Wiklund K, Dich J
Department of Cancer Epidemiology, Radiumhemmet, Karolinska Institute and Hospital, Stockholm, Sweden.
Eur J Cancer Prev. 1995 Feb;4(1):81-90. doi: 10.1097/00008469-199502000-00008.
We have conducted a cohort study of cancer risks among 140,208 Swedish farmers in order to compare their cancer risks with those of the general male population. Since there were no individual data regarding exposure to agricultural chemicals and acquiring such data was not realistic, we obtained crude and hypothetical estimates for exposure by dividing the data into time periods, year-of-birth cohorts and geographical areas. The cohort was followed-up in the Cancer Environment Register from 1 January 1971 either until death or until 31 December 1987. The relative risk was computed as the ratio of the observed and expected number of cases (SIR = standardized incidence ratio). A total of 15,040 cases were observed vs 18,918 expected, resulting in a statistically significant decreased SIR of 0.80 (95% confidence interval: 0.78-0.81). The SIR was significantly decreased for several cancer sites, and the lowest value was found for tongue, lung, oesophagus, liver and urinary organs, which is in agreement with other studies on cancer risks among farmers. Other major cancer sites with decreased SIRs were the colon, rectum, pancreas and kidney. Lip cancer and multiple myeloma showed statistically significant increased risks. SIRs for stomach cancer, prostate cancer, skin carcinoma, malignant melanoma, tumours in connective tissue or muscle, malignant lymphomas and leukaemia were all close to unity, which is not consistent with several other studies that have shown increased risks for these sites. For malignant lymphomas the SIR increased over time, though not significantly, and was highest among younger farmers. The SIR for non-Hodgkin lymphoma was lowest in the northernmost region. This gives some support to the hypothesis that there is an association between non-Hodgkin lymphoma and exposure to pesticides and other agricultural chemicals. It is of note that the SIR for multiple myeloma was significantly increased in those parts of Sweden where the use of pesticides has been less frequent and in lower amounts.
我们对140208名瑞典农民的癌症风险进行了一项队列研究，以便将他们的癌症风险与一般男性人群的风险进行比较。由于没有关于接触农用化学品的个体数据，且获取此类数据不现实，我们通过将数据按时间段、出生队列年份和地理区域进行划分，获得了粗略的和假设的接触估计值。该队列从1971年1月1日起在癌症环境登记处进行随访，直至死亡或1987年12月31日。相对风险计算为观察到的病例数与预期病例数之比（SIR = 标准化发病率）。共观察到15040例病例，预期病例数为18918例，导致SIR在统计学上显著降低，为0.80（95%置信区间：0.78 - 0.81）。几个癌症部位的SIR显著降低，舌、肺、食管、肝和泌尿器官的SIR值最低，这与其他关于农民癌症风险的研究一致。SIR降低的其他主要癌症部位是结肠、直肠、胰腺和肾脏。唇癌和多发性骨髓瘤的风险在统计学上显著增加。胃癌、前列腺癌、皮肤癌、恶性黑色素瘤、结缔组织或肌肉肿瘤、恶性淋巴瘤和白血病的SIR均接近1，这与其他一些显示这些部位风险增加的研究不一致。对于恶性淋巴瘤，SIR随时间增加，虽不显著，且在年轻农民中最高。非霍奇金淋巴瘤的SIR在最北部地区最低。这为非霍奇金淋巴瘤与接触农药和其他农用化学品之间存在关联的假设提供了一些支持。值得注意的是，在瑞典农药使用频率较低且用量较少的地区，多发性骨髓瘤的SIR显著增加。
