Cancer Causes & Control

, Volume 28, Issue 3, pp 177–190 | Cite as

Pesticide exposure and liver cancer: a review

  • Trang VoPhamEmail author
  • Kimberly A. Bertrand
  • Jaime E. Hart
  • Francine Laden
  • Maria M. Brooks
  • Jian-Min Yuan
  • Evelyn O. Talbott
  • Darren Ruddell
  • Chung-Chou H. Chang
  • Joel L. Weissfeld
Review article



To review the epidemiologic literature examining pesticide exposure and liver cancer incidence.


A search of the MEDLINE and Embase databases was conducted in October 2015. Eligibility criteria included examining hepatocellular carcinoma (HCC) or primary liver cancer, pesticides as an exposure of interest, and individual-level incidence. The review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.


Forty-eight papers were assessed for eligibility and 15 studies were included in the review. The majority of studies were conducted in China and Egypt (n = 8), used a case–control design (n = 14), and examined HCC (n = 14). Most studies showed no association between self-reported and/or occupational exposure to pesticides and liver cancer risk. Six studies demonstrated statistically significant positive associations, including three biomarker-based studies (two using pre-diagnostic sera) that reported higher serum levels of dichlorodiphenyltrichloroethane (DDT) were associated with increased HCC risk. Studies indirectly measuring pesticide exposure using self-reported exposure, occupation, job-exposure matrices, or geographic residence demonstrated inconsistent results. These studies were limited by exposure assessment methods, lack of confounder information, minimal case confirmation, selection bias, and/or over-adjustment.


There is mixed evidence suggesting a possible association between specific pesticides and HCC risk, with the strongest evidence observed in biomarker-based studies. In particular, organochlorine pesticides, including DDT, may increase HCC risk. Future research should focus on improved pesticide exposure assessment methods, potentially incorporating multiple approaches including biomonitoring while considering the chemicals of interest, historical exposure to address latency periods, and examining specific chemicals and exposure pathways.


Liver cancer Hepatocellular carcinoma Pesticides Epidemiology Review 



The authors declare no conflicts of interest. Dr. VoPham is supported by the National Institutes of Health (NIH) National Cancer Institute (NCI) Training Program in Cancer Epidemiology (T32 CA009001). Dr. Hart is supported by the NIH National Institute of Environmental Health Sciences (NIEHS) P30 ES000002.


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Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  • Trang VoPham
    • 1
    • 2
    Email author
  • Kimberly A. Bertrand
    • 3
  • Jaime E. Hart
    • 2
    • 4
  • Francine Laden
    • 1
    • 2
    • 4
  • Maria M. Brooks
    • 5
  • Jian-Min Yuan
    • 5
    • 6
  • Evelyn O. Talbott
    • 5
  • Darren Ruddell
    • 7
  • Chung-Chou H. Chang
    • 8
  • Joel L. Weissfeld
    • 5
    • 6
  1. 1.Department of EpidemiologyHarvard T. H. Chan School of Public HealthBostonUSA
  2. 2.Channing Division of Network MedicineBrigham and Women’s Hospital and Harvard Medical SchoolBostonUSA
  3. 3.Slone Epidemiology CenterBoston UniversityBostonUSA
  4. 4.Department of Environmental HealthHarvard T. H. Chan School of Public HealthBostonUSA
  5. 5.Department of Epidemiology, Graduate School of Public HealthUniversity of PittsburghPittsburghUSA
  6. 6.Division of Cancer Control and Population SciencesUniversity of Pittsburgh Cancer InstitutePittsburghUSA
  7. 7.Spatial Sciences InstituteUniversity of Southern CaliforniaLos AngelesUSA
  8. 8.Division of General Internal MedicineUniversity of Pittsburgh School of MedicinePittsburghUSA

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