Association between chronic exposure to pesticides and recorded cases of human malignancy in Gaza Governorates (1990–1999)

https://doi.org/10.1016/S0048-9697(01)00868-3Get rights and content

Abstract

Epidemiological association between chronic exposure to pesticides and recorded cases of human malignancy in Gaza Governorates during the years 1990–1999 was studied. The pesticide usage in Gaza Governorates was recorded in detail. It ranged from 216.9 to 393.3 t from 1990 to 1999, respectively. Banned and extremely hazardous pesticides are identified according to their carcinogenicity, genotoxicity and cytotoxicity. Hospital cases of cancers in men and women were recorded. Each tumor type was grouped according to sex and age group from 0 to >65 years. Total cases recorded in males were 2277, with average annual incidence and age-adjusted rate/100 000 was 53.2 and 96.8 respectively, whereas the total for females was 2458 cases, average annual incidence and age-adjusted rate/100 000 was 59.7 and 105.3, respectively, over the same 10 years. Lung cancer, lymphomas, leukemia, cancers of the urinary bladder, prostate, brain, colon, stomach and liver were the most abundant among males, while breast cancer, leukemia, lymphomas, cancers of the brain, uterus, lung, thyroid gland and liver were the most abundant in females. Statistical analysis using correlation coefficients and P values showed highly significant positive correlations between the type of pesticide and cancer incidence for male, female and both sexes. Correlation coefficients and P values, respectively, for both sexes were: 0.992 and 0.000 for insecticides; 0.952 and 0.000 for fungicides; 0.812 and 0.004 for herbicides; 0.925 and 0.000 for nematicides; 0.992 and 0.000 for others; and 0.994 and 0.000 for all types of pesticides. In the densely populated agricultural areas, it is not possible to separate or differentiate between occupational and general public exposure. Consequently, the introduction of and heavy use and misuse of pesticides and other toxic substances in the Gaza environment is suspected to correlate with the growing incidence of cancer. Precise determination of the effects of chronic exposure is, therefore, urgently needed. Future legislation to stop and regulate the use of extremely hazardous compounds will be essential. Continuous records for chronic diseases and cancers are also required for future follow-ups and periodical risk-assessment evaluations. Hence, further epidemiological studies are needed with detailed exposure assessment for individual pesticides, taking measures to reduce risk into consideration.

Introduction

Two thirds of Gaza Governorates (total 365 km2) is an arable area with 1 000 000 Palestinian inhabitants living and working, mostly in agriculture (Safi, 1998). In this densely populated area, more than 250 t of formulated pesticides, in addition to 900 t of methyl bromide, are used annually to protect the major crops, including vegetables, citrus, olives and grapes (Safi, 1995, Safi et al., 1993). Farmers engaged in spraying, dusting or handling pesticides are exposed to direct occupational-exposure hazard. In addition, indirect environmental pollution hazards are increasing as a result of pesticide residues being transferred and accumulated across the food chain. Levels of residues of the organochlorine insecticides and non-insecticidal hazardous pollutants, including dioxins, dibenzofurans and PCBs, were monitored in the Gaza environment and surroundings (Richter and Safi, 1997, Richter et al., 1998, Schecter et al., 1997a, Schecter et al., 1997b). The risk of exposure to these residues in the general population is highly intensified when these residues are from highly persistent banned pesticides, as has been documented (Safi et al., 1993). The increased risk was demonstrated when appreciable residue levels were detected in mothers’ milk. Benzene hexachloride concentration in breast milk in Israeli mothers was averaged as 2500 μg/kg (ppb), 800-fold greater than the level of 3 ppb in the USA during the same year (Richter and Safi, 1997). The authors indicated that, after organochlorine pesticides had been banned in the Western World, Israel followed suit, with the exception of endosulfan, which was sprayed on cotton, and DDT, which continued to be used against sand fly in the Negev. Besides, organochlorine pesticides continued to be the heavily used in the occupied West Bank and Gaza Governorates. This is why the need for developing a program combining surveillance and severe restrictions regarding the use of these proven carcinogenic organochlorine pesticides has been stressed (Safi et al., 1993).

Previous studies showed increased incidence of cancer in farmers and agricultural workers related to their occupational background exposure to organochlorine and other pesticides. Greenhouse exposure is expected to be of higher risk, due to the relatively closed system and the frequency of pesticide applications (Illing, 1997). Higher rates of cancers (breast and others) were recorded among farmers, and even the general population, in Mexico, probably due to the continuous exposure to organochlorine pesticides and other industrial pollutants (Lopez-Carrillo et al., 1996, Lopez-Carrillo et al., 1997). In Hawaii, higher rates of breast cancer were recorded due to exposure to organochlorine pollutants (DDTs and others), which were proved to act as endocrine disrupters (Allem et al., 1997, El-Sebae and Safi, 1998). Significant increased pancreatic cancer risk was found after exposure to chloropropulate and DDT (Fryzek et al., 1997). A positive association between prostate cancer and farming was attributed to the exposure to endocrine disrupters, mainly organochlorine pesticides (Keller-Byrne et al., 1997). Investigation of cancer incidence and mortality around a pesticide factory in Britain revealed an excess of skin melanoma, lung, stomach, pancreas, and prostate cancers (Wikinson et al., 1997).

Recently, several published reports suggested an association between exposure to pesticides and different types of human cancer. Frequent occupational exposure to pesticides or home pesticide use was more strongly associated with childhood leukemia, neuroblastoma, Wilm's tumor, soft-tissue sarcoma, Ewing's sarcoma, non-Hodgkin's lymphoma (NHL) and cancers of the brain, colon, rectum, and testis (Daniels et al., 1997, Zahm and Ward, 1998). Exposure to herbicides in total, including phenoxyacetic acids, resulted in increased risk for NHL (Hardell and Eriksson, 1999) and the risk of soft-tissue sarcoma (Lynge, 1998). Fungicides also increased the risk for NHL when combined. Occupational exposure to specific chemicals (pesticides and others) plays an important role in the development of NHL in Canada (Mao et al., 2000) and the USA (Baris and Zhahm, 2000). Workers in the developing countries suffer from anemia and many endemic infectious diseases, and therefore will be highly susceptible to cancer onset. Records from Al-Shifa Hospital at Gaza during the period 1990–1994 showed that breast cancer cases accounted for 34% of all cancer cases in women (Richter and Safi, 1997). This is why the present epidemiological study was devoted to accomplish a comprehensive survey of all the reported hospital cases of malignancy in Gaza Governorates during the period 1990–1999.

Section snippets

Materials and methods

All records from Al-Shifa hospital (all recorded cases of human malignancy in public hospitals of Gaza Governorates are registered at Al-Shifa hospital) in Gaza were used as a database in a computerized program to generate the required epidemiological data. Sex, age and type of cancer for each patient were stored and followed up. Relying on clinical diagnosis, each cancer incidence was defined and grouped. All the human subjects (males and females) belong to the general population inhabiting

Results

The clinical data collected are presented in Table 1, Table 2, where all incidences of cancers were recorded for all ages of both males and females. A total of 25 different clinical types of malignancy were covered for a series of age-group intervals, starting from 0 up to >65 years old. The total cancer incidence registered for the 10 successive years 1990–1999 is summarized and tabulated in Table 1, Table 2. The overall total of annual cancer incidence/100 000 in both sexes was almost

Discussion

From Table 1, the frequency of the different types of cancer in males can be arranged in the following descending order: lung and other respiratory; lymphomas; leukemia; urinary bladder; prostate; brain; colon; stomach and small intestine; larynx; liver; pancreas; others and unknown; rectum; skin; lip, oral cavity and pharynx; kidney; bone; soft tissue; thyroid gland; testis and penis; esophagus; gall bladder; endocrine gland; breast; and eye. Also, statistical significant correlations between

Acknowledgements

I would like to acknowledge Prof Dr A.H. Al-Sebae, Professor of Pesticides Chemistry and Toxicology, for his critical reading of and comments on the manuscript.

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