Agricultural work (predominantly farming) is an occupation that has been most frequently associated with MM.81 Early reports from Iowa farmers in the 1970s showed a significantly higher mortality rate for MM and leukemia.82 A recent update of these data suggest that association between farmers and MM is weaker than initially reported.983 84 Similar results were reported from Sweden. There were 568 MM cases among 254,417 men working in agriculture, with an estimated RR of 1.20 (95% CI 1.09-1.33).85 Meta-analyses of peer-reviewed studies of MM and farming including 32 studies published between 1981 and 1996 confirmed a low risk of MM.86 Other studies evaluated the work environment in agriculture and risk of MM. Farming has many potential carcinogenic exposures, such as animals and zoophilic viruses, grains, dust, fertilizers, pesticides, or benzene and engine fumes. In Italy, a case-controlled study for 71 cases of leukemia, lymphoma, and myeloma estimated the risk of hematologic malignancies for agricultural workers at 1.63 (95% CI 0.69-4.34) in males and 6.00 (95% CI 1.21-25.52) in females, with significantly increased risks after DDT exposure (OR = 4.11; 95% CI 1.16-14.55).87 In another case-control study from Italy, MM risk was not increased among workers in agriculture as a whole (OR = 1.31, 95% CI 0.62-2.74), but was increased among workers cultivating apples and pears and with exposure to chlorinated insecticides.88 In a large cohort of 120,000 male and 85,000 female farmers in Finland, 17,000 cancer cases were observed. Compared with the incidence of cancer in the Finnish population, both genders experienced a 17-18% decreased risk of cancer. The risks were low in smoking-related cancers. Cancers with higher incidence were lip cancer and Hodgkin's disease in males. Risk of Hodgkin's disease was highest in farms without animals (RR = 1.74, CI 1.12-2.59). MM was found in excess among farmers working in pig or poultry farms.89 Others studies failed to link farm animals to MM.90

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