Cancer Causes & Control

, Volume 30, Issue 4, pp 311–322 | Cite as

Cancer incidence in the Agricultural Health Study after 20 years of follow-up

  • Catherine C. LerroEmail author
  • Stella Koutros
  • Gabriella Andreotti
  • Dale P. Sandler
  • Charles F. Lynch
  • Lydia M. Louis
  • Aaron Blair
  • Christine G. Parks
  • Srishti Shrestha
  • Jay H. Lubin
  • Paul S. Albert
  • Jonathan N. Hofmann
  • Laura E. Beane Freeman
Original Paper



To evaluate cancer incidence in the Agricultural Health Study (AHS), a cohort of private pesticide applicators, their spouses, and commercial applicators, based on 12,420 cancers, adding 5,989 cancers, and 9 years of follow-up since last evaluation.


We calculated age, year, sex, and race-adjusted standardized incidence ratios (SIR) and 95% confidence intervals (CI) for cancer sites in the AHS relative to the general population.


Overall AHS cancer incidence was lower than the general population (SIRprivate = 0.91, CI 0.89–0.93; SIRspouse = 0.89, CI 0.86–0.92; SIRcommercial = 0.83, CI 0.76–0.92), with notable deficits across applicators and spouses for oral cavity, pancreas, and lung cancers. Cancer excesses included prostate cancer, lip cancer, certain B-cell lymphomas (e.g., multiple myeloma), acute myeloid leukemia (AML), thyroid cancer, testicular cancer, and peritoneal cancer. The lung cancer deficit was strongest among applicators reporting potential exposure to endotoxin at study enrollment (tasks such as raising animals and handling stored grain).


Although an overall deficit in cancer was observed, there were notable exceptions, including newly observed excesses for AML, thyroid, testicular, and peritoneal cancers. Furthermore, endotoxin exposure may, in part, account for observed lung cancer incidence deficits. Cancer incidence patterns in the AHS suggest farm exposures’ relevance to cancer etiology.


Farming Cancer Incidence Pesticides Endotoxin 



This work was supported by the Intramural Research Program of the National Institutes of Health, the National Cancer Institute at the National Institutes of Health (Z01-CP010119), and the National Institute of Environmental Health Sciences at the National Institutes of Health (Z01-ES049030). Data in this analysis are based on Agricultural Health Study releases P1REL201701 and AHSREL201706.

Supplementary material

10552_2019_1140_MOESM1_ESM.docx (41 kb)
Supplementary material 1 (DOCX 40 KB)


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Copyright information

© This is a U.S. government work and its text is not subject to copyright protection in the United States; however, its text may be subject to foreign copyright protection 2019

Authors and Affiliations

  • Catherine C. Lerro
    • 1
    Email author
  • Stella Koutros
    • 1
  • Gabriella Andreotti
    • 1
  • Dale P. Sandler
    • 2
  • Charles F. Lynch
    • 3
  • Lydia M. Louis
    • 1
  • Aaron Blair
    • 1
  • Christine G. Parks
    • 2
  • Srishti Shrestha
    • 2
  • Jay H. Lubin
    • 4
  • Paul S. Albert
    • 4
  • Jonathan N. Hofmann
    • 1
  • Laura E. Beane Freeman
    • 1
  1. 1.Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and GeneticsNational Cancer InstituteRockvilleUSA
  2. 2.National Institute of Environmental Health SciencesResearch Triangle ParkUSA
  3. 3.Department of EpidemiologyUniversity of IowaIowa CityUSA
  4. 4.Biostatistics Branch, Division of Cancer Epidemiology and GeneticsNational Cancer InstituteRockvilleUSA

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