| Abstract |
Introduction: The international literature has reported adequate evidence that cancer is a common cause of morbidity and mortality in farmers worldwide, as well as in the general population. In this profession, however, we often observe a lower incidence and mortality for all cancers than in other professions, while at the same time there are very high rates in certain specific types of malignancies. Reliable population data in Greece is missing, even though it is a predominantly rural country.
Aim: The current study aimed to identify which types of cancer are more common in farmers versus other occupations in Crete, Greece and to explore whether farmers as a profession acts as a determinant of the occurrence of these types of cancer.
Methodology: This study was part of the work of the Population-based Cancer Registration Center in Crete (C.R.C.) and followed the design of a pooled data analysis study within the open population of the C.R.C. For the needs of the research for malignant neoplasms based on profession, the study population was defined as the whole counties and municipalities of Crete. Study population was the total number of permanent residents of Crete (total population based on the 2011 census: 623,065). Of these, the total number of cases that had a confirmed diagnosis of any malignancy and were recorded in the CCP database was extracted. (as new cases and / or deaths) for the period 1992 to 2018. This total was the sample of our study (n = 48,451). Data analysis focused on the calculation of age-weighted incidence (ASIR / 100,000) and mortality (ASMR / 100.00), as well as the application of Spearman’s correlation coefficient and Binary logistic regression. All controls were two-sided at level of significance a = 0.05.
Results: The total sample was 48,451 cases of malignancies, and specifically the morbidity and mortality rates for all cancers in the total population for the period 1992-2018 were: ASIR = 324.1 / 100,000/ year and ASMR = 157, 5 / 100,000 / year. The total number of farmers was 7,912, about 16% of the total. The total morbidity and mortality for this population group was: ASIR = 305.3 / 100,000 farmers / year and ASMR = 198.2 / 100,000 farmers / year respectively. Farmers have a lower risk of mortality from any cancer than other occupations (RR = 0.5). However, they have a statistically significantly higher risk of mortality than other occupations of various types of malignancies. Specifically, the malignant neoplasms found (Pvalue <0.05) to be of increased risk for farmers (ranking RRs from highest to lowest) are as follows: skin melanoma (RR = 4), leukemias (RR = 2.2) , brain (RR = 2.1), stomach (RR = 1.9), mouth and lip (RR = 1.9), non-Hodgkin lymphomas (RR = 1.8), esophagus (RR = 1.6) , other malignancies of connective and soft tissue (RR = 1.6), prostate (RR = 1.5), liver and intrahepatic bile ducts (RR = 1.5), myeloma (RR = 1.4), lung and bronchi (RR = 1.3), colon (RR = 1.3) and Hodgkin lymphomas (RR = 1.3). Regarding the risk of morbidity of farmers from these types of cancer, it was shown that the existence of a family history of the same cancer increases the risk by 1.7 times. Respectively, the presence of a family history of other cancers showed an increased RR = 1.4. Other risk factors were smoking (RR = 1.8), number of packs of cigarettes per day (RR = 2.1), alcohol consumption (RR = 1.3), the number of glasses per day (RR = 1.7) and living near an area with high levels of BC, PM2.5, PM10 and / or NO2 (RR = 1.8). Regarding the risk of death of farmers from these types of cancer, the same factors mentioned above were found and characterized as statistically significant determinants that increase the risk. However, in the case of mortality, the stage at diagnosis also plays a core role, which the higher it is, the greater the risk by 2.5 times .
Conclusions: Farmers in Crete appeared to be of particular interest in terms of the incidence and mortality from malignancies. Of particular interest is the high mortality in certain types of cancer and the increased risk depending on various clinical characteristics and behavioral profiles. Particular discussion is needed at the stage at diagnosis, which appears to be advanced in this population group, indicating potential barriers to accessing health services or the particularities regarding health behavior of this population.
|
Search
