Cancer Mortality Among Agricultural
Workers in the State of Rio de Janeiro,
Brazil
Armando 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
Excesses
Deficits
Stomach
Lung
Brain
Kidney
cardiovascular diseases Non-Hodgkin’s lymphoma
Leukemia
Low mortality for all
cancers together
Soft tissue sarcoma
Blair and Zahm, 1995
Colon
Bladder
Liver
Background
Pesticide Sales (Million US$). Brazil 1992-2003
The Brazilian scenario
3,500
Million US$
3,000
2,500
2,000
1,500
1,000
500
0
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003
Year
Pesticide Sales by Class (Million US$). Brazil, 1992-2003.
1,600
Acaricides
Insecticides
Fungicides
Herbicides
Others
1,400
Increasing use of pesticides
Million US$
1,200
50% of all Latin America Sales
1,000
800
600
400
200
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003
Year
Background
Deaths/100000
The Brazilian scenario
Low
Medium
High
Background
The Brazilian scenario
Southeast region
40% of all pesticide
consumption in Brazil
52 kg of
pesticide/worker/year
Background
The Brazilian scenario
Southeast region
São 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?
Approach
Study design
Study area
Mortality data were obtained
from the
Cantagalo
Brazilian National Mortality System
Duas Barras
(www.datasus.gov.br)
Sumidouro
1979-1998
Farmworkers
(occupation
Teresópolis
codes:600-639)
Male
30-69 years old
Living in 6 cities from Rio de
Bom Jardim
Nova Friburgo
Janeiro
Rio de Janeiro City
Approach
Reference populations
Study
area
Local
reference
Cantagalo
Rio de Janeiro City
Duas Barras
Porto Alegre City
Sumidouro
Teresópolis
Observed-to-expected ratio
Mortality Odds Ratio (MOR)
as suggested by Miettinen &
Wang, 1981.
Rio de Janeiro City
Bom Jardim
Nova Friburgo
Results
General Mortality (1979-1998)
3871 deaths
Cancer deaths among agricultures (3069 yr old). Serrana Region, state of Rio
de Janeiro, 1979-1998
Cardiovascular diseases (1349;
Site
Deaths
%
Stomach
64
23.6
External causes (711; 18.4%)
Esophagus
48
17.7
Cancer (410; 10.6%)
30
11.1
17
6.3
Oral cavity
15
5.35
Prostate
8
2.95
Leukemia
8
2.95
34.8%)
Lung
271 deaths (30-69 yearsLarynx
old)
Results
Cancer mortality odds ratio, male agriculture workers 30–69 years old, Serrana
Region, State of Rio de Janeiro, 1979–1998
Agricultores
Local
No.
MOR
95% CI
1979 to 1988
All cancers
Stomach
Esophagus
Lung
Larynx
Oral cavity
Leukemia
Próstate
Brain
Colon
Liver
Pancreas
126
30
23
13
6
6
5
3
3
2
2
2
0.92
1.05
1.66
0.60
0.81
1.34
1.16
0.51
0.49
0.72
0.48
0.46
1989 to 1998
All cancers
Stomach
Esophagus
Lung
Larynx
Oral cavity
Próstate
Liver
Pancreas
Leukemia
Bones
Colon
Soft Tissues
145
34
25
17
11
9
5
5
5
3
3
2
2
1.00
1.39
2.04
0.72
1.22
1.80
0.65
1.09
1.02
0.67
2.39
1.02
2.05
Rio de Janeiro
MOR
95% CI
0.71-1.50
1.05-2.49
0.32-1.03
0.30-1.77
0.49-2.92
0.38-2.70
0.10-1.49
0.10-1.43
0.09-2.60
0.06-1.73
0.06-1.66
0.66
1.36
2.34
0.28
0.77
0.65
1.17
0.39
0.50
0.34
0.32
0.32
0.96-1.95
1.32-3.02
0.42-1.15
0.61-2.18
0.82-3.42
0.21-1.51
0.35-2.54
0.33-2.38
0.14-1.96
0.49-6.98
0.12-3.68
0.25-7.40
0.91
2.19
3.28
0.43
1.53
0.85
0.57
0.97
0.89
0.48
2.47
0.31
2.48
Porto Alegre
MOR
95% CI
0.92-1.94
1.48-3.51
0.15-0.48
0.28-1.68
0.24-1.42
0.38-2.73
0.08-1.14
0.10-1.46
0.04-1.23
0.04-1.15
0.04-1.15
0.52
1.64
1.22
0.20
0.57
0.57
0.84
0.38
0.42
0.29
0.45
0.24
1.11-2.34
0.77-1.83
0.11-0.34
0.21-1.24
0.21-1.24
0.27-1.96
0.08-1.11
0.09-1.23
0.03-1.05
0.05-1.62
0.03-0.87
1.51-3.07
2.12-4.85
0.25-0.69
0.76-2.74
0.39-1.61
0.18-1.33
0.31-2.26
0.29-2.07
0.10-1.40
0.51-7.21
0.04-1.12
0.30-8.95
0.60
1.99
1.40
0.27
1.11
0.91
0.46
0.78
0.52
0.57
2.27
0.21
1.32
1.38-2.79
0.91-2.07
0.16-0.43
0.55-1.99
0.42-1.73
0.15-1.07
0.25-1.82
0.17-1.21
0.12-1.66
0.45-6.63
0.02-0.76
0.16-4.76
Results
Cancer mortality odds ratio, male agriculture workers 50–69 years old, Serrana
Region, State of Rio de Janeiro, 1979–1998
Agricultures
No.
1979 to 1988
All cancers
Stomach
Esophagus
Lung
Larynx
Oral cavity
Prostate
Brain
Leukemia
Penis
1989 to 1998
All cancers
Stomach
Esophagus
Lung
Larynx
Oral cavity
Prostate
Pancreas
Liver
Leukemia
Local
MOR
CI 95%
Rio de Janeiro
MOR
CI 95%
Porto Alegre
MOR
CI 95%
107
27
21
11
5
4
3
2
1
1
0.95
1.14
1.70
0.53
0.92
1.48
0.49
0.48
0.50
5.54
0.78-1.16
0.75-1.66
1.05-2.60
0.26-0.95
0.30-2.14
0.40-3.79
0.10-1.43
0.06-1.73
0.01-2.78
0.14-30.85
0.70
1.49
2.65
0.28
0.74
0.54
0.40
0.55
0.39
2.88
0.57-0.85
0.98-2.17
1.64-4.05
0.14-0.50
0.24-1.72
0.20-1.38
0.08-1.17
0.12-0.24
0.01-2.17
0.07-16.01
0.55
1.90
1.45
0.19
0.58
0.50
0.40
0.41
0.28
10.94
0.45-0.67
1.25-2.77
0.90-2.22
0.09-0.34
0.19-1.35
0.14-1.28
0.08-1.17
0.05-1.48
0.01-1.55
0.28-60.93
125
27
22
16
10
7
4
4
3
2
1.00
1.37
2.32
0.87
1.35
1.77
0.56
1.01
0.90
0.84
0.83-1.20
0.90-2.00
1.45-3.50
0,50-1.41
0.65-2.48
0.71-3.64
0.15-1.63
0.27-2.58
0.18-2.63
0.10-3.03
1.06
2.27
3.80
0.50
2.31
0.89
0.50
0.93
0.55
0.88
0.88-1.27
1.50-3.31
2.38-5.74
0.29-0.81
1.11-4.25
0.36-1.83
0.14-1.28
0.25-2.38
0.11-1.61
0.11-3.18
0.69
2.09
1.62
0.32
1.28
1.07
0.42
0.53
0.69
0.67
0.57-0.83
1.38-3.05
1.02-2.45
0.18-0.52
0.61-2.35
0.43-2.20
0.11-1.07
0.14-1.36
0.14-2.01
0.08-2.42
Results
Cancer mortality odds ratio, male agriculture workers 30-49 years old, Serrana
Region, State of Rio de Janeiro, 1979–1998
Agricultores
No.
1979 to 1988
19
All cancers
4
Leukemia
3
Stomach
2
Esophagus
2
Lung
2
Oral cavity
1
Larynx
1
Brain
1
Soft tissues
1
Testis
1
Penis
1989 to 1998
All cancers
Stomach
Esophagus
Liver
Oral cavity
Larynx
Lung
Prostate
Leukemia
Soft tissues
Pancreas
Testis
23
7
3
2
2
1
1
1
1
1
1
1
Local
MOR CI 95%
Rio de Janeiro
MOR CI 95%
Porto Alegre
MOR CI 95%
0.69
1.8
0.57
1.05
1.05
1.14
0.48
0.52
3.15
6.30
6.30
0.41-1.08
0.49-4.60
0.12-1.66
0.13-3.79
0.13-3.79
0.14-4.11
0.01-2.67
0.01-2.89
0.08-17.54
0.16-35.09
0.16-35.09
0.50
2.32
0.77
1.10
0.28
0.72
0.79
0.41
3.53
3.42
6.43
0.30-0.78
0.63-5.94
0.16-2.25
0.13-3.97
0.03-1.01
0.09-2.60
0.02-4.40
0.01-2.28
0.09-19.66
0.08-19.05
0.16-35.81
0.40
1.62
0.77
0.49
0.22
0.86
0.51
0.44
2.02
2.88
6.73
0.24-.062
0.33-4.73
0.16-2.25
0.06-1.77
0.02-0.79
0.10-3.10
0.01-2.84
0.01-2.45
0.05-11.25
0.07-19.04
0.17-37.49
1.00
1.73
1.25
2.66
1.11
0.74
0.23
6.65
0.47
2.22
0.60
6.65
0.63-1.50
0.69-3.56
0.26-3.65
0.32-9.6
0.13-4.01
0.02-4.12
0.01-1.28
0.17-37.04
0.01-2.62
0.06-12.36
0.01-3.34
0.17-37.04
0.70
2.34
2.03
1.92
0.75
0.92
0.18
5.34
0.51
3.35
0.94
6.52
0.44-1.05
0.94-4.82
0.42-5.92
0.23-6.93
0.09-2.71
0.02-5.12
0.00-1.00
0.13-29.74
0.01-2.84
0.08-18.66
0.02-5.23
0.16-36.32
0.46
2.19
0.92
1.10
0.64
0.65
0.10
2.68
0.43
1.19
0.69
1.19
0.29-0.69
0.88-4.51
0.19-2.68
0.13-3.97
0.08-2.31
0.01-3.62
0.00-0.55
0.07-14.92
0.01-2.39
0.03-6.63
0.02-3.84
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