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Biomedicine & Pharmacotherapy 63 (2009) 383e395
Review
Anatomopathology Laboratory, Centre Hospitalier Universitaire de Fort de France, French West Indies, F-97200 Fort de France, Martinique
b
Joint Committee of Medical Doctors for Martiniques Environmental Health, Martinique
c
Department of Urology, Centre Hospitalier Universitaire de Fort de France, French West Indies, F-97200 Fort de France, Martinique
d
French West Indies, F-97200 Fort de France, Martinique
e
Department of Obstetrics and Gynaecology, Centre Hospitalier Universitaire de Fort de France, French West Indies, F-97200 Fort de France, Martinique
f
Department of Paediatrics, Centre Hospitalier Regional du Lamentin, French West Indies, F-97232 Lamentin, Martinique
g
Department of Paediatrics, Centre Hospitalier Universitaire de Fort de France, French West Indies, F-97200 Fort de France, Martinique
h
Cancer Research Center, Association for Research and Treatments Against Cancer (ARTAC), 57-59 rue de la convention, F-75015 Paris, France
i
Paris V University, Department of Medical Oncology, European Hospital Georges Pompidou (HEGP), F-75015 Paris, France
Received 16 March 2009; accepted 15 April 2009
Available online 12 June 2009
Abstract
Prostate and breast cancers have become very frequent in Martinique. We previously conducted a multifactorial analysis in the French
Caribbean Island, Martinique, in order to elucidate the aetiology of prostate cancer. Using a linear regression analysis, we found that the growth
curves of incidence rates for Martinique and metropolitan France have been significantly diverging since 1983. Although a Caribbean genetic
susceptibility factor may be involved in prostate carcinogenesis: this factor, because it could not have changed during the observation period,
cannot per se account for the growing incidence of this cancer in the island. We therefore suggested that among possible environmental factors,
the intensive and prolonged exposure to Carcinogenic, Mutagenic and/or Reprotoxic (CMR) or presumed CMR pesticides may account for the
observed growing incidence of prostate cancer and thus may be involved in prostate carcinogenesis.
In this study, we further attempt to show that due to their carcinogenic properties, pesticides and especially organochlorine pesticides may in
fact be causally implicated in the growing incidence of prostate cancer in Martinique. Also, we suggest that CMR or presumed CMR pesticides
may be causally involved in the growing incidence of breast cancer through a common endocrine disruption mechanism.
We therefore propose that protective medical recommendations should be immediately set up and carried out by general practitioners,
paediatricians, obstetricians, gynaecologists and urologists; and that public health measures of primary precaution and prevention should be
urgently taken in close collaboration with health professionals in order to protect population, more especially pregnant women and children, with
the final objective perhaps that these medical recommendations and public health measures will stop Martiniques cancer epidemic.
2009 Elsevier Masson SAS. All rights reserved.
Keywords: Endocrine disruptors; Prostate cancer; Breast cancer; Cancer; Carcinogenesis; Pesticides; Foetus-susceptibility; Obesity; Low dose
Abbreviations: AMREC, association martiniquaise de recherche et depidemiologie sur le cancer; ARs, androgenic receptors; BPA, bisphenol A; CMR,
carcinogenic mutagenic and/or reprotoxic; CYP450, cytochrome P450; DDE, 1,1-dichloro-2,20 -bis-p-chlorophenyl-ethylene; DDT, dichloro-diphenyl-trichloroethane; DHT, dihydrotestosterone; ERs, estrogen receptors; GJIC, gap junctional intercellular communication; HCB, hexachlorobenzene; HCH, hexachlorohexane;
IARC, international agency for research on cancer; InVS, institut national de veille sanitaire; PCBs, polychlorobiphenyls; PIN, precancerous prostate intraneoplasic.
* Corresponding author at: ARTAC, 57-59 rue de la convention, 75015 Paris, France. Tel.: 33 (0)1 45 78 53 53; fax: 33 (0)1 45 78 53 50.
E-mail address: artac.cerc@wanadoo.fr (D. Belpomme).
0753-3322/$ - see front matter 2009 Elsevier Masson SAS. All rights reserved.
doi:10.1016/j.biopha.2009.04.043
384
1. Introduction
Using a linear regression analysis, we have found that the
growth curves of prostate cancer incidence rates for
Martinique and metropolitan France have been significantly
diverging since 1983 [1]. Because these curves are not
parallel, this suggests that although a Caribbean genetic
susceptibility factor may be involved in prostate carcinogenesis, this factor, because it could not have changed during the
observation period e the duration of this period is too short for
effective genetic change associated with gene segregation -,
cannot per se account for the observed growing incidence of
prostate cancer in the island.
Estimation of the total amount of pesticides brought to the
island and mapping analysis of soil pollution showed that water
contamination originates from banana plantations and that
people were permanently contaminated since 1955 by huge
quantities of pesticides. Indeed, our analysis in 1972 revealed that
all subjects investigated for the presence of pesticides in their
adipose tissue have been contaminated by extremely high levels
of organochlorine pesticides such as dichloro-diphenyl-trichloroethane (DDT), 1,1-dichloro-2,20 -bis-p-chlorophenylethylene (DDE), a, b and several of them by g Hexachlorohexane
(HCH), and aldrin and dieldrin.
We therefore have suggested that environmental factors
such as the intensive and prolonged exposure to Carcinogenic,
Mutagenic and/or Reprotoxic (CMR) or presumed CMR
pesticides may account for the observed growing incidence of
prostate cancer and thus may be involved in prostate
carcinogenesis.
In the present paper, we further attempt to show that due to
their carcinogenic properties, pesticides and especially
organochlorine pesticides may in fact be causally implicated
in the growing incidence of prostate cancer in Martinique.
Also, we suggest that these pesticides may be implicated in the
growing incidence of breast cancer, since rise of incidence of
breast and prostate cancers occurred approximately at
a similar time and pesticides used in the island have been
experimentally shown to cause both cancer types through
common endocrine disrupting mechanisms. We therefore
propose that public health measures of primary precaution and
prevention should be immediately taken in order to protect
population from pesticide exposure.
91.9
77
82.5
Metropolitan departments
Bas-Rhin
69.34
Calvados
72.12
Doubs
47.53
Ise`re
70.70
Somme
52.26
Tarn
80.77
70.73
71.48
67.36
80.57
74.82
66.05
75
74.5
75.6
76.3
73.3
76.4
81.9
82.5
82.7
83.1
81.3
83
Martinique
65.3
75.3
82.1
152.7
World standardized rates per 100,000; data source was obtained from
Globocan 2002 [140].
b
Data source was obtained from Score sante [141] (year 1999).
385
Fig. 4. Age distribution for breast cancer for 2002 in Martinique in comparison
with metropole France. Median age (years) is 60e69 for Martinique and
similar for metropolitan France.
386
387
Table 2
CMR and presumed CMR pesticides used intensively since 1955 in Martinique.
On the market
HCB
Technical DDTa
Technical HCHb
Lindane
Toxaphene
Aldrin/dieldrin
Endosulfan
Endrind
Chlordanese
Chlordecone
Perchlordecone (mirex)f
Simazineg
a
b
c
d
e
f
g
h
1933
1939
1940c
1940c
1945
1950c
1954c
1960c
1960c
1972
1977c
1991c
Maximum of use
1960e90
1950e60
1950e60
1972e84
1960
1980e90
Continuation of use
1998
1992
1992
1980
1980
1990
1990
2001
1993
IARC classification
2B
2B
2B
2B
2B
3
NCh
3
2B
2B
2B
3
Technical DDT is a mixture of the isomers p,p0 -DDT (85%), o,p0 -DDT (15%) and o,o0 -DDT (<1%).
Technical HCH is a mixture of the isomers a, b and g.
Official data not available.
Endrin is a dieldrin stereoisomer.
Chlordanes include trans-chlordane, cis-chlordane, trans-nonachlor, cis-nonachlor and heptachlor.
To our knowledge, mirex was not used intensively in Martinique, but in Guadeloupe.
Simazine, a non organochlorinated molecule, is associated with an increased risk of prostate cancer [19].
Not classified.
Table 3
Mean concentrations and extremes values of organochlorinated pesticides dosed in the adipose tissue of normal subjects in 1972 in Martinique.a,b
DDT
DDE
aHCH
bHCH
gHCH
16e68 years
(28)
2.5
(0.7e9)
2.66
(0.3e16)
0.14
(0.01e0.6)
0.30
(0.06e2)
0.10
(0.03e0.24)
11e16 years
(6)
1.1
(0.8e8)
2
(1.4e7)
0.14
(0.04e0.3)
0.36
(0.14e0.6)
0.2
e
388
389
390
391
392
393
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