A systematic review of myeloid leukemias and occupational pesticide exposure
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To conduct a systematic review and meta-analyses of published studies examining the association between myeloid leukemias (ML) and occupational pesticide exposure.
Studies were identified from a MEDLINE search through 31 May 2006 and from the reference lists of identified publications. Studies were summarized and evaluated for publication bias. Relative risk estimates for ML were extracted from 17 cohort and 16 case–control studies published between 1979 and 2005. Fixed- or random-effect meta-analysis models were used depending on the presence of heterogeneity between studies. Separate analyses were conducted after stratification for study design, occupational group, ML subtype or gender.
The overall meta-rate ratio estimate (meta-RR) for the cohort studies was 1.21 (95% confidence interval [CI] 0.99–1.48). Substantial heterogeneity existed among cohort studies (p = 1.064 × 10−5), mainly reflecting the varying occupational categories examined. The meta-RR was 6.32 (95% CI: 1.90–21.01) for manufacturing workers and 2.14 (95% CI: 1.39–3.31) for pesticide applicators. After stratification of cohort studies by specific ML subtype, an increased risk of acute myeloid leukemia (AML) was found (meta-RR: 1.55; 95% CI: 1.02–2.34). No significant heterogeneity was detected among case–control studies and an increased risk of chronic myeloid leukemia (CML) was found among men (meta-RR: 1.39; 95% CI: 1.03–1.88) and farmers or agricultural workers (meta-RR: 1.38; 95% CI: 1.06–1.79).
The strongest evidence of an increased risk of ML comes from manufacturing workers and pesticide applicators. Further studies will be needed to correlate reliable exposure data within these specific occupational groups with well-defined subtypes of leukemia to refine this assessment.
KeywordsMeta-analysis Myeloid leukemia Pesticides Occupation Risk
- 1.Lee GR, Foerster J, Lukens J, Paraskevas F, Greer JP, Rodgers GM (1999) Wintrobe’s clinical hematology (Hardcover), 10th edn. Lippincott Williams & Wilkins, 2764 ppGoogle Scholar
- 2.Beers MH, Berkow R (1999) Leukemias. The Merck manual of diagnosis and therapy, 17th edn. Merck & Co. Inc., Merck Research Laboratories, Whitehouse Station, NJ, USAGoogle Scholar
- 6.Linet MS, Cartwright RA (1996) The leukemias. In: Schottenfeld D, Fraumeni JF Jr (eds) Cancer epidemiology and prevention, 2nd edn. Oxford University Press, NewYork, NY, pp 841–879Google Scholar
- 11.International Classification of Disease (1989). 10th revision. http://www.wolfbane.com/icd/index.html
- 12.Greenberg PL, Young NS, Gattermann N (2002) Myelodysplastic syndromes. Hematology (Am Soc Hematol Educ Program) 136–161Google Scholar
- 13.Breslow NE, Day NE (1987) Statistical methods in cancer research: the design and analysis of cohort studies. IARC scientific publications vol II, no 82. International Agency for Research on Cancer, LyonGoogle Scholar
- 15.Clarke M, Oxman AD (eds) (2000) Cochrane reviewers’ handbook 4.1 (updated June 2000). In: Review Manager (RevMan) (computer program). Version 4.1. The Cochrane Collaboration 2000, Oxford, EnglandGoogle Scholar
- 17.Greenland S (1998) Meta-analysis. In: Rothman KJ, Greenland S (eds) Modern epidemiology, 2nd edn. Lippincott-Raven, Philadelphia, pp 643–673Google Scholar
- 41.Bjork J, Albin M, Welinder H, Tinnerberg H, Mauritzson N, Kauppinen T, Stromberg U, Johansson B, Billstrom R, Mikoczy Z, Ahlgren T, Nilsson PG, Mitelman F, Hagmar L (2001) Are occupational, hobby, or lifestyle exposures associated with Philadelphia chromosome positive chronic myeloid leukaemia? Occup Environ Med 58:722–727PubMedCrossRefGoogle Scholar
- 59.Hoppin JA (2005) Integrating exposure measurements into epidemiologic studies in agriculture. Scand J Work Environ Health 31(suppl 1):110–114Google Scholar