Pesticides and childhood cancer: an update of Zahm and Ward's 1998 review.

Children are exposed to pesticides through a number of sources, including residential and agricultural applications. Parental occupational exposure to pesticides is also a concern because exposures occurring during pregnancy and carry-home residues also contribute to children's cumulative burden. A number of epidemiological studies consistently reported increased risks between pesticide exposures and childhood leukemia, brain cancer, neuroblastoma, non-Hodgkin's lymphoma, Wilms' tumor, and Ewing's sarcoma. An extensive review of these studies was published in 1998 (Zahm & Ward, 1998). Fifteen case-control studies, 4 cohort studies, and 2 ecological studies have been published since this review, and 15 of these 21 studies reported statistically significant increased risks between either childhood pesticide exposure or parental occupational exposure and childhood cancer. Therefore, one can confidently state that there is at least some association between pesticide exposure and childhood cancer. However, an unambiguous mechanistic cause-and-effect relationship between pesticide exposure and childhood cancer was not demonstrated in these studies, and modifying factors such as genetic predisposition, rarely considered in the reviewed studies, likely play an important role. While the time window of exposure may be a crucial determinant for biological effects associated with pesticide exposure on children, studies have not contributed definitive information on the most vulnerable period. Accurate exposure assessment remains a challenge; future epidemiological studies need to assess gene-environment interactions and use improved exposure measures, including separate parental interviews, specific pesticide exposure questions, and semiquantitative exposure measures that can be used to confirm information obtained through questionnaires.