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Non-cancer health effects of pesticides

Systematic review and implications for family doctors

K.J. Kerr, MD DIP ENV HEALTH
Lecturer in the Department of Family and Community Medicine at the University of Toronto in Ontario

L.H. Sanin, MD MPH ScD
Professor in the Department of Public Health Sciences at the Universidad Autonoma de Chihuahua in Mexico

D.C. Cole, MD MSc FRCPC
Associate Professor of Medicine in the Department of Public Health Sciences at the University of Toronto

K.L. Bassil, MSc
Doctoral candidate in the Department of Public Health Sciences at the University of Toronto

C. Vakil, MD CCFP FCFP
Assistant Professor in the Department of Family Medicine at Queen’s University in Kingston, Ont

Correspondence to: Dr Margaret Sanborn, Chesley Medical Clinic, Box 459, Chesley, ON N0G 1L0; e-mail msanborn{at}sbghc.on.ca

OBJECTIVE To investigate whether there are associations between exposure to pesticides and 4 chronic non-cancer health effects: dermatologic, neurologic, reproductive, and genotoxic effects.

DATA SOURCES We searched PreMedline, MEDLINE, and LILACS using the key word pesticide combined with the term for the specific health effect being searched. Reviewers scanned the references of all articles for additional relevant studies.

STUDY SELECTION Studies since 1992 were assessed using structured inclusion and quality-of-methods criteria. Studies scoring <4 on a 7-point global methodologic quality scale were excluded. In total, 124 studies were included. These studies had a mean quality score of 4.88 out of 7.

SYNTHESIS Strong evidence of association with pesticide exposure was found for all neurologic outcomes, genotoxicity, and 4 of 6 reproductive effects: birth defects, fetal death, altered growth, and other outcomes. Exposure to pesticides generally doubled the level of genetic damage as measured by chromosome aberrations in lymphocytes. Only a few high-quality studies focused on the dermatologic effects of pesticides. In some of these studies, rates of dermatitis were higher among those who had had high exposure to pesticides on the job.

CONCLUSION Evidence from research on humans consistently points to positive associations between pesticide exposure and 3 of the 4 non-cancer health outcomes studied. Physicians have a dual role in educating individual patients about the risks of exposure and in reducing exposure in the community by advocating for restrictions on use of pesticides.