Cancer incidence among pesticide applicators exposed to chlorpyrifos in the agricultural health study

Won Jin Lee, Aaron Blair, Jane A. Hoppin, Jay H. Lubin, Jennifer A. Rusiecki, Dale P. Sandler, Mustafa Dosemeci, Michael C.R. Alavanja*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

151 Scopus citations


Background: Chlorpyrifos is one of the most widely used insecticides in the United States. We evaluated the incidence of cancer among pesticide applicators exposed to chlorpyrifos in the Agricultural Health Study, a prospective cohort study of licensed pesticide applicators in Iowa and North Carolina. Methods: A total of 54383 pesticide applicators were included in this analysis. Detailed information on pesticide exposure and lifestyle factors was obtained from self-administered questionnaires completed at the time of enrollment (December 1993-December 1997). Poisson regression analysis was used to evaluate the association between chlorpyrifos exposure and cancer incidence after adjustment for potential confounders. All statistical tests were two-sided. Results: A total of 2070 incident malignant neoplasms were diagnosed through 2001. The rate ratio for all cancers combined among chlorpyrifos-exposed applicators compared with nonexposed applicators was 0.97 (95% confidence interval = 0.87 to 1.08). For most cancers analyzed, there was no evidence of an exposure-response relationship. However, the incidence of lung cancer was statistically significantly associated with both chlorpyrifos lifetime exposure-days (Ptrend = .002) and chlorpyrifos intensity-weighted exposure-days (Ptrend = .036). After adjustment for other pesticide exposures and demographic factors, individuals in the highest quartile of chlorpyrifos lifetime exposure-days (> 56 days) had a relative risk of lung cancer 2.18 (95% confidence interval = 1.31 to 3.64) times that of those with no chlorpyrifos exposure. Conclusion: Our findings suggest an association between chlorpyrifos use and incidence of lung cancer that deserves further evaluation.

Original languageEnglish
Pages (from-to)1781-1789
Number of pages9
JournalJournal of the National Cancer Institute
Issue number23
StatePublished - 1 Dec 2004
Externally publishedYes


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