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Jérémie Rudant,^1,2 Florence Menegaux,^1,2 Guy Leverger,³ André Baruchel,⁴ Brigitte Nelken,⁵ Yves Bertrand,⁶ Catherine Patte,⁷ Hélène Pacquement,⁸ Cécile Vérité,⁹ Alain Robert,¹⁰ Gérard Michel,¹¹ Geneviève Margueritte,¹² Virginie Gandemer,¹³ Denis Hémon,^1,2 and Jacqueline Clavel^1,2,14

¹INSERM (Institut national de la santé et de la recherche médicale), Villejuif, France; ²Univ Paris-Sud, Villejuif, France; ³AP HP (Assistance Publique des Hôpitaux de Paris), Hôpital Armand Trousseau, Paris, France; ⁴AP HP (Assistance Publique des Hôpitaux de Paris), Hôpital Saint-Louis and Hôpital Robert-Debré, Paris, France; ⁵Hôpital Jeanne de Flandre, Lille, France; ⁶Hôpital Debrousse, Lyon, France; ⁷Institut Gustave Roussy, Villejuif, France; ⁸Institut Curie, Paris, France; ⁹Hôpital Pellegrin Tripode, Bordeaux, France; ¹⁰Hôpital des Enfants, Toulouse, France; ¹¹Hôpital La Timone, Marseille, France;¹²Hôpital Arnaud de Villeneuve, Montpellier, France; ¹³CHU-hôpital Sud, Rennes, France; ¹⁴French National Registry of Childhood Blood malignancies (RNHE), Villejuif, France

Abstract
Objectives: We investigated the role of household exposure to pesticides in the etiology of childhood hematopoietic malignancies.

Methods: The national registry-based case–control study ESCALE (Etude sur les cancers de l'enfant) was carried out in France over the period 2003–2004. Population controls were frequency matched with the cases on age and sex. Maternal household use of pesticides during pregnancy and paternal use during pregnancy or childhood were reported by the mothers in a structured telephone questionnaire. Insecticides (used at home, on pets, or for garden crops) , herbicides, and fungicides were distinguished. We estimated odds ratios (ORs) using unconditional regression models closely adjusting for age, sex, degree of urbanization, and type of housing (flat or house) .

Results: We included a total of 764 cases of acute leukemia (AL) , 130 of Hodgkin lymphoma (HL) , 166 of non-Hodgkin lymphoma (NHL) , and 1,681 controls. Insecticide use during pregnancy was significantly associated with childhood AL [OR = 2.1 ; 95% confidence interval (CI) , 1.7–2.5], both lymphoblastic and myeloblastic, NHL (OR = 1.8 ; 95% CI, 1.3–2.6) , mainly for Burkitt lymphoma (OR = 2.7 ; 95% CI, 1.6–4.5) , and mixed-cell HL (OR = 4.1 ; 95% CI, 1.4–11.8) , but not nodular sclerosis HL (OR = 1.1 ; 95% CI, 0.6–1.9) . Paternal household use of pesticides was also related to AL (OR = 1.5 ; 95% CI, 1.2–1.8) and NHL (OR = 1.7 ; 95% CI, 1.2–2.6) ; but for AL the relationships did not remain after adjustment for maternal pesticide use during pregnancy.

Conclusion: The study findings strengthen the hypothesis that domestic use of pesticides may play a role in the etiology of childhood hematopoietic malignancies. The consistency of the findings with those of previous studies on AL raises the question of the advisability of preventing pesticide use by pregnant women.

Key words: acute leukemia, children, Hodgkin lymphoma, non-Hodgkin lymphoma, pesticide, pregnancy. Environ Health Perspect 115:1787–1793 (2007) . doi:10.1289/ehp.10596 available via http://dx.doi.org/ [Online 25 September 2007]

Address correspondence to J. Rudant, INSERM U754, 16, AV, Paul Vaillant Couturier, F-94807 Villejuif Cedex, France. Telephone: 33 1 45 59 50 37. Fax: 33 1 45 59 51 51. E-mail: rudant@vjf.inserm.fr

Supplemental Material is available online at http://www.ehponline.org/members/2007/10596/suppl.pdf

We are grateful to the SFCE (Société française des cancers de l'enfant) investigators of the ESCALE study (see Supplemental Material) ; M.-H. Da Silva ; C. Steffen ; A. Goubin and the staff of the French National Registry of Childhood Blood Malignancies ; C. Tricoche and the team of interviewers (Callson) ; and S. Mélèze and M.-A. Noel (Institut CSA) .

This research was sponsored by grants from INSERM, Fondation de France, ARC (Association pour la recherche sur le cancer) , AFSSAPS (Agence française de sécurité sanitaire des produits de santé) , AFSSET (Agence française de sécurité sanitaire de l'environnement et du travail) , and Cent pour sang la vie.

This work, presented at the Grell Meeting 2007 in Montreal, was awarded the "Enrico Anglesio" Prize, offered by the "Anglesio Moroni Foundation," Turin, Italy.

The authors declare they have no competing financial interests.

Received 25 June 2007 ; accepted 24 September 2007.