Mul$ple'pes$cide'exposures'and' the'risk'of'mul$ple'myeloma'in' - PowerPoint PPT Presentation

Mul$ple'pes$cide'exposures'and' the'risk'of'mul$ple'myeloma'in' Canadian'men' Linda&Kachuri,&Paul&Demers,&Aaron&Blair,&John&Spinelli,& Manisha&Pahwa,&John&McLaughlin,&Punam&Pahwa,& James&Dosman,&Shelley&Harris& & UICC&World&Cancer&Congress& August&28,&2012&

Background' • MulGple&myeloma&(MM)&is&the&2 nd &most&common&hematological& cancer&worldwide,&with&2400&cases&expected&in&Canada&in&2012 1& • EGology&of&MM&is&poorly&understood& – Risk&factors&include:&older&age,&male&gender,&ethnicity& & • Higher&risk&of&MM&in& agricultural'occupa$ons 3,4,5 :& – Excess&risks&partly&aSributed&to& pes$cide'exposure 4,5,6& – PosiGve&associaGons&observed&for&certain&herbicides 4,5,7 &&& – and&insecGcides,&specifically&organochlorines&and& carbamates& 4,6,7 & 1& Canadian&Cancer&Society:&Canadian&Cancer&StaGsGcs&2012 & 2& Alexander&DD,&Mink&PJ,&Adami&HO,&&et&al.&Int&J&Cancer.&2007;120&Suppl&12:40\61.& 3& Lope&V,&Perez\Gomez&B,&Aragones&N,&et&al.&Cancer&Epidemiol&Biomarkers&Prev.&2008;&17(11):3123\7.&& 4& Eriksson&M,&Karlsson&M.&Br&J&Ind&Med.&1992;&49(2):95\103.&& 5& Baris&D,&Silverman&DT,&Brown&LM&et&al.&Scand&J&Work&Environ&Health.&2004;&30(3):215\22.& 6& Nanni&O,&Falcini&F,&Buiad&E&et&al.&Cancer&Causes&Control.&1998;&9(3):277\83& 7& Pahwa&P,&Karunanayake&CP,&Dosman&JA.&J&Agromedicine.&2012;&17(1):40\50& &

Background' • Why&focus&on&mulGple&pesGcide&exposures? && – More&accurately&reflects&how&exposures&occur&in& agricultural&sedngs& – Focusing&only&on&individual&pesGcides&might&miss&addiGve& effects&from&mulGple&pesGcide&use& – Studies&have&examined&risks&of&non\Hodgkin&lymphoma& from&exposure&to&mulGple&pesGcides&and&pesGcide& combinaGons 1,2 ,&but&this&has&not&been&done&for&MM& 1& De&Roos&AJ,&Zahm&SH,&Cantor&KP&et&al.&Occup&Environ&Med.&2003;&60(9):E11.& 2 &Hohenadel&K,&Harris&SA,&McLaughlin&JR&et&al.&Int&J&Environ&Res&Public&Health.&2011;&8(6):2320\30.&&& &

Objec$ves' • This&study&extends&previous&analyses&that&examined&risks&of&MM& among&men&from&exposure&to&individual&pesGcides 1 & & 1. To&invesGgate&the&associaGon&between&self\reported&use&of& mul$ple'pes$cides' and&the&risk&of&MM&among&men& 2. To&examine&commonly&used& pes$cide'combina$ons' with& the&goal&of&assessing&interacGve&joint&effects& & 1& Pahwa&P,&Karunanayake&CP,&Dosman&JA.&J&Agromedicine.&2012;&17(1):40\50&

Study'Popula$on' • Cross\Canada&Study&of&PesGcides&and&Health&(CCSPH):& case@ control'study &conducted&on&males&aged&19&years&and&older&in& six&provinces&between&1991&and&1994& • Incident'MM'cases' recruited&from&provincial&cancer&registries& and&hospitals& • Popula$on'controls' were&idenGfied&through&health&insurance& records&and&frequency\matched&by&age&(±2&years)&and& province& BC' AB' SK' MB' QC' ON'

Data'Collec$on' • Stage'1:'Postal'ques$onnaires'' – informaGon&on&pesGcide&use&& – demographic&characterisGcs& – medical&and&occupaGonal&history& & • Stage'2:'Telephone'interviews' with&subjects&reporGng&&≥10& hours/year&of&pesGcide&use&and ' 15%&random&sample&of&the& remainder ' – detailed&informaGon&on&individual&pesGcide&use&

Mul$ple'Pes$cide'Exposures' • PesGcides&were&grouped&in&the&following&categories:&& 1. Type:' herbicides,&insecGcides,&fungicides& 2. Chemical'class:' phenoxy&herbicides,&organochlorines,& organophosphates,&carbamates& 3. Carcinogenic'poten$al:' pesGcides&rated&as&“probably& carcinogenic”&(IARC&2A&or&higher),&and&“possibly& carcinogenic”&(IARC&2B&or&higher)& • Pes$cide'combina$ons: &2&pesGcides&used&by&the&same&subject&& Note:&a&composite&carcinogenicity&score&was&created&using&assessments&from&the& IARC&Monographs,&US&Environmental&ProtecGon&Agency&(EPA)&Integrated&Risk& InformaGon&System&(IRIS),&and&the&US&EPA&Office&of&PesGcides&Program&(OPP)&

Sta$s$cal'Analyses' • LogisGc&regression&was&used&to&calculate&odds&raGos&(OR)&and& 95%&confidence&intervals&(CI)&and&to&obtain&p trend& – Models&were&adjusted&for&age,&province&of&residence,&use&of&a&proxy& respondent,&and&smoking&status& • CombinaGons&of&pesGcides&used&by&20&or&more&parGcipants& were&tested&for&interacGon&on&the&addiGve&scale&using&the& Interac$on'Contrast'Ra$o'(ICR) 1 :' ICR '=' OR both&pesGcides &–&OR pesGcide & 1 &–&OR pesGcide & 2 +1& ICR'>'0.5'indicates'super@addi$ve'joint'effects' 1& De&Roos&AJ,&Zahm&SH,&Cantor&KP&et&al.&Occup&Environ&Med.&2003;&60(9):E11.&&

Results'' • 342&MM&cases,&1506&controls& • Response&rate:&58%&for&cases,&48%&for&controls& • Compared&to&controls,&MM&cases:& – Were&older&(64&vs.&54&years)& – Had&higher&use&of&proxy&respondents&(30&%&vs.&15%)&& – Had&a&higher&proporGon&of&ever&smokers&(74%&vs.&64%)& &

Results'@'Carcinogenicity' Number'of'pes$cides'used' Cases'N'(%)' Controls'N'(%)' OR adj '(95%'CI)' Possibly&carcinogenic&\&IARC&2B&or&higher& & 0& 248&(72.51)& 1162&(77.16)& 1.00& & 1& 29&(8.48)& 107&(7.10)& 1.51&(0.95,&2.39)& 2\4& 46&(13.45)& 171&(11.35)& 1.24&(0.84,&1.82)& 5&or&more& 19&(5.56)& 66&(4.38)& 1.45&(0.85,&2.47)& p trend =0.07& Probably&carcinogenic&&\&IARC&2A&or&higher& 0& 279&(81.58)& 1317&(87.45)& 1.00& 1& 37&(10.82)& 112&(7.44)& 1.59'(1.03,'2.44)' 2& 16&(4.68)& 54&(3.59)& 1.33&(0.76,&2.33)& 3&or&more& 10&(2.92)& 23&(1.53)& 1.96'(0.96,'4.01)' p trend =0.01' Note:&a&composite&carcinogenicity&score&was&created&using&assessments&from&the& IARC&Monographs,&US&Environmental&ProtecGon&Agency&(EPA)&Integrated&Risk& InformaGon&System&(IRIS),&and&the&US&EPA&Office&of&PesGcides&Program&(OPP)&

Results'–'Chemical'Class' Number'of'pes$cides'used' Cases'N'(%)' Controls'N'(%)' OR adj '(95%'CI)' Phenoxy&herbicides& & 0& 248&(72.51)& 1188&(78.88)& 1.00& & 1& 29&(8.48)& 183&(12.15)& 1.53'(1.08,'2.18)' 2\4& 46&(13.45)& 86&(5.71)& 0.85&(0.47,&1.51)& 5&or&more& 19&(5.56)& 49&(3.25)& 1.61&(0.85,&3.05)& p trend =0.14& Organochlorines& 0& 279&(81.58)& 1317&(87.45)& 1.00& 1& 37&(10.82)& 112&(7.44)& 1.18&(0.80,&1.74)& 2& 16&(4.68)& 54&(3.59)& 1.00&(0.55,&1.82)& 3&or&more& 10&(2.92)& 23&(1.53)& 2.10'(1.03,'4.31)' p trend =0.11& Carbamates& 0& 315&(92.11)& 1444&(95.88)& 1.00& 1&or&more& 27&(7.89)& 62&(4.12)& 2.08'(1.26,'3.42)' .&