Cancer Risk Among Residents of Rhineland-Palatinate Winegrowing Communities - Recent Advances and Issues in Environmental Science - page 105

with a large area under cultivation, the power of the study to detect slight increases in
incidence is limited. Many other potential risk factors of occupation and lifestyle from
living in agricultural area would need to be discussed to explain the findings, but these
would have to be collected in a study using individual information. For instance, data
on socioeconomic levels or smoking prevalence were not available on a small scale.
The use of 1996 data on agricultural characteristics might be criticized, since a lag
time of 4-7 years for cancers occurring 2000-2003 is not plausible. It was not possible
to obtain older data, but since the political boundaries did not change and agricultural
land use stayed constant, their use seems warranted in the current study.
The completeness of reported cancer cases is still relatively low in Rhineland-
Palatinate (about 80% for all cancers). Therefore, the calculation of SIRs for residents
of winegrowing communities in comparison with the population of Rhineland-Palati-
nate might at least partly refl ect a higher completeness rather than truly elevated risks.
As a probably more reliable approach of calculating cancer risks, we therefore decided
to compare the observed cancer cases in communities with a medium or a large area
under cultivation with--as a kind of internal reference--the number of cases reported
in communities with a small area under cultivation. While we regard the “internal”
comparison of winegrowing communities (communities with a medium or large area
versus small are under cultivation) as a more reliable approach than the comparison
with the Rhineland-Palatinate population, we nevertheless cannot totally exclude a
higher (or lower) completeness in communities with a medium or large area under
cultivation than in communities with a small area under cultivation.
Increased Incidence of Endocrine-related Tumors with the Estimated
Incidence of Cancer in the National Population of Germany as Reference
In our primary analysis, we compared cancer rates in communities with a large respi-
ratory medium area under cultivation with cancer rates in communities with a small
area under cultivation. However, in fact even in communities with a small area under
cultivation, cancer incidence might be elevated, potentially leading to an underesti-
mation of the results of our primary analysis (concerning RRs in communities with
medium or large area under cultivation). In a side analysis, we therefore calculated
SIRs regardless of the incompleteness of the Rhineland-Palatinate cancer. Because of
the incompleteness of the Rhineland-Palatinate cancer registry, the results of the cal-
culation of SIR tend to underestimate the true cancer risks for incompletely recorded
cancer subentities; therefore decreased SIR should not be interpreted. If SIRs were cal-
culated with the estimated incidence of cancer in the national population of Germany
as reference, among men we found an elevated SIR for prostate cancer and testicular
cancer in communities with a large area under wine cultivation. Among women, we
found an elevated SIR for endometrial cancer and (in communities with a medium
area under cultivation, but not in communities with a large area under cultivation) for
breast cancer incidence. Altogether, the results of our additional SIR analysis are com-
patible with a potential carcinogenic role of pesticides in the etiology of endocrine-
related tumors of the breast, testis, prostate, and endometrium.