International Journal of Epidemiology, Vol 28, 365-374, Copyright © 1999 by International Epidemiological Association
C Wesseling, D Antich, C Hogstedt, AC Rodriguez and A Ahlbom
BACKGROUND: This study describes geographical differences in cancer
incidence in Costa Rica, and investigates if some of these differences may
be related to pesticides. METHODS: Data were combined from the cancer
registry (1981-1993), the 1984 population census, the 1984 agricultural
census, and a national pesticide data set. The 81 counties of Costa Rica
were the units for the ecological analyses. Adjacent counties were grouped
into 14 regions (3 urban and 11 rural) with relatively similar
socioeconomic characteristics. County indices for population density and
agricultural variables were constructed and categorized. Differences across
regions and categories were assessed by comparing observed numbers of
incident cases to expected values derived from national rates. Within the
tertile of most rural counties, rate ratios between categories of high and
low pesticide use were calculated. RESULTS: In urban regions, excesses were
observed for lung, colorectal, breast, uterus, ovary, prostate, testis,
kidney, and bladder cancers; and in rural regions for gastric, cervical,
penile, and skin cancers. Skin cancers (lip, melanoma, non-melanocytic skin
and penile cancer) occurred in excess in coffee growing areas with
extensive use of paraquat and lead arsenate. In the most rural subset,
heavy pesticide use was associated with an increase of cancer incidence
overall and at a considerable number of specific sites, including lung
cancer (relative risk [RR] 2.0 for men and 2.6 for women) and all female
hormone-related cancers (RR between 1.3 and 1.8). CONCLUSIONS: Regions and
populations at high risk for specific cancers were identified. Several
hypotheses for associations between pesticides and cancer emerged. The
findings call for studies at the individual level.
ARTICLES
Geographical differences of cancer incidence in Costa Rica in relation to environmental and occupational pesticide exposure
Central American Institute of Studies on Toxic Substances, Universidad Nacional, Heredia, Costa Rica.
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