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Int. J. Environ. Res. Public Health 2014, 11, 4449-4527; doi:10.3390/ijerph110404449 International Journal of Environmental Research and Public Health ISSN 1660-4601 www.mdpi.com/journal/ijerph Review Non-Hodgkin Lymphoma and Occupational Exposure to Agricultural Pesticide Chemical Groups and Active Ingredients: A Systematic Review and Meta-Analysis Leah Schinasi * and Maria E. Leon Section of Environment and Radiation, International Agency for Research on Cancer 150, Cours Albert Thomas, 69372 Lyon Cedex 08, France; E-Mail: [email protected] * Author to whom correspondence should be addressed; E-Mail: [email protected]; Tel.: +33-472-73-8485; Fax: +33-472-73-8320. Received: 12 February 2014; in revised form: 31 March 2014 / Accepted: 1 April 2014 / Published: 23 April 2014 Abstract: This paper describes results from a systematic review and a series of meta-analyses of nearly three decades worth of epidemiologic research on the relationship between non-Hodgkin lymphoma (NHL) and occupational exposure to agricultural pesticide active ingredients and chemical groups. Estimates of associations of NHL with 21 pesticide chemical groups and 80 active ingredients were extracted from 44 papers, all of which reported results from analyses of studies conducted in high-income countries. Random effects meta-analyses showed that phenoxy herbicides, carbamate insecticides, organophosphorus insecticides and the active ingredient lindane, an organochlorine insecticide, were positively associated with NHL. In a handful of papers, associations between pesticides and NHL subtypes were reported; B cell lymphoma was positively associated with phenoxy herbicides and the organophosphorus herbicide glyphosate. Diffuse large B-cell lymphoma was positively associated with phenoxy herbicide exposure. Despite compelling evidence that NHL is associated with certain chemicals, this review indicates the need for investigations of a larger variety of pesticides in more geographic areas, especially in low- and middle-income countries, which, despite producing a large portion of the world’s agriculture, were missing in the literature that were reviewed. Keywords: pesticides; insecticides; herbicides; fungicides; lymphoma; non-Hodgkin; occupational; agricultural OPEN ACCESS

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