pesticidi, rischio di cancro, Provincia di Vercelli, Italia Abstract Background: As the link between agricultural pesticides and numerous types of human cancers is well- known. Farmers living in the Province of Vercelli (Italy) were observed to verify if they have a higher cancer risk than the rest of the local employed population. Literature showed a well-known excess of cancer morbidity and mortality in the Province of Vercelli, but only few studies focused on cancer incidence in local farmers. Studying farmers could allow to assess the causal importance respectively of environmental pressure and professional exposure factors in explaining cancer excesses in the above-mentioned area. Materials and methods: The present ecological study considered all cancer new cases recorded among the mean employed population with a range of age from 25 to 84 years and resident in the Province of Vercelli during the four-year period 2002-2005. Cancer odds ratios, by gender and type of cancer, between farmers and non-farmers were calculated. Results: Farmers showed a higher risk for the following tumors: colorectal (OR 2.38, IC95%: 1,76-2,87), leaukaemia (OR 2.65, IC95%:2,12-2,89), digestive system (OR 2.16, IC95% 1,92-2,33), lymphoma OR 2.08, IC95%:1,99-2,23), melanoma (OR 2.90, IC95%:2,54-3,15), myeloma OR 3.55, IC95%:3,23-3,70), pancreas OR 3.38, IC95%:3,14-3,61), lung (1.59, IC95%:1,12-2,38) and kidney (2.70, IC95%:2,41-2,99). Males showed a higher risk for lung cancer, females for liver neoplasm, melanoma and lymphoma. Conclusions: Farmers showed a higher risk for several cancers. Further studies are needed, in order to examine in detail the issue, to encourage the use of personal protective equipment and to promote a more responsible pesticides use. Introduction ever-increasing and ever-changing use in agriculture made pesticide exposure a major Pesticides are considered as one of the environmental health issue in agricultural main factors involved in environmental communities (2). contamination of today’s world (1): their Agricultural pesticides are mostly * Department of Translational Medicine, University of Eastern Piedmont “Amedeo Avogadro”, Novara, Italy ** Department of Brain and Behavioural Sciences, Section of Biostatistics, Neurophysiology and Psychiatry, Unit of Medi- cal Statistics and Computational Genomics - Clinical Epidemiology and Health Planning Laboratory, University of Pavia, Italy *** Department of Clinical and Biological Sciences, University of Turin, Orbassano, Turin, Italy **** Health Services Research Group, School of Public Health, Faculty of Medicine, University of Leuven, Belgium Sources of Funding: None. Conflicts of Interest: the Authors declare that they have no conflict of interest. 256 C. Salerno et al. constituted by toxic, persistent and bio- (1). Several pesticides were associated accumulative substances, which affect the with various cancers: many national and soil physical and chemical properties: they international researches confirmed the link can be found in about the half of fruits between the use of pesticides in agriculture and vegetables eaten every day and they and numerous types of human tumours (see extensively pollute environmental matrices, Table 1 and related references in Appendix) including surface water and groundwater (6, 7). The mechanisms by which pesticides (3). A recent research by the Italian Higher may be linked to cancer in humans are Institute for the Environmental Protection unclear: potential mechanisms include and Research (Istituto Superiore per la oxidative stress, DNA damage, chromosome Protezione e la Ricerca Ambientale, ISPRA) aberration, immune response abnormality found 166 pesticides in Italian water, some of and chronic inflammation (8). which (e.g. atrazine) were forbidden a long In the present ecological study, a specific time ago: 34.4% of surface water samples workers’ group (the farmers) resident in the and 12.3% of groundwater ones resulted to Province of Vercelli (Italy) was observed in be polluted by pesticides whose quantity order to verify if its occupational exposure exceeded law limits for drinking water (4). to pesticides could be linked to cancer Agricultural pesticides are extremely incidence. harmful to environmental health and to The Province of Vercelli has a strong several very useful living organisms (3): it is agricultural tradition: agriculture, especially enough to mention the recent bees murrain based on rice-growing, is the main economic due to neonicotinoid pesticides based on activity in this area. On the other hand, imidacloprid (5). several important sources of environmental Long-term contact to pesticides can harm pressure are concentrated in this small area: human life and can disturb the function a municipal solid waste incinerator near of different organs in the body, including the town of Vercelli and two nuclear sites, nervous, endocrine, immune, reproductive, one near the town of Trino Vercellese (the renal, cardiovascular and respiratory systems nuclear power plant “Enrico Fermi”, active Table 1 - Studies about the association between pesticides exposure and cancer (104 studies were found and 83 were included: complete references are reported in Appendix A) Modified and adapted from: Bassil KL, Vakil C, Sanborn M, Cole DC, Kaur JS, Kerr KJ. Cancer health effects of pesticides: systematic review. Can Fam Physician 2007; 53 (10): 1704-11. Type of cancer No. of No. of Summary of results studies found studies included Lung 4 4 2/4 found positive associations 5/6 found positive associations; Breast 12 6 1 found decreased risk with exposure Pancreatic 3 3 All found positive associations Non-Hodgkin lymphoma 32 27 23/27 found positive associations Leukemia 23 16 14/16 found positive associations Brain 11 11 All found positive associations Prostate 10 8 All found positive associations Stomach 1 1 Found a positive association Ovarian 1 1 Failed to find an association Kidney 7 6 All found positive associations Cancer risk among farmers in the Province of Vercelli (Italy) 257 until 1986) and one near the town of Saluggia cases) recorded in the reference population (deposit of 80% of national nuclear waste). during the four-year period 2002-2005. Literature showed a well-known excess The Province of Vercelli is not served of cancer morbidity and mortality in the by a cancer registry (10). Therefore, to Province of Vercelli (9-13), but only few estimate the number of cases included intra- studies focused on cancer incidence in extra Regional passive mobility, Hospital local farmers and on the possible role of Discharge Forms (Schede di Dimissione their professional exposure to pesticides Ospedaliera, SDO) were used (16). SDOs (14). Studying farmers could allow to also contained information about age, assess the causal importance respectively gender, profession and type of diagnosed of environmental pressure and professional cancer. SDOs were consulted in the Local exposure factors in explaining cancer Health Unit of Vercelli (Azienda Sanitaria morbidity and mortality excesses in the Locale Vercelli, ASL VC) (17). above-mentioned area. Prevalent cases (admissions after the first hospitalization) were identified by consulting the SDOs of ASL VC concerning the period Objectives 2000-2001 and were excluded. Only cancer cases confirmed by the The present research aimed to discover if histopathology report (about 70% of those in a greater number of cancer cases among local the SDOs) were considered. Histopathology farmers could support the hypothesis that this reports were consulted at the Service of specific workers’ group have a higher risk to Pathological Anatomy of ASL VC (17). develop cancer diseases than the rest of the Cancer cases were then divided in cases resident employed population. The Authors recorded in farmers and non-farmers. tried to determine in a preliminary way if their This division was done according to the data were consistent with literature studies profession indicated on SDOs and confirmed (6-8), in order to delve into such results and by patients at hospitalization moment. to validate them with further researches. Patients who did not write their profession were excluded. Profession of patients who self declared Materials and methods farmers in SDOs was verified by consulting data about social security contributions Reference population paid during the period 1965-2005: only In the present ecological study, the patients who paid at least one year of social mean employed population with a range security contributions as farmers were of age from 25 to 84 years and resident in considered. Their occupational history the Province of Vercelli (Piedmont Region, was then controlled: farmers who also paid Italy) during the four-year period 2002-2005 any social security contributions for job was chosen as reference population. Farmers activities associated with higher cancer vs. non-farmers were considered. risk (e.g. textile workers) were excluded. Data were obtained from the Statistics Data about social security contributions Office of the Vercelli Chamber of Commerce were taken from Italian National Institute (15). of Social Security (Istituto Nazionale di Previdenza Sociale, INPS) (18). It was not Cancer cases possible to perform these contributions The present study considered all the first checks for non-farmers because data were hospital admissions for cancer (incident new not available. 258 C. Salerno et al. The Authors decided to use new clinical resident in the Province of Vercelli during cases instead of prevalent ones, in order the four-year period 2002-2005 amounted to to avoid profession redundancy and to be 74,000 workers (42,000 males and 32,000 sure that every worker (and his profession) females). Farmers represented 5,81% of was counted only once.
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