Human Health Effects: Cancer, Pesticides, Ergonomics Steve

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Human Health EffectsCancer, Pesticides,
Ergonomics

• Steven Kirkhorn, MD, MPH
• Immanuel St. Josephs
• Mayo Health System

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Health issues

• Increased
• respiratory disease, arthritis, hearing loss,
  skin cancer
• Migrant health clinic issues-dermatitis, enteric
  infectious diseases, respiratory,
  musculoskeletal, diabetes
• Decreased
• generally decreased mortality of all causes
• tobacco and alcohol-related cancers
• cardiovascular

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Cancers of Concern

• Increase in cancers that are increasing in other
  segments of the population also
• Lip
• Multiple myeloma
• Childhood brain tumors
• Prostate-weak association but significant

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Inconsistent associations

• NHL and phenoxyacetic acid herbicides
• Breast/ovarian cancer and DDT/DDE
• Prostate
• Skin, melanoma
• soft tissue sarcoma
• Rectal, colon-increased PMRs in Iowa

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No apparent associations

• Leukemia and herbicides
• Ovarian cancer and atrazine
• Colon, soft tissue sarcoma, melanoma, rectal
  -Wisconsin study 1981-1990

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Weaknesses of studies

• Heterogeneity of studies, type of farming,
  geographic area
• Limitations of exposure assessment
• Multiple hazard exposures
• pesticides, fertilizers, paints, solvents,
• infectious microorganisms, endotoxin
• dusts

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Recommendations

• Improved biomarkers
• Increased use of biological monitoring
• Improved homogeneity of studies
• Standardization of endpoints
• Focus upon populations with greater exposures to
  pesticides(fruit, vegetable, hot houses)
• Present focus upon grain producers with average
  of 7-28 days/year of exposure

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Pesticide-related illnesses

• Annual decreases in pesticide fatalities,
  hospitalizations, and acute poisonings
• Possible explanations
• improved worker education -WPS
• Improved technology-application/mixing
• De-registration of more toxic agents
• Better labeling and regulation

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Common symptoms in pesticide applicator

• 20-44 of applicators have exposures and symptoms
• headache
• skin irritation
• respiratory and flu-like symptoms in animal
  applications

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Neurologic complications Acute pesticide
exposure

• Organophosphate induced delayed polyneuropathy
  (OPIDP)
• Intermediate syndrome

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Long-term neurologic effects of pesticides

• Dose-response relationship suggested
• Peripheral neuropathy
• Slowed reaction time
• Altered concentration
• Non-specific CNS effects
• ? Parkinsons/motion disorders

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Endocrine disrupter effects of pesticides

• Female cancer concerns
• Breast cancer
• Ovarian cancer
• Male reproductive effects

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Endocrine disrupter effects of agricultural
chemicals

• No strong association with exposure and time to
  pregnancy
• Reproductive effects
• Increased malefemale ratio(Garry et al 1996)
• Not seen-Savitz et al 1997
• Infertility
• Delayed time to conception
• Spontaneous abortions, pre-term delivery

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Pesticides and birth defects

• Birth defects-limb reduction, oral-facial,
  cryptorchidism
• Minor defects in ecological study of applicators
  in area with high use of fungicides and
  chlorphenoxy
• More pronounced in infants conceived in spring

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Pesticide issues-Monitoring Concerns

• Lack of inter-laboratory standards
• Variable results depending upon kit/lab
• variable reporting units
• Lack of consistent collection and storage
  techniques
• Activation/inactivation of cholinesterase
• Lack of reliable, inexpensive field monitoring

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Recommendations

• Improved causal linkages and dose-response
  relationships
• Improved biomarkers
• Improved consistency and accuracy of evaluation
  of acute and chronic cholinesterase depression

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Recommendations

• Improved reporting of pesticide-related illnesses
• Nation-wide effort to improve and standardize
  medical surveillance of pesticide applicators and
  others with regular exposure to pesticides

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Ergonomic issues

• High incidence of musculoskeletal conditions-
  primarily back pain
• California-Back 24, upper back 19, wrist 18
• Osorio et al, 1998

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Chronic low back pain prevalence

• Nursery workers back 46 of injuries
• Chronic back pain-71 swine producers
• Von Essen and McCurdy, 1998
• Back pain-26 of farmers and ranchers
• Xiang et al, 1999
• Arthritis of hips and knees in dairy
• May, 1998, Thelin 1991

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Ergonomic issues

• Increasing labor intensive agricultural work
• Fruit harvesting, nurseries, small vegetable
• Raised arms, pressure from straps of bags,
  repetitive forceful lifting, pinching, stooping,
  bending and twisting
• Varied duties at multiple locations

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Interventions

• Handles on pots in nurseries-decrease pinch
• Pallet trucks and tracks, automated washers
• Loading ramps
• Move to smaller pots
• Improved fruit bags and straps, vests
• Hinged boxes (Fulmer et al. 2000)

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Recommendations

• Thorough functional job assessments
• Development of lighter, more flexible equipment,
  new tools, raising beds
• Develop simple solutions that are inexpensive to
  produce and apply
• Meyers et al. 1995, 1997

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Other areas of concern

• Zoonoses
• Hepatitis E
• Cryptosporodiosis
• Coliforms
• Sin nombre virus
• Q fever
• Dermatitis
• Contact dermatitis
• Under-reported

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Emerging concerns of biotechnology

• Probable improvement in hazard exposures
• New exposures may occur

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Bacillus thuringiensis (Bt) exposure issues

• Positive skin prick tests, specific IgE
  antibodies, and nasal lavage cultures higher in
  high Bt-exposure workers.
• No respiratory symptoms
• Berstein et al. Immune responses in farm workers
  after exposure to Bt pesticides.
• Environ Health Perspect 107 575-82. (1999)

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General recommendations

• Improved medical surveillance
• Improved reporting of illnesses, repetitive
  stress injuries
• Establishment of dose-response relationships,
  biological monitoring
• Better definition of study end-points
• Continued support of prospective studies The
  Agricultural Health, Keokuk, California Farmer
  Cohort Studies