Occupational Exposure to Pesticides and the Incidence of Lung Cancer in the Agricultural Health Study

Environ Health Perspect. 2017 Apr;125(4):544-551. doi: 10.1289/EHP456. Epub 2016 Jul 6.


Background: Occupational pesticide use is associated with lung cancer in some, but not all, epidemiologic studies. In the Agricultural Health Study (AHS), we previously reported positive associations between several pesticides and lung cancer incidence.

Objective: We evaluated use of 43 pesticides and 654 lung cancer cases after 10 years of additional follow-up in the AHS, a prospective cohort study comprising 57,310 pesticide applicators from Iowa and North Carolina.

Methods: Information about lifetime pesticide use and other factors was ascertained at enrollment (1993-1997) and updated with a follow-up questionnaire (1999-2005). Cox proportional hazards models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for smoking (smoking status and pack-years), sex, and lifetime days of use of any pesticides.

Results: Hazard ratios were elevated in the highest exposure category of lifetime days of use for pendimethalin (1.50; 95% CI: 0.98, 2.31), dieldrin (1.93; 95% CI: 0.70, 5.30), and chlorimuron ethyl (1.74; 95% CI: 1.02, 2.96), although monotonic exposure-response gradients were not evident. The HRs for intensity-weighted lifetime days of use of these pesticides were similar. For parathion, the trend was statistically significant for intensity-weighted lifetime days (p = 0.049) and borderline for lifetime days (p = 0.073). None of the remaining pesticides evaluated was associated with lung cancer incidence.

Conclusions: These analyses provide additional evidence for an association between pendimethalin, dieldrin, and parathion use and lung cancer risk. We found an association between chlorimuron ethyl, a herbicide introduced in 1986, and lung cancer that has not been previously reported. Continued follow-up is warranted.

Publication types

  • Research Support, N.I.H., Intramural

MeSH terms

  • Agricultural Workers' Diseases / epidemiology*
  • Agriculture
  • Humans
  • Incidence
  • Iowa / epidemiology
  • Lung Neoplasms / epidemiology*
  • North Carolina / epidemiology
  • Occupational Exposure / statistics & numerical data*
  • Pesticides*
  • Proportional Hazards Models
  • Prospective Studies


  • Pesticides