Exposure Study population SMR, relative risk or odds ratio (95% confidence interval) Main strengths Main limitations Reference Ecological studies Arsenic Members of the Mormon church from Millard County, Utah SMR compared to the general population of Utah: 1.45 (1.07–1.91) Quite good characterisation of exposure. Cohort population with restrictive life style No clear dose-effect relationship; no correction for confounding [105 ] Arsenic Residents of 314 of the 361 districts in Taiwan Multivariate-adjusted regression coefficient for age-adjusted mortality per 100,000 person-years for every 0.1 ppm increase in arseniclevel of well water: 0.5 (SE: 0.2) P < 0.05 Quite good characterisation of exposure Incomplete correction for confounding [106 ] Case-control studies Polychlorinated Biphenyl congener 153 OR for greater than median adipose tissue concentration: 3.15 (1.04–9.54) Trans-chlordane OR for greater than median adipose tissue concentration: 3.49 (1.08–11.2) Polychlorinated Biphenyl congener 153 General population of Örebro County, Sweden OR for prostate cancer with PSA > median, for greater than median adipose tissue concentration: 30.3 (3.24–284) Highly relevant parameter of personal internal exposure. Adequate correction for confounding. Small number of subjects [107 ] Trans-chlordane OR for prostate cancer with PSA > median, for greater than median adipose tissue concentration: 11.0 (1.87–64.9)
Small number of subjects. The biological relevance of the arbitrary cut-off point of PSA is unclear Hexachlorobenzene OR for prostate cancer with PSA > median for greater than median adipose tissue concentration: 9.84 (1.99–48.5), Cohort studies Polychlorinated Biphenyls Electrical Capacitor Manufacturing Workers in New York and Massachusetts Prostate cancer mortality increased with cumulative exposure to RR = 6.05 for the highest quartile (trend
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value = 0.0001) Quite elaborate characterisation of exposure Limited correction for confounding [108 ] Beta-hexachlorocyclohexane ORs for the 2° and 3° tertiles of detectable values were 1.46 (0.52–4.13) and 3.36 (1.24–9.10) (P for trend = 0.02) Trans-nonachlor Participants in the U.S. National Health and Nutrition Examination Survey (1999-2000) ORs for the 2° and 3° tertiles of detectable values were 5.84 (1.06–32.2) and 14.1 (2.55–77.9) (P for trend = 0.002) Measurement of personal internal exposure. Adequate correction for confounding Self-reported cancer diagnosis. Only 65 cases [109 ] Dieldrin ORs for the 2° and 3° tertiles of detectable values were 1.06 (0.30–3.73) and 2.74 (1.01–7.49) (P for trend = 0.04) Prospective cohort studies Application of pesticides Participants in the Agricultural Health Study in Iowa and North Carolina OR: 1.14 (1.05, 1.24) compared to male populations of Iowa and North Carolina Participants: 55,332 male pesticide applicators Elaborate characterization of external exposure. Adequate correction for confounding Short followup period [110 ] Meta-analysis Application of pesticides 22 studies (1986–2003) RR: 1.24 (1.06–1.45) RR's higher in North America than in Europe RR's homogenous in same region No bias Limited info on specific chemicals [111 ] Manufacturing of pesticides 18 studies (1984–2004) RR: 1.28 (1.05–1.58). Consistent increase for all chemical classes, significant for phenoxy herbicides No publication bias Limited info on specific chemicals [112 ]
