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Lymphoma risk and occupational exposure to pesticides: results of the Epilymph study
  1. Pierluigi Cocco1,
  2. Giannina Satta1,
  3. Stefania Dubois1,
  4. Claudia Pili1,
  5. Michela Pilleri1,
  6. Mariagrazia Zucca2,
  7. Andrea Martine ‘t Mannetje3,
  8. Nikolaus Becker4,
  9. Yolanda Benavente5,
  10. Silvia de Sanjosé5,13,
  11. Lenka Foretova6,
  12. Anthony Staines7,
  13. Marc Maynadié8,
  14. Alexandra Nieters9,
  15. Paul Brennan10,
  16. Lucia Miligi11,
  17. Maria Grazia Ennas2,
  18. Paolo Boffetta12,14
  1. 1Department of Public Health, Clinical and Molecular Medicine, Occupational Health Section, University of Cagliari, Monserrato, Italy
  2. 2Department of Biomedical Sciences, University of Cagliari, Monserrato, Italy
  3. 3Centre for Public Health Research, Massey University, Wellington, New Zealand
  4. 4German Cancer Research Center, Heidelberg, Germany
  5. 5Unit of Infections and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology, Hospitalet de Llobregat, Spain
  6. 6Department of Cancer Epidemiology and Genetics, Masaryk Memorial Cancer Institute, Brno, Czech Republic
  7. 7School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
  8. 8Dijon University Hospital, Dijon, France
  9. 9Centre of Chronic Immunodeficiency, University of Freiburg, Freiburg, Germany
  10. 10International Agency for Research on Cancer, Lyon, France
  11. 11ISPO Cancer Prevention and Research Institute, Florence, Italy
  12. 12The Tisch Cancer Institute and Institute for Translational Epidemiology, Mount Sinai School of Medicine, New York, New York, USA
  13. 13Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain
  14. 14International Prevention Research Institute, Lyon, France
  1. Correspondence to Professor Pierluigi Cocco, Department of Public Health, Occupational Health Section, University of Cagliari, Asse Didattico – Policlinico Universitario, SS 554, km 4,500, 09042 Monserrato (Cagliari), Italy; coccop{at}


Objectives We investigated the role of occupational exposure to specific groups of agrochemicals in the aetiology of lymphoma overall, B cell lymphoma and its most prevalent subtypes.

Methods In 1998–2003, 2348 incident lymphoma cases and 2462 controls were recruited to the EPILYMPH case-control study in six European countries. A detailed occupational history was collected in cases and controls. Job modules were applied for farm work including specific questions on type of crop, farm size, pests being treated, type and schedule of pesticide use. In each study centre, industrial hygienists and occupational experts assessed exposure to specific groups of pesticides and individual compounds with the aid of agronomists. We calculated the OR and its 95% CI associated with lymphoma and the most prevalent lymphoma subtypes with unconditional logistic regression, adjusting for age, gender, education and centre.

Results Risk of lymphoma overall, and B cell lymphoma was not elevated, and risk of chronic lymphocytic leukaemia (CLL) was elevated amongst those ever exposed to inorganic (OR=1.6, 95% CI 1.0 to 2.5) and organic pesticides (OR=1.5, 95% CI 1.0 to 2.1). CLL risk was highest amongst those ever exposed to organophosphates (OR=2.7, 95% CI 1.2 to 6.0). Restricting the analysis to subjects most likely exposed, no association was observed between pesticide use and risk of B cell lymphoma.

Conclusions Our results provide limited support to the hypothesis of an increase in risk of specific lymphoma subtypes associated with exposure to pesticides.

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