Cancer Mortality

Among Agricultural

Workers in the State of

Rio de Janeiro, BrazilArmando Meyer

National School of Public Health/ Oswaldo Cruz Foundation

Background

Modern agriculture and

pesticide use

2.5 million ton (around 5.6

billions pounds)

US$ 30 billion

Pesticide use in developing

countries

Less than 30%

Most of poisonings and death

Background

Environmental and human

health problems

acute poisonings

reproductive,

neurotoxicity

cancer

Cancer among farmers

Low general mortality

Low mortality for

cardiovascular diseases

Low mortality for all

cancers together

Excesses Deficits

Stomach Lung

Brain Kidney

Non-Hodgkin’s lymphoma Colon

Leukemia Bladder

Soft tissue sarcoma Liver

Blair and Zahm, 1995

Background

The Brazilian scenarioPesticide Sales (Million US$). Brazil 1992-2003

0

500

1,000

1,500

2,000

2,500

3,000

3,500

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

Year

Mill

ion U

S$

Pesticide Sales by Class (Million US$). Brazil, 1992-2003.

-

200

400

600

800

1,000

1,200

1,400

1,600

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

Year

Mill

ion U

S$

Acaricides

I nsecticides

Fungicides

Herbicides

Others

Increasing use of pesticides

50% of all Latin America Sales

Background

The Brazilian scenario

Low Medium High

Deaths/100000

Background

The Brazilian scenario

Southeast region

40% of all pesticide

consumption in Brazil

52 kg of

pesticide/worker/year

Background

The Brazilian scenarioSoutheast regionSão Lourenço Valley

56 kg of pesticides/worker/year

18 kg of pesticides/worker/year

Questions

Is the cancer mortality among farmworkers in this region different from that observed in the general population?

For what types of cancer?

Is the mortality increasing?

Nova Friburgo

Rio de Janeiro City

Teresópolis

Sumidouro

Duas Barras

Cantagalo

Bom Jardim

Study areaStudy designMortality data were obtained from the

Brazilian National Mortality System

(www.datasus.gov.br)

1979-1998

Farmworkers (occupation

codes:600-639)

Male

30-69 years old

Living in 6 cities from Rio de

Janeiro

Approach

Approach

Nova Friburgo

Rio de Janeiro City

Teresópolis

Sumidouro

Duas Barras

Cantagalo

Bom Jardim

Study areaReference populations

Local reference

Rio de Janeiro City

Porto Alegre City

Observed-to-expected ratio

Mortality Odds Ratio (MOR)

as suggested by Miettinen &

Wang, 1981.

Site Deaths %

Stomach 64 23.6

Esophagus 48 17.7

Lung 30 11.1

Larynx 17 6.3

Oral cavity 15 5.35

Prostate 8 2.95

Leukemia 8 2.95

Results

General Mortality (1979-1998)

3871 deaths

Cardiovascular diseases (1349;

34.8%)

External causes (711; 18.4%)

Cancer (410; 10.6%)

271 deaths (30-69 years old)

Cancer deaths among agricultures (30-69 yr old). Serrana Region, state of Rio

de Janeiro, 1979-1998

Results

Agricultores Local Rio de Janeiro Porto Alegre No. MOR 95% CI MOR 95% CI MOR 95% CI

1979 to 1988 All cancers 126 0.92 0.66 0.52

Stomach 30 1.05 0.71-1.50 1.36 0.92-1.94 1.64 1.11-2.34 Esophagus 23 1.66 1.05-2.49 2.34 1.48-3.51 1.22 0.77-1.83

Lung 13 0.60 0.32-1.03 0.28 0.15-0.48 0.20 0.11-0.34 Larynx 6 0.81 0.30-1.77 0.77 0.28-1.68 0.57 0.21-1.24

Oral cavity 6 1.34 0.49-2.92 0.65 0.24-1.42 0.57 0.21-1.24 Leukemia 5 1.16 0.38-2.70 1.17 0.38-2.73 0.84 0.27-1.96

Próstate 3 0.51 0.10-1.49 0.39 0.08-1.14 0.38 0.08-1.11 Brain 3 0.49 0.10-1.43 0.50 0.10-1.46 0.42 0.09-1.23 Colon 2 0.72 0.09-2.60 0.34 0.04-1.23 0.29 0.03-1.05 Liver 2 0.48 0.06-1.73 0.32 0.04-1.15 0.45 0.05-1.62

Pancreas 2 0.46 0.06-1.66 0.32 0.04-1.15 0.24 0.03-0.87

1989 to 1998 All cancers 145 1.00 0.91 0.60

Stomach 34 1.39 0.96-1.95 2.19 1.51-3.07 1.99 1.38-2.79 Esophagus 25 2.04 1.32-3.02 3.28 2.12-4.85 1.40 0.91-2.07

Lung 17 0.72 0.42-1.15 0.43 0.25-0.69 0.27 0.16-0.43 Larynx 11 1.22 0.61-2.18 1.53 0.76-2.74 1.11 0.55-1.99

Oral cavity 9 1.80 0.82-3.42 0.85 0.39-1.61 0.91 0.42-1.73 Próstate 5 0.65 0.21-1.51 0.57 0.18-1.33 0.46 0.15-1.07

Liver 5 1.09 0.35-2.54 0.97 0.31-2.26 0.78 0.25-1.82 Pancreas 5 1.02 0.33-2.38 0.89 0.29-2.07 0.52 0.17-1.21

Leukemia 3 0.67 0.14-1.96 0.48 0.10-1.40 0.57 0.12-1.66 Bones 3 2.39 0.49-6.98 2.47 0.51-7.21 2.27 0.45-6.63 Colon 2 1.02 0.12-3.68 0.31 0.04-1.12 0.21 0.02-0.76

Soft Tissues 2 2.05 0.25-7.40 2.48 0.30-8.95 1.32 0.16-4.76

Cancer mortality odds ratio, male agriculture workers 30–69 years old, Serrana Region, State of Rio de Janeiro, 1979–1998

ResultsCancer mortality odds ratio, male agriculture workers 50–69 years old, Serrana Region, State of Rio de Janeiro, 1979–1998

Agricultures Local Rio de Janeiro Porto Alegre No. MOR CI 95% MOR CI 95% MOR CI 95%

1979 to 1988 All cancers 107 0.95 0.78-1.16 0.70 0.57-0.85 0.55 0.45-0.67

Stomach 27 1.14 0.75-1.66 1.49 0.98-2.17 1.90 1.25-2.77 Esophagus 21 1.70 1.05-2.60 2.65 1.64-4.05 1.45 0.90-2.22

Lung 11 0.53 0.26-0.95 0.28 0.14-0.50 0.19 0.09-0.34 Larynx 5 0.92 0.30-2.14 0.74 0.24-1.72 0.58 0.19-1.35

Oral cavity 4 1.48 0.40-3.79 0.54 0.20-1.38 0.50 0.14-1.28 Prostate 3 0.49 0.10-1.43 0.40 0.08-1.17 0.40 0.08-1.17

Brain 2 0.48 0.06-1.73 0.55 0.12-0.24 0.41 0.05-1.48 Leukemia 1 0.50 0.01-2.78 0.39 0.01-2.17 0.28 0.01-1.55

Penis 1 5.54 0.14-30.85 2.88 0.07-16.01 10.94 0.28-60.93 1989 to 1998

All cancers 125 1.00 0.83-1.20 1.06 0.88-1.27 0.69 0.57-0.83 Stomach 27 1.37 0.90-2.00 2.27 1.50-3.31 2.09 1.38-3.05

Esophagus 22 2.32 1.45-3.50 3.80 2.38-5.74 1.62 1.02-2.45 Lung 16 0.87 0,50-1.41 0.50 0.29-0.81 0.32 0.18-0.52

Larynx 10 1.35 0.65-2.48 2.31 1.11-4.25 1.28 0.61-2.35 Oral cavity 7 1.77 0.71-3.64 0.89 0.36-1.83 1.07 0.43-2.20

Prostate 4 0.56 0.15-1.63 0.50 0.14-1.28 0.42 0.11-1.07 Pancreas 4 1.01 0.27-2.58 0.93 0.25-2.38 0.53 0.14-1.36

Liver 3 0.90 0.18-2.63 0.55 0.11-1.61 0.69 0.14-2.01 Leukemia 2 0.84 0.10-3.03 0.88 0.11-3.18 0.67 0.08-2.42

ResultsCancer mortality odds ratio, male agriculture workers 30-49 years old, Serrana Region, State of Rio de Janeiro, 1979–1998

Agricultores Local Rio de Janeiro Porto Alegre No. MOR CI 95% MOR CI 95% MOR CI 95%

1979 to 1988 All cancers 19 0.69 0.41-1.08 0.50 0.30-0.78 0.40 0.24-.062 Leukemia 4 1.8 0.49-4.60 2.32 0.63-5.94 1.62 0.33-4.73

Stomach 3 0.57 0.12-1.66 0.77 0.16-2.25 0.77 0.16-2.25 Esophagus 2 1.05 0.13-3.79 1.10 0.13-3.97 0.49 0.06-1.77

Lung 2 1.05 0.13-3.79 0.28 0.03-1.01 0.22 0.02-0.79 Oral cavity 2 1.14 0.14-4.11 0.72 0.09-2.60 0.86 0.10-3.10

Larynx 1 0.48 0.01-2.67 0.79 0.02-4.40 0.51 0.01-2.84 Brain 1 0.52 0.01-2.89 0.41 0.01-2.28 0.44 0.01-2.45

Soft tissues 1 3.15 0.08-17.54 3.53 0.09-19.66 2.02 0.05-11.25 Testis 1 6.30 0.16-35.09 3.42 0.08-19.05 2.88 0.07-19.04 Penis 1 6.30 0.16-35.09 6.43 0.16-35.81 6.73 0.17-37.49

1989 to 1998

All cancers 23 1.00 0.63-1.50 0.70 0.44-1.05 0.46 0.29-0.69 Stomach 7 1.73 0.69-3.56 2.34 0.94-4.82 2.19 0.88-4.51

Esophagus 3 1.25 0.26-3.65 2.03 0.42-5.92 0.92 0.19-2.68 Liver 2 2.66 0.32-9.6 1.92 0.23-6.93 1.10 0.13-3.97

Oral cavity 2 1.11 0.13-4.01 0.75 0.09-2.71 0.64 0.08-2.31 Larynx 1 0.74 0.02-4.12 0.92 0.02-5.12 0.65 0.01-3.62

Lung 1 0.23 0.01-1.28 0.18 0.00-1.00 0.10 0.00-0.55 Prostate 1 6.65 0.17-37.04 5.34 0.13-29.74 2.68 0.07-14.92

Leukemia 1 0.47 0.01-2.62 0.51 0.01-2.84 0.43 0.01-2.39 Soft tissues 1 2.22 0.06-12.36 3.35 0.08-18.66 1.19 0.03-6.63

Pancreas 1 0.60 0.01-3.34 0.94 0.02-5.23 0.69 0.02-3.84 Testis 1 6.65 0.17-37.04 6.52 0.16-36.32 1.19 0.03-6.63

Summary

High mortality for stomach cancer

High mortality for esophagus cancer

The role of alcohol and smoking

Low mortality for lung cancer

MOR’s were higher among wokers with 50-60 yr old

MOR’s were higher in the 90’s