Household Exposure to Pesticides and Risk of Childhood Hematopoietic Malignancies: The ESCALE Study (SFCE)

Jérémie Rudant; Florence Menegaux; Guy Leverger; André Baruchel; Brigitte Nelken; Yves Bertrand; Catherine Patte; Hélène Pacquement; Cécile Vérité; Alain Robert; Gérard Michel; Geneviève Margueritte; Virginie Gandemer; Denis Hémon; Jacqueline Clavel


Environ Health Perspect. 2007;115(12):1787-1793. 

In This Article

Abstract and Introduction

Objectives: We investigated the role of household exposure to pesticides in the etiology of childhood hematopoietic malignancies.
Methods: The national registry-based case-control study ESCALE (Etude sur les cancers de l'enfant) was carried out in France over the period 2003-2004. Population controls were frequency matched with the cases on age and sex. Maternal household use of pesticides during pregnancy and paternal use during pregnancy or childhood were reported by the mothers in a structured telephone questionnaire. Insecticides (used at home, on pets, or for garden crops) , herbicides, and fungicides were distinguished. We estimated odds ratios (ORs) using unconditional regression models closely adjusting for age, sex, degree of urbanization, and type of housing (flat or house).
Results: We included a total of 764 cases of acute leukemia (AL) , 130 of Hodgkin lymphoma (HL) , 166 of non-Hodgkin lymphoma (NHL) , and 1,681 controls. Insecticide use during pregnancy was significantly associated with childhood AL [OR = 2.1 ; 95% confidence interval (CI) , 1.7-2.5], both lymphoblastic and myeloblastic, NHL (OR = 1.8 ; 95% CI, 1.3-2.6) , mainly for Burkitt lymphoma (OR = 2.7 ; 95% CI, 1.6-4.5) , and mixed-cell HL (OR = 4.1 ; 95% CI, 1.4-11.8) , but not nodular sclerosis HL (OR = 1.1 ; 95% CI, 0.6-1.9) . Paternal household use of pesticides was also related to AL (OR = 1.5 ; 95% CI, 1.2-1.8) and NHL (OR = 1.7 ; 95% CI, 1.2-2.6) ; but for AL the relationships did not remain after adjustment for maternal pesticide use during pregnancy.
Conclusion: The study findings strengthen the hypothesis that domestic use of pesticides may play a role in the etiology of childhood hematopoietic malignancies. The consistency of the findings with those of previous studies on AL raises the question of the advisability of preventing pesticide use by pregnant women.

Hematopoietic malignancies are the most common childhood cancers, with world age-standardized incidence rates of 43.1, 6.7, and 8.9 per million children in France for leukemia, Hodgkin lymphoma (HL), and non-Hodgkin lymphoma (NHL), respectively (Clavel et al. 2004). The etiology of those malignancies remains largely unknown. Some epidemiologic studies have suggested that pesticides might increase the risk of childhood hematopoietic malignancies (Daniels et al. 1997; Infante-Rivard and Scott Weichenthal 2007; Jurewicz and Hanke 2006; Nasterlack 2006, 2007; Zahm and Ward 1998). Furthermore, the International Agency for Research on Cancer (IARC) has classified the occupational spraying of insecticides as probably carcinogenic to humans (group 2A); adult lymphoma is one of the main cancers suspected (IARC 1991). Children can be exposed to pesticides in utero or during childhood through their parents' work, domestic use, or the general environment (residues in food, water, air, and soil). It is not clear which sources of pesticide exposure are the most important for children, and household pesticide exposure may be a major exposure for children (Bradman and Whyatt 2005; Grossman 1995). No French survey on household pesticide use is available, but surveys conducted in North America and the United Kingdom reported high rates of household use or storage of pesticides (Adgate et al. 2000; Grey et al. 2006).

This study investigated the relationshipbetween household exposure to pesticides and the risks of childhood acute leukemia (AL), HL, and non-NHL, focusing on intrauterine exposures, using data generated by the French national population-based case-control study, ESCALE (Etude sur les cancers de l'enfant).


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