ABSTRACT

The goal of this study was to estimate the prevalence of environmental and occupational exposure to pesticides according to sociodemographic factors among cancer patients. It is a cross-sectional study with cancer patients in the state of Mato Grosso. The prevalence of environmental and occupational exposure to pesticides was calculated as to the variables gender, age, macro-region, and education. Pesticide use per agricultural crops in liters was estimated, and a thematic map was constructed following the macro-region of the agricultural economy. Of the 998 patients, most were female (54.9%), aged between 50 and 69 years old (50.1%), had less than eight years of schooling (60.7%), and resided in the South-Central macro-region (55.4%). Regarding environmental and occupational exposure, 53.1% of the patients live or have lived in a municipality with agricultural plantations; 17.4% lived near crops; 43.4% worked in agriculture, livestock, or extractivism; and 22.9% worked or work directly with pesticides. Environmental and occupational exposure was higher in males, in the older age groups, schooling from 0 to 4 years, and in the macro-regions with higher pesticide use. The study concluded that environmental and occupational exposure among cancer patients is associated to sociodemographic characteristics and macro-regions of the agricultural economy.

KEYWORDS
Pesticides; Neoplasms; Occupational exposure; Environmental exposure

RESUMO

O objetivo deste estudo foi estimar a prevalência de exposição ambiental e ocupacional aos agrotóxicos conforme fatores sociodemográficos entre pacientes com câncer. Trata-se de um estudo observacional de delineamento transversal com pacientes com câncer do estado de Mato Grosso. Foi calculada a prevalência de exposição ambiental e ocupacional aos agrotóxicos conforme as variáveis sexo, faixa etária, região e escolaridade. Foram estimados o uso de agrotóxicos por culturas agrícolas em litros e construído mapa temático segundo a macrorregião de economia agropecuária. Dos 998 pacientes, a maioria era do sexo feminino (54,9%), tinha entre 50 e 69 anos (50,1%), possuía menos de oito anos de escolaridade (60,7%) e residiam na macrorregião Centro-Sul (55,4%). Em relação à exposição ambiental e ocupacional, 53,1% dos pacientes moram ou moraram em município com plantação agrícola, 17,4% residiam próximo à lavoura, 43,4% trabalharam na agricultura, pecuária ou extrativismo e 22,9% trabalharam ou trabalham diretamente com agrotóxicos. A exposição ambiental e ocupacional foi maior no sexo masculino, nas faixas etárias mais elevadas, escolaridade de 0 a 4 anos e nas macrorregiões de maior uso de agrotóxicos. Conclui-se que a exposição ambiental e ocupacional entre pacientes com câncer se associou as características sociodemográficas e macrorregiões de economia agropecuária.

PALAVRAS-CHAVE
Agrotóxicos; Neoplasias; Exposição ocupacional; Exposição ambiental

Introduction

Brazil is the largest pesticide consumer in the world, and the State of Mato Grosso is the largest consumer in Brazil¹1 Bombardi LM. Agrotóxicos e agronegócio: arcaico e moderno se fundem no campo brasileiro. In: Merlino T, Mendonça ML. Direitos humanos no Brasil 2012: relatório da Rede Social de Justiça e Direitos Humanos. São Paulo: Rede Social de Justiça e Direitos Humanos, 2012.,²2 Pignati WA, Machado JMH, Cabral JF. Acidente rural ampliado: o caso das “chuvas” de agrotóxicos sobre a cidade de Lucas do Rio Verde - MT. Ciênc. saúde coletiva. 2007; 12(1):105-14.. Such consumption is directly related to the agribusiness production process, which involves the large-scale use of pesticides in aerial, tractor, or manual spraying²2 Pignati WA, Machado JMH, Cabral JF. Acidente rural ampliado: o caso das “chuvas” de agrotóxicos sobre a cidade de Lucas do Rio Verde - MT. Ciênc. saúde coletiva. 2007; 12(1):105-14.,³3 Pignati WA, Oliveira NP, Silva AMC. Vigilância aos agrotóxicos: quantificação do uso e previsão de impactos na saúde-trabalho-ambiente para os municípios brasileiros. Ciênc. saúde coletiva. 2014; 19(12):4669-78..

As to Pignati et al.²2 Pignati WA, Machado JMH, Cabral JF. Acidente rural ampliado: o caso das “chuvas” de agrotóxicos sobre a cidade de Lucas do Rio Verde - MT. Ciênc. saúde coletiva. 2007; 12(1):105-14. and Oliveira et al.⁴4 Oliveira LK, Pignati WA, Pignatti MG, et al. Processo sócio-sanitário-ambiental da poluição por agrotóxicos na bacia dos rios Juruena, Tapajós e Amazonas em Mato Grosso, Brasil. Saúde Soc. 2018; 27(2):573-87., the contamination of the air, rainwater, rivers, springs, and soil results from the increase in pesticide drift and residues. This widespread chemical contamination scenario exposes human health to risks, and environmental health is harmed due to large-scale releases of new pesticides in Brazil in recent years. The underreporting of pesticide poisonings in Brazil and in the state of Mato Grosso⁵5 Pignati WA, Soares MR, Lara SS, et al. Exposição aos agrotóxicos, condições de saúde autorreferidas e Vigilância Popular em Saúde de municípios mato-grossenses. Saúde debate. 2022; 46(2):45-61.,⁶6 Nasrala Neto E, Lacaz, FAC, Pignati WA. Health surveillance and agribusiness: the impact of pesticides on health and the environment. Danger ahead! Ciênc. saúde coletiva. 2014; 19(12):4709-18. is also an issue. As to Bombardi¹1 Bombardi LM. Agrotóxicos e agronegócio: arcaico e moderno se fundem no campo brasileiro. In: Merlino T, Mendonça ML. Direitos humanos no Brasil 2012: relatório da Rede Social de Justiça e Direitos Humanos. São Paulo: Rede Social de Justiça e Direitos Humanos, 2012., it is also possible to infer the presence of a large number of underreported pesticide poisoning episodes as to observe the ratio between the low number of reported intoxication and the pesticide sales volume.

Pignati et al.²2 Pignati WA, Machado JMH, Cabral JF. Acidente rural ampliado: o caso das “chuvas” de agrotóxicos sobre a cidade de Lucas do Rio Verde - MT. Ciênc. saúde coletiva. 2007; 12(1):105-14.,³3 Pignati WA, Oliveira NP, Silva AMC. Vigilância aos agrotóxicos: quantificação do uso e previsão de impactos na saúde-trabalho-ambiente para os municípios brasileiros. Ciênc. saúde coletiva. 2014; 19(12):4669-78.,⁵5 Pignati WA, Soares MR, Lara SS, et al. Exposição aos agrotóxicos, condições de saúde autorreferidas e Vigilância Popular em Saúde de municípios mato-grossenses. Saúde debate. 2022; 46(2):45-61., Bombardi¹1 Bombardi LM. Agrotóxicos e agronegócio: arcaico e moderno se fundem no campo brasileiro. In: Merlino T, Mendonça ML. Direitos humanos no Brasil 2012: relatório da Rede Social de Justiça e Direitos Humanos. São Paulo: Rede Social de Justiça e Direitos Humanos, 2012., Curvo et al.⁷7 Curvo HRM, Pignati WA, Pignatti MG. Morbimortalidade por câncer infantojuvenil associada ao uso agrícola de agrotóxicos no Estado de MT- Brasil. Rio de Janeiro, Cad. saúde coletiva. 2013; 21(1):10-17., Neves and Pignati⁸8 Neves MS, Pignati WA, Pignatti MG, et al. Determinação social do processo saúde-adoecimento mental de trabalhadores rurais no Brasil. Aceno. 2020; 7(14):231-48., Costa et al.⁹9 Costa V, Pignati WA, Neves MN, et al. Aspectos socioeconômicos, culturais e ambientais dos suicídios de trabalhadores(as) no agronegócio na Bacia do Rio Juruena, Mato Grosso. In: Pignati WA, Corrêa MLM, Leão LHC, et al., organizers. Desastres sócio-sanitários-ambientais do agronegócio e resistências agroecológicas no Brasil. São Paulo: Outras Expressões; 2021., Lara et al.¹⁰10 Lara SS, Pignati WA, Pignatti MG, et al. Intoxicações agudas por agrotóxicos relacionadas ao trabalho: nas regiões que mais produzem, maior é a incidência no Mato Grosso. In: Pignati WA, Corrêa MLM, Leão LHC, et al., organizers. Desastres sócio-sanitários-ambientais do agronegócio e resistências agroecológicas no Brasil. São Paulo: Outras Expressões; 2021., Soares et al.¹¹11 Soares MR, Andrade ACS, Pignatti MG, et al. Abortos espontâneos em municípios de uso agrícola de agrotóxicos no Mato Grosso. In: Pignati WA, Corrêa MLM, Leão LHC, et al., organizers. Desastres sócio-sanitários-ambientais do agronegócio e resistências agroecológicas no Brasil. São Paulo: Outras Expressões; 2021., Mostafalou and Abdollahi.¹²12 Mostafalou S, Abdollahi M. Pesticides: an update of human exposure and toxicity. Arch Toxicol. 2017; 91(2):549-99., Guyton et al.¹³13 Guyton KZ, Loomis D, Grosse Y, et al. Carcinogenicity of tetrachlorvinphos, parathion, malathion, diazinon, and glyphosate. Lancet Oncol. 2015; 16(5):490-1., IARC¹⁴14 Internacional Agency for Research on Cancer. Monographs evaluate DDT, lindane, and 2,4-Db, 2015. [access 2023 Jan 10]. Available at: https://www.iarc.fr/wp-content/uploads/2018/07/pr236_E.pdf.
https://www.iarc.fr/wp-content/uploads/2... , and Séralini et al.¹⁵15 Séralini GE, Clair E, Mesnage R, et al. Republished study: long term toxicity of a roundup herbicide and a roundup-tolerant genetically modified maize. Env. Sci. Eur. 2014; (26):1-17. have shown the most relevant acute and chronic poisoning effects on the health of workers, populations, and the environment due to the use of pesticides, fertilizers, and transgenic seeds, among them are: adult and child cancers, endocrine disorders, neurological and cognitive disorders, fetal malformation, mental illness, suicide, miscarriage, evolving in many cases to death or irreversible damage to the health of individuals. Nogueira et al.¹⁶16 Nogueira FAM, Szwarcwald CL, Damacena GN. Exposição a agrotóxicos e agravos à saúde em trabalhadores agrícolas: o que revela a literatura? Rev Bras Saúde Ocup. 2020; 45(e36)., Pluth et al.¹⁷17 Pluth TB, Zanini LAG, Battisti IDE. Pesticide exposure and cancer: an integrative literature review. Saúde debate. 2019; 43(122):906-24., Lerro et al.¹⁸18 Lerro CC, Freeman LEB, Portengen L, et al. A longitudinal study of atrazine and 2,4-d exposure and oxidative stress markers among iowa corn farmers. Environ Mol Mutagen. 2017; 38(1):30-8. and Moura¹⁹19 Moura LTR, Bedor CNG, Lopez RVM, et al. Exposição ocupacional a agrotóxicos organofosforados e neoplasias hematológicas: uma revisão sistemática. Rev Bras Epidemiol. 2020; 23(e200022). reveal the increased risk of breast, prostate, lung, bladder, and lymphoma cancers due to environmental and occupational exposure to pesticides.

Given the above - contributing factors to the processes of surveillance, notification, and expansion of information on the effects of acute and chronic poisoning by pesticides in Brazil -, this article aims to estimate the prevalence of environmental and occupational exposure to pesticides as per sociodemographic factors among cancer patients in Mato Grosso.

Material and methods

This study is part of the research project ‘Cancer and its associated factors: analysis of population-based and hospital registry in Cuiabá-MT’, developed by the Institute of Collective Health-UFMT, by means of NEAST - Center for Environmental, Health and Labor Studies and VIGICAN Project in partnership with the State Department of Health (SES-MT) and funded by the Ministry of Labor (MPT) 23rd Region.

This is an observational, cross-sectional study of cancer patients aged 18 years or older treated in oncology referral services in the state. The cancer care network in the state has five services qualified as UNACON, being three in the capital and two in the state²⁰20 Mato Grosso. Secretaria de Estado de Saúde. Resolução CIB/MTnº001 de 09 de Março de 2017. Dispõe sobre a homologação da Resolução CIB/MT Ad referendum Nº 001 de 20 de fevereiro de 2017 que versa sobre a aprovação do Plano de Ação da Atenção Oncológica no Estado de Mato Grosso 2017 a 2019. Diário Oficial. 10 Mar 2017. [access 2023 Jan 10]. Available at: http://www.saude.mt.gov.br/legislacao?origem=19&p=ad+referendum&num=01&mes=&ano=2017.
http://www.saude.mt.gov.br/legislacao?or... countryside. The institutions select for study²⁰20 Mato Grosso. Secretaria de Estado de Saúde. Resolução CIB/MTnº001 de 09 de Março de 2017. Dispõe sobre a homologação da Resolução CIB/MT Ad referendum Nº 001 de 20 de fevereiro de 2017 que versa sobre a aprovação do Plano de Ação da Atenção Oncológica no Estado de Mato Grosso 2017 a 2019. Diário Oficial. 10 Mar 2017. [access 2023 Jan 10]. Available at: http://www.saude.mt.gov.br/legislacao?origem=19&p=ad+referendum&num=01&mes=&ano=2017.
http://www.saude.mt.gov.br/legislacao?or... comprised the Júlio Muller University Hospital (HUJM), the teaching hospital of the Federal University of Mato Grosso (UFMT), and the Mato Grosso Cancer Hospital (HCan) - a High Complexity Oncology Care Unit (UNACON), reference in cancer care in the State, and responsible for about 70% of the total oncology care in Mato Grosso.

A convenience sample of patients aged 18 years or older under treatment for cancer seen at the outpatient clinics of HCan and HUJM, was selected during the period from November 2019 to March 2020. All those who were waiting for care on the day of data collection were invited to participate in the survey.

The maximum proportion (p = 0.50), a tolerable error (2.5%), and a confidence level (95%) were taken into account for the sample calculation of cancer patients interviewed in the two selected hospital units, the number of admissions from the hospital cancer registry (2015), of patients aged 20 years or older units. The estimated sample size was 1,050 patients, considering 10% of losses. A total of 1,122 patients over 18 years of age were invited to participate in the survey, of whom six refused, 21 could not locate their records, and 83 had an unconfirmed cancer diagnosis. The final sample was made up of 1,012 patients, 968 of whom were treating at the HCan outpatient clinic and 44 at the HUJM. Of this total, 14 (1.4%) were excluded for living in other states, why 998 patients remained in the sample analyzed.

Data collection was performed by trained interviewers by means of face-to-face interviews in a place reserved for this purpose in the outpatient clinics, with the aid of an electronic data collector (Open Data Kit - ODK) installed on an Android tablet. We used a structured questionnaire divided into twelve blocks previously tested in the pilot study.

Environmental exposure to pesticides was measured by two questions: ‘Are there agricultural crops in the municipality you live or have lived in last ten years? (soybean, corn, cotton, and sugarcane)?’ (yes; no); and ‘Is your residence close to any crops?’ (yes; no). Occupational exposure to pesticides was measured by two questions: ‘Has the respondent worked in agriculture, livestock or extractivism?’ (yes; no); and ‘Have you worked or do you work with pesticides: insecticides, fungicides, herbicides, acaricide?’ (yes; no). The distance from the residence to the farm was also evaluated: less than 10 meters, 10 to 50 meters, 50 to 90 meters, 90 to 300 meters, 300 to 1,000 meters, and more than 1,000 meters.

The independent variables were gender: male and female; age group: 18 to 39; 40 to 49; 50 to 59; 60 to 69; 70 years or older; education: 0 to 4; 5 to 8; 9 to 11; 12 years or more; and municipality of residence following the macro-regions of agricultural economy: South Central; Middle North; Northeast; Northwest; North; West, and Southeast²¹21 Instituto Mato-grossense de economia agropecuária. Mapa das macrorregiões do IMEA. [sem local]: IMEA; 2017. [access 2023 Jan 10]. Available at: http://www.imea.com.br/upload/publicacoes/arquivos/justificativamapa.pdf.
http://www.imea.com.br/upload/publicacoe... .

To estimate the use of pesticides by municipalities and agricultural crops, we collected information on the planted area in hectares as for the municipal agricultural production of IBGE/SIDRA and the Pignati et al.²²22 Pignati WA, Lima FANS, Lara SS, et al. Distribuição espacial do uso de agrotóxicos no Brasil: uma ferramenta para a vigilância em saúde. Ciênc. saúde coletiva. 2017; 22(10):3281-93. method, which estimates the consumption of pesticides per liter according to permanent and temporary cultures and municipalities. After the calculation, carried out by multiplying the planted area per crop and the estimated pesticide use per liter, we summed up the consumption per year and per municipality and calculated the mean of the period for the seven macro-regions of the Agricultural Economics Institute (IMEA)²¹21 Instituto Mato-grossense de economia agropecuária. Mapa das macrorregiões do IMEA. [sem local]: IMEA; 2017. [access 2023 Jan 10]. Available at: http://www.imea.com.br/upload/publicacoes/arquivos/justificativamapa.pdf.
http://www.imea.com.br/upload/publicacoe... .

Descriptive analysis was performed using absolute and relative frequencies and the calculation of the mean and Standard Deviation (SD). We estimated the prevalence and respective confidence intervals (95%CI) of environmental and occupational pesticide exposure according to gender, age group, education, and agricultural economy macro-regions. Pearson’s chi-square test was applied to investigate the factors associated with exposure to pesticides. The analyses were performed in STATA software version 16.0 and R version 4.1.0. This study adopted a 5% significance level. The thematic map was constructed by using ESRII’s ArcGis 10.5 geographic software and the digital mesh of municipalities in Mato Grosso²³23 Instituto Brasileiro de Geografia e Estatística. Malha Municipal Mato Grosso, por municípios. Rio de Janeiro: IBGE; 2020. [access 2023 Jan 10]. Available at: https://www.ibge.gov.br/geociencias/organizacao-do-territorio/malhas-territoriais/15774-malhas.html?=&t=downloads.
https://www.ibge.gov.br/geociencias/orga... .

The project and this study were approved by the Ethics Committee of the Júlio Muller University Hospital (CEP-HUJM) CAAE: 98150718.1.0000.8124, opinion number 3.048.183 dated 11/20/2018, and by the CEP SES-MT CAAE: 98150718.1.3003.5164, opinion number 3.263.744 dated 12/04/2019. They also received a public funding provided by the technical cooperation agreement No. 08/2019, signed between the Public Ministry of Labor of Mato Grosso, 23nd region, and the Institute of Collective Health of UFMT.

Results

The mean age among the 998 patients was 56.7 years old (SD: 14.3); the majority of females (54.9%); age group between 50 and 69 years of age (50.1%), less than eight years of schooling (60.7%); residing in the Central-South macro-region (55.4%), where the capital Cuiabá is located (28.2%); it is followed by the Southeast macro-region (14.2%), and, in a smaller proportion, by the Northeast macro-region (3.5%; table 1).

Regarding the spatial distribution of pesticide use according to the macro-region of the agricultural economy, we observed higher consumption in the mid-north macro-region, followed by the Southeast and West macro-regions (figure 1-A). Most of the patients surveyed reside in the South-Central macro-region, followed by the Southeast, West, and North macro-regions (figure 1-B).

Regarding environmental and occupational exposure to pesticides, 53.1% live or have lived in a municipality with agricultural crops; 17.4% lived near a plantation; 43.4% have worked in agriculture, livestock, or extractivism; and 22.9% have worked or work with pesticides (tables 2 and 3). Among those who reported living near crops, 39.0% resided more than 1,000 meters away, 22.6% from 300 to 1,000 meters, 26.3% from 50 to 300 meters, and 11.6% less than 50 meters away.

The highest prevalence of living or having lived in a municipality with an agricultural plantation was among males, with 0 to 4 years of schooling and who did not reside in the South-Central macro-region. Living close to crops was more frequent among those with 0 to 4 years of schooling, 4 to 8 years of schooling, and who resided in the Western, Mid-Northern, and Northeastern macro-regions. Working in agriculture, livestock, or extractivism and working or having worked directly with pesticides was more frequent among males, older age group, increasing dose-response effect, from 0 to 4 years of schooling, who did not reside in the South-Central macro-region (tables 2 and 3).

Discussion

The estimated population of Mato Grosso in 2020 was 3,526,220 inhabitants. The State is the third largest in the country; a density of 3.9 inhabitants per km²; 141 municipalities distributed in seven macro-regions with an agricultural economy²³23 Instituto Brasileiro de Geografia e Estatística. Malha Municipal Mato Grosso, por municípios. Rio de Janeiro: IBGE; 2020. [access 2023 Jan 10]. Available at: https://www.ibge.gov.br/geociencias/organizacao-do-territorio/malhas-territoriais/15774-malhas.html?=&t=downloads.
https://www.ibge.gov.br/geociencias/orga... ; the largest population concentration is found in the capital, Cuiabá, with 618,124 inhabitants²⁴24 Instituto Brasileiro de Geografia e Estatística. Cidades: Mato Grosso. Rio de Janeiro: IBGE; 2021. [access 2023 Jan 10]. Available at: https://cidades.ibge.gov.br/brasil/mt/panorama.
https://cidades.ibge.gov.br/brasil/mt/pa... . The State has the highest consumption of pesticides and deforestation in the country, annually using more than 13 million hectares for the cultivation of monocultures, and a pesticide use that exceeds 207 million per year, being the mid-north region responsible for 28% of this consumption²²22 Pignati WA, Lima FANS, Lara SS, et al. Distribuição espacial do uso de agrotóxicos no Brasil: uma ferramenta para a vigilância em saúde. Ciênc. saúde coletiva. 2017; 22(10):3281-93..

This geo-economic scenario is marked by the contamination of waters, environmental matrices⁴4 Oliveira LK, Pignati WA, Pignatti MG, et al. Processo sócio-sanitário-ambiental da poluição por agrotóxicos na bacia dos rios Juruena, Tapajós e Amazonas em Mato Grosso, Brasil. Saúde Soc. 2018; 27(2):573-87.,²⁵25 Beserra L. Agrotóxicos, vulnerabilidades socioambientais e saúde: uma avaliação participativa em municípios da bacia do rio Juruena, Mato Grosso. [dissertação]. Cuiabá: Instituto de Saúde Coletiva da UFMT; 2017. and food²⁶26 Montanari Corrêa ML, Pignati WA, Pignatti MG, et al. Alimento ou mercadoria? Indicadores de autossuficiência alimentar em territórios do agronegócio, Mato Grosso, Brasil. Saúde debate. 2019; 43(123):1070-83.. An increase in childhood cancer⁷7 Curvo HRM, Pignati WA, Pignatti MG. Morbimortalidade por câncer infantojuvenil associada ao uso agrícola de agrotóxicos no Estado de MT- Brasil. Rio de Janeiro, Cad. saúde coletiva. 2013; 21(1):10-17. cases, acute poisoning by pesticides¹⁰10 Lara SS, Pignati WA, Pignatti MG, et al. Intoxicações agudas por agrotóxicos relacionadas ao trabalho: nas regiões que mais produzem, maior é a incidência no Mato Grosso. In: Pignati WA, Corrêa MLM, Leão LHC, et al., organizers. Desastres sócio-sanitários-ambientais do agronegócio e resistências agroecológicas no Brasil. São Paulo: Outras Expressões; 2021., work accidents related to agricultural and agro-industrial activities²⁷27 Fava NR, Soares MR, Andrade ACS, et al. Tendência dos acidentes de trabalho no agronegócio em Mato Grosso, Brasil, 2008 a 2017. Rev Bras Saúde Ocup. 2023; 48:e3., mental disorders, and suicide attempts⁸8 Neves MS, Pignati WA, Pignatti MG, et al. Determinação social do processo saúde-adoecimento mental de trabalhadores rurais no Brasil. Aceno. 2020; 7(14):231-48., among other issues related to exposure to pesticides, have also been identified. The timber industry production and mineral exploration in the State also generate chemical contaminants in their industrial processes, such as wood dust, silica, and heavy metals, which are associated with the occurrence of cancer²⁸28 Instituto Nacional de Câncer José Alencar Gomes da Silva. Ambiente, trabalho e câncer: aspectos epidemiológicos, toxicológicos e regulatórios. Rio de Janeiro: INCA; 2021..

Most of the study population currently resides in the center-south macro-region (55.4%), where the state capital is located, and the agricultural production does not predominate. This data may reflect the migration of patients from the countryside to the capitals for cancer treatment due to the inexistence of these services, as shown by Freire et al.²⁹29 Freire MEM, Costa SFG, Lima RAG, et al. Qualidade de vida relacionada à saúde de pacientes com câncer em cuidados paliativos. Texto & Contexto - Enferm. 2018; 27(2):e5420016.. The specialized oncology care services in the State are distributed in five health macro-regions and are concentrated in the North-Central macro-region, where the capital is located³⁰30 Mato Grosso. Secretaria Estadual de Saúde de Mato Grosso. Plano Estadual de Saúde - PES. 2016-2019. Cuiabá: SES-MT; 2017. [access 2023 Jan 10]. Available at: https://www.saude.ms.gov.br/planejamento/plano-estadual-de-saude/.
https://www.saude.ms.gov.br/planejamento... ,³¹31 Mato Grosso. Secretaria de Estado de Saúde de Mato Grosso. Caderno de Indicadores Demográficos Mato Grosso. Cuiabá: SES-MT; 2018. [access 2023 Jan 10]. Available at: http://www.seplan.mt.gov.br/documents/363424/0/Caderno+de+Indicadores+Demogr%C3%A1ficos+de+2018_atualizado+26.11.2018.pdf/702891e0-990c-e293-cf43-1fea25dd74a2.
http://www.seplan.mt.gov.br/documents/36... . So, it is necessary to consider the history of environmental and occupational exposure to pesticides and their connections with cancer³²32 Damalas CA, Eleftherohorinos IG. Pesticide exposure, safety issues, and risk assessment indicators. Int J Environ Res Public Health. 2011; 8(5):1402-19., considering the migration of patients to large centers and capitals for cancer treatment²⁹29 Freire MEM, Costa SFG, Lima RAG, et al. Qualidade de vida relacionada à saúde de pacientes com câncer em cuidados paliativos. Texto & Contexto - Enferm. 2018; 27(2):e5420016..

The prevalence of environmental and occupational exposure to pesticides in cancer patients in the state of Mato Grosso was higher in males and increased with older age groups, except for the variable of living near farms, which showed no significant association with gender and age group. Regarding schooling, the highest prevalence was observed in the lower schooling levels (0 to 8 years).

When analyzing the prevalence of environmental exposure to pesticides by region of residence, this study found that 53.1% live or have lived in cities with agricultural plantations, and 17.4% live near a farm, residing in cities of the Mid-North, North, West, and Southeast regions. Pignat et al.²¹21 Instituto Mato-grossense de economia agropecuária. Mapa das macrorregiões do IMEA. [sem local]: IMEA; 2017. [access 2023 Jan 10]. Available at: http://www.imea.com.br/upload/publicacoes/arquivos/justificativamapa.pdf.
http://www.imea.com.br/upload/publicacoe... pointed out seven municipalities in Mato Grosso macro-regions among the ten with the highest consumption of pesticides in Brazil. They are distributed among the mid-north: Sorriso, Nova Mutum, Nova Uniratã; west: Sapezal, Campo Novo do Parecis; southeast: Campo Verde; and center-south: Diamantino,

The results of this study corroborate Pluth et al.¹⁷17 Pluth TB, Zanini LAG, Battisti IDE. Pesticide exposure and cancer: an integrative literature review. Saúde debate. 2019; 43(122):906-24., who shows an association between living near farming crops or in regions of intense agricultural production and an increased risk of developing cancers. Soares³³33 Soares MR, Andrade ACS, Galvão ND, et al. Câncer infanto-juvenil: nas regiões mais produtoras e que mais usam agrotóxicos, maior é a morbidade e mortalidade no Mato Grosso. In: Pignati WA, organizer. Desastres sócio-sanitário-ambientais do agronegócio e resistências agroecológicas no brasil. 1. ed. São Paulo: Outras expressões; 2021 p. 249-62. showed an increase in cancer morbidity rates in municipalities of the mid-north macro-region of Mato Grosso, as well as in the West and North macro-regions, which, in this study, showed prevalence of environmental (76%) and occupational (69.1%) exposure to pesticides.

When analyzing the prevalence of occupational exposure to pesticides by labor history, this study identified 43.4% respondents working in agriculture, livestock, or extractivism, and 22.9% who have worked or currently work with pesticides. The data converge to the evidence of Damalas et al.³²32 Damalas CA, Eleftherohorinos IG. Pesticide exposure, safety issues, and risk assessment indicators. Int J Environ Res Public Health. 2011; 8(5):1402-19., Weichenthal et al.³⁴34 Weichenthal S, Moase C, Chan P. A review of pesticide exposure and cancer incidence in the agricultural health study cohort. Ciênc. saúde coletiva. 2012; 17(1):255-70., Nogueira et al.¹⁶16 Nogueira FAM, Szwarcwald CL, Damacena GN. Exposição a agrotóxicos e agravos à saúde em trabalhadores agrícolas: o que revela a literatura? Rev Bras Saúde Ocup. 2020; 45(e36)., Moura et al.¹⁹19 Moura LTR, Bedor CNG, Lopez RVM, et al. Exposição ocupacional a agrotóxicos organofosforados e neoplasias hematológicas: uma revisão sistemática. Rev Bras Epidemiol. 2020; 23(e200022)., and Pignati et al.²2 Pignati WA, Machado JMH, Cabral JF. Acidente rural ampliado: o caso das “chuvas” de agrotóxicos sobre a cidade de Lucas do Rio Verde - MT. Ciênc. saúde coletiva. 2007; 12(1):105-14..

Damalas et al.³²32 Damalas CA, Eleftherohorinos IG. Pesticide exposure, safety issues, and risk assessment indicators. Int J Environ Res Public Health. 2011; 8(5):1402-19. indicate that the presence of pesticides in the work environment puts workers’ health at risk, which increases whenever directly handling pesticides occurs. In this article, the prevalence of exposure to pesticides among participants who work or have worked directly with pesticide handling was 22.9%.

Moura et al.¹⁹19 Moura LTR, Bedor CNG, Lopez RVM, et al. Exposição ocupacional a agrotóxicos organofosforados e neoplasias hematológicas: uma revisão sistemática. Rev Bras Epidemiol. 2020; 23(e200022). showed an association between occupational exposure to organophosphates and the development of hematological neoplasms. Studies have pointed to the active ingredients of 2,4-D, diazinone, glyphosate, malathion and the development of different types of cancers¹⁶16 Nogueira FAM, Szwarcwald CL, Damacena GN. Exposição a agrotóxicos e agravos à saúde em trabalhadores agrícolas: o que revela a literatura? Rev Bras Saúde Ocup. 2020; 45(e36).,¹⁸18 Lerro CC, Freeman LEB, Portengen L, et al. A longitudinal study of atrazine and 2,4-d exposure and oxidative stress markers among iowa corn farmers. Environ Mol Mutagen. 2017; 38(1):30-8.. Despite the higher prevalence of those who reported having worked in agriculture, livestock, or extractivism compared to the prevalence of those who reported working or having worked directly with pesticides, the findings corroborate evidence of the association between developing cancer and the use of pesticides, when glyphosate, diuron, 2,4-D, acephate, atrazine, and malathion have been the most commonly used pesticides in Mato Grosso, as for Pignati et al.²²22 Pignati WA, Lima FANS, Lara SS, et al. Distribuição espacial do uso de agrotóxicos no Brasil: uma ferramenta para a vigilância em saúde. Ciênc. saúde coletiva. 2017; 22(10):3281-93..

Regarding the gender variable, the findings of this study corroborate the evidence of Oesterlund et al.³⁵35 Oesterlund AH, Thomsen JF, Sekimpi DK, et al. Pesticide knowledge, practice and attitude and how it affects the health of small-scale farmers in Uganda: a cross-sectional study. Afr Health Sci. 2014; 14(2):420-33. that point to a lower risk of symptoms related to occupational exposure to pesticides for females when compared to males. The authors criticize the small number of studies that compare different exposures by gender or sex. Regarding schooling, this study showed a higher prevalence of occupational exposure among participants of low education, which may consequence of not understanding or being unaware of the use of PPE and the proper handling of pesticides³⁶36 Assis MP, Barcella RC, Padilha JC, et al. Health problems in agricultural workers occupationally exposed to pesticides. Rev Bras Med Trab. 2021; 18(3):352-63.. The data corroborate Silva et al.³⁷37 Silva AMC, Soares MR, Silva NA, et al. Environmental and occupational exposure among cancer patients in Mato Grosso, Brazil. Rev Bras Epidemiol. 2022; 25(1):e220018., who showed more frequent environmental and occupational exposure among participants of less education. The authors argue that such occupational exposure may be related to jobs that require less schooling and are linked to directly handling pesticides.

As for age, this study found an increase in the prevalence of occupational exposure in older age groups. Regarding environmental exposure, the variable ‘residing near the farm’ showed no significant association with gender or age group. The result corroborates Silva et al.³⁷37 Silva AMC, Soares MR, Silva NA, et al. Environmental and occupational exposure among cancer patients in Mato Grosso, Brazil. Rev Bras Epidemiol. 2022; 25(1):e220018., who emphasize the increase in exposure with increasing age as an expected result.

Cross-sectional studies provide necessary information for planning and organizing health services; however, this study has the limitation of not having a counterpart group, i.e., participants who do not have cancer. However, the profile of environmental and occupational exposure to pesticides observed in this study was similar to the population without the studied effect, i.e., being a cancer patient. Finally, convenience sampling may also infer selection bias; this research was carried out in a reference hospital for cancer treatment in the State that provides services for patients from different regions or municipalities, which allows for a sample variety, so corroborates this bias reducing.

This study showed a higher prevalence of environmental and occupational exposure to pesticides in cancer patients in the state of Mato Grosso among male participants; and increasing in prevalence as a consequence of increasing in age, lower education, and greater use of pesticides in macro-regions.

The findings contribute to expanding the information needed to guide the formulation of policies, programs, and actions of health surveillance in the state of Mato Grosso, which is regarded by the literature as the largest Brazilian pesticide consumer and that carries out a high rate of pesticide poisoning underreporting, whether because the lack of worker health surveillance or of external pressures to notify the registry.

Data show evidence of the complexity in the evaluation of cancer associated to occupational and environmental exposure to pesticides, as they bring together interrelated variables from the causal, historical, economic, political, and geographical reasons that determine the conditions of exposure, illness, and death due to contamination by pesticides³⁸38 Breilh J. Critical epidemiology and the people’s health. New York: Oxford University Press; 2020..

This study suggests also the implementation of health surveillance in the state of Mato Grosso inhabitants exposed to pesticides as the investigation of pesticide contamination biomarkers among the population of municipalities that intensely use pesticides in farming and among workers in these productive sectors. They are necessary for the production of new evidence and forms of action to be taken against the risks produced by environmental and occupational contamination resulting from the use of pesticides.

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