Objectives Farmers are considered at lower risk of lung cancer. However, specific tasks can expose them to hazardous air contaminants such as pesticides, diesel exhaust and mineral dust. This study aimed to assess the associations between various crops and related tasks and the risk of lung cancer, overall and by histological subtypes.
Methods AGRIculture and CANcer is a prospective French cohort of individuals affiliated to the agricultural health insurance scheme. Incident lung cancers (n=897) were identified by cancer registries from enrolment (2005–2007) to 2013. Data on crop and livestock exposure during lifetime were obtained from the enrolment questionnaire. We used a Cox model with attained age as timescale, adjusted for gender, smoking history and exposure to cattle and horses. Effects of duration and surface were assessed and analyses stratified on gender and smoking status were performed.
Results Winegrowers were at higher risk of adenocarcinoma (HR=1.27 (95% CI 0.94 to 1.72)). We also found an association between pea growing and small cell lung cancer: significant effect of duration (ptrend=0.04) and the suggestion of a surface–effect relationship (ptrend=0.06); increased risk (HR=2.38 (95% CI 1.07 to 5.28)) for pesticide users; and significant effect of duration (ptrend=0.01) for harvesters. The risk of squamous cell carcinoma was increased for sunflower growing (HR=1.59 (95% CI 0.97 to 2.62), fruit-tree pruning (HR=1.44 (95% CI 0.92 to 2.27)) and pesticide use on beets (HR=1.47 (95% CI 0.92 to 2.34)). Corn and/or wheat/barley growers were at lower risk of lung cancer.
Conclusions Our results suggest associations between lung cancer and several crop-related tasks, even if we cannot rule out some chance findings due to multiple comparisons.
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Contributors PL supervised the study. MB performed analyses and wrote the manuscript’s draft. PL, IB, ST, CL and BCG provided methodological help. All authors critically reviewed the manuscript.
Funding The authors would like to thank the Ligue Contre le Cancer (Nationale and Comités du Calvados, de l’Orne, de la Manche, du Maine et Loire et de Paris), the Mutualité Sociale Agricole (caisse centrale et caisses des Alpes du Nord, de l’Alsace, de Bourgogne, des Côtes Normandes, de Franche Comté, de Gironde, de Loire-Atlantique Vendée, de Midi Pyrénées Nord, de la Picardie), the Fondation de France (Mr Edouard Serres), the Agence Nationale de Sécurité Sanitaire de l’Alimentation, de l’Environnement et du Travail (within the call for projects 2005, 2006 and 2010 of the programme ’Environnement Santé Travail' of ANSES, with funding from l’ONEMA in support of the Ecophyto 2018 plan), the Institut National du Cancer, the Association pour la Recherche sur le Cancer (grant number ARC 02-010), the Institut National de Médecine Agricole, the Conseil Régional de Basse Normandie and the François Baclesse Comprehensive Cancer Centre, which funded this work.
Competing interests None declared.
Patient consent Obtained.
Ethics approval CCTIRS/CNIL.
Provenance and peer review Not commissioned; externally peer reviewed.
Collaborators Members of the Agrican group: Arveux P (Registre des Cancers du Sein et Cancers Gynécologiques de Côte d’Or), Bara S (Registre Général des Cancers de la Manche), Bouvier AM (Registre Bourguignon des cancers Digestifs), Busquet T (MSA Gironde), Colonna M (Registre Général des Cancers de l’Isère), Coureau G (Registre Général des Cancers de la Gironde), Delanoé M (MSA Midi Pyrénées Nord), Grosclaude P (Registre Général des Cancers du Tarn), Guizard AV (Registre Général des Tumeurs du Calvados), Herbrecht P (MSA Alsace), Laplante JJ (MSA Franche Comté), Lapotre-Ledoux B (Registre Général des Cancers de la Somme), Launoy G (Registre des tumeurs digestives du Calvados), Lenoir D (MSA Bourgogne), Marrer E (Registre Général des cancers du Haut-Rhin), Marcotullio E (Caisse Centrale de la MSA), Maynadié M (Registre des Hémopathies Malignes Côte d’Or), Molinié F (Registre Général de la Loire-Atlantique et Vendée), Monnereau A (Registre des Hémopathies Malignes de la Gironde), Paumier A (MSA Picardie), Pouzet P (MSA Côtes Normandes), Thibaudier JM (MSA Alpes du Nord), Troussard X (Registre Régional des Hémopathies Malignes de Basse Normandie), Velten M (Registre Général des Cancers du Bas-Rhin), Wavelet E (MSA Loire Atlantique-Vendée), Woronoff AS (Registre général des tumeurs du Doubs).