cancer de mama e agrotoxicos

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https://doi.org/10.1007/s11356-023-26420-8
RESEARCH ARTICLE
Exposure to pesticides and breast cancer in the city of Petrópolis, 
Brazil
Louise Moura de Rezende1 · Sabrina da Silva Santos1  · Gina Torres Rego Monteiro1
Received: 24 August 2022 / Accepted: 8 March 2023 
© The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2023
Abstract
To investigate the association between pesticide use and breast cancer. A hospital-based case–control study was conducted 
in Petrópolis city, Brazil. The study data were obtained through interviews, and the magnitude of the association between 
self-reported pesticide exposure and breast cancer was determined using unconditional logistic regression. A higher esti-
mated risk for breast cancer was found in women exposed to pesticides for 10 or more years, where this association was 
not statistically significant after adjusting for potential confounders (OR = 1.40; 95% CI 0.85–2.49). A positive statistically 
significant association was found between breast cancer and higher educational level or previous use of hormone replacement 
therapy (HRT), whereas having had 2 or more pregnancies to term proved a protective factor. Further studies elucidating 
the contribution of pesticide exposure to the development of breast cancer are needed, given that current findings in the 
literature are conflicting.
Keywords Breast cancer · Pesticides · Case–control study · Self-reported exposure · Petrópolis city · Brazil
Introduction
Breast cancer is a public health issue worldwide and a dis-
ease which requires prevention and control owing to its 
high rates of incidence and mortality. Rates of breast cancer 
incidence and mortality have been rising significantly over 
the years. In fact, since 2020, according to IARC estimates, 
breast cancer has become the most incident cancer in the 
world, exceeding lung cancer, with an incidence rate of 58.5 
cases per 10,000 population (Sung et al. 2021).
Most cases of cancer are associated with environmen-
tal exposure, including pesticides. A wide range of these 
compounds is classified as carcinogenic by the International 
Agency for Research on Cancer (WHO and IARC 2014). 
The action mechanisms can be a genotoxic effect, as can be 
seen for organochlorine and organophosphorus compounds 
(Jamil et al. 2004). Farther, a broad number of pesticides 
are considered as endocrine disruptors (Mnif et al. 2011) 
and some, such as atrazine, organophosphorus compounds, 
carbamates, and pyrethroids, were shown to be immunotoxic 
(Lee and Choi 2020). These mechanisms are involved in the 
physiopathology of breast cancer (Wan et al. 2022; Souza 
et al. 2022; Arévalo-Jaramillo et al. 2019). Corroborating 
these relationships, many studies have shown that individu-
als who work in farming and agriculture, and those who 
live in rural communities or that are exposed to pesticides, 
carry a higher risk of developing breast cancer (Eldakroory 
et al. 2017; Huang et al. 2019; Paydar et al. 2019; Silva et al. 
2019; Engel et al. 2017; Huang et al. 2019; Paydar et al. 
2019; Silva et al. 2019). However, these associations remain 
unclear since some studies have identified higher risk, but 
without statistical significance (Aronson et al. 2000; Demers 
et al. 2000; Farooq et al. 2010; Wolff et al. 2000; Zota et al. 
2010; Werder et al. 2020).
Since 2008, Brazil has been ranked as one of the larg-
est users of pesticides worldwide (Carneiro et al. 2015; 
Worldometer 2022; FAO 2022; Almeida et al. 2017; Pig-
nati et al. 2017). In the state for Rio de Janeiro, around 
1,800,000 hectares of land are dedicated to agriculture. In 
the state’s Mountain Region, where the cities of Petrópolis, 
Teresópolis, and São José do Vale do Rio Preto comprise the 
main agricultural center, 7% of the population is engaged in 
Responsible Editor: Lotfi Aleya
 * Sabrina da Silva Santos 
 sabrina_ssantos@hotmail.com
1 National School of Public Health (ENSP, Escola Nacional 
de Saúde Pública), Oswaldo Cruz Foundation (FIOCRUZ), 
Rio de Janeiro, RJ, Brazil
/ Published online: 15 March 2023
Environmental Science and Pollution Research (2023) 30:56534–56541
1 3
http://crossmark.crossref.org/dialog/?doi=10.1007/s11356-023-26420-8&domain=pdf
http://orcid.org/0000-0001-8327-3546
farming activities (IBGE 2006). Pesticide use in the region 
amounts to 56 kg per agricultural worker annually, exceed-
ing the state average (Peres and Moreira 2007).
Against this background, the objective of the present 
study was to investigate the association between self-
reported pesticide exposure and female breast cancer, 
according to risk factors related to exposure to estrogen, in 
women hospitalized in the city of Petropolis, a city where 
this relationship has not previously been investigated.
Materials and methods
Study design and participants
This is a hospital-based case–control study with newly diag-
nosed female breast cancer cases confirmed by histopatho-
logical tests and classified according to the IDC-10 of the 
World Health Organization (WHO 1993), at the Oncology 
Treatment Center in the city of Petrópolis between Decem-
ber 2014 and March 2020.
Control subjects were female inpatients of a general hos-
pital, the Alcides Carneiro Municipal Hospital, during the 
study period, in the same age range of controls.
Cases and control individuals with a previous history of 
cancer, at terminal stage of the disease or that presented 
cognitive impairment precluding communication or compre-
hension of the study questionnaire, were excluded. Female 
inpatients admitted for the treatment of any type of cancer or 
for symptoms potentially associated with the clinical picture 
of breast cancer were also excluded.
A total sample of 191 cases and 185 controls was inter-
viewed by trained personnel at the health clinic where they 
were undergoing treatment. A structured questionnaire cov-
ering sociodemographic, lifestyle, and previous contact with 
pesticides information was applied. These research instru-
ment initially presented a series of questions about the use 
of pesticides in general (applications at home, in gardens, 
on pets, in commercial buildings, and on farm crops, storage 
of grain or other agricultural products, and forestry applica-
tions). When the interviewee answered in the affirmative to 
any of them, a list of trade names for specific products was 
presented. For each used product, data about quantity, fre-
quency, and protective equipment were requested. Addition-
ally, individuals involved in agricultural activities answered 
questions about characteristics of the property and the crops 
produced on it.
Statistical analysis
The magnitude of the association between pesticide expo-
sure and breast cancer was determined by calculating crude 
odds ratio (OR) or by OR adjusted for potential confounders, 
using the unconditional logistic regression method. Analy-
ses were performed for estimated confidence intervals with 
a 5% level of significance (p = 0.05). The multiple logistic 
regression model was constructed by testing all variables 
with a p value < 0.20 on crude analysis and retaining in the 
final model only variables which statistical significance (p 
value < 0.05), after adjusting for the other variables in the 
model, or changed the effect of the variable of interest by 
more than 10%. Lastly, the quality of the final model was 
verified by residual analysis. All statistical analyses were 
carried out using the SPSS 20.0 software package (IBM).
With a sample size of 190 cases and 184 controls, consid-
ering a 95% significance level and a population prevalence 
of self-reported pesticide exposure, for over 10 years, of 
17.7%, this study has a power of 80% to detect an OR = 2.0 
between such exposure and female breast cancer, as calcu-
lated by EpiInfo 7.2.4.0.
Ethical considerations
The procedures adopted in this project conformed with the 
recommendations of Resolution no. 466/12 of the National 
Boardof Health, of 12th December 2012, and the study was 
approved by the Research Ethics Committee of the ENSP 
(CAAE permit: 31,126,514.0.0000.5240) and by the com-
mittees of the participating hospitals.
Results
The population characteristics are presented in Table 1. 
Cases had a mean age of 58.16 (SD ± 12.4) years, while 
controls had a mean age of 50.89 (SD ± 17.0) years. 
Although age-frequency matching was employed, there 
was a statistically significant difference in age between 
the two groups (p < 0.001). Age was therefore used as an 
adjustment variable in the final model. Cases and controls 
were predominantly white, low-educated, and overweight 
(mean BMI = 28.1 for cases and 26.6 for controls). Most 
participants reported no history of alcohol or tobacco use, 
and the two groups differed significantly for smoking status 
(p = 0.032).
There was no difference between case and control groups for 
age at menarche or use of oral contraceptives, family history of 
breast cancer, or breastfeeding, where most women reported hav-
ing practiced breastfeeding. However, the menopause started later 
in cases than in controls (p < 0.001), and statistically significant dif-
ferences were observed for use of HRT (p < 0.001) and for number 
of children (p = 0.006), even though the first pregnancy occurred 
before the age of 30 years in most women for both groups.
Regarding environmental and occupational exposure to 
pesticides (Table 2), the groups were similar for pesticide 
use, largely for domestic purposes and also for lifetime use 
56535Environmental Science and Pollution Research (2023) 30:56534–56541
1 3
of these substances. Among women reporting residential 
use of pesticides, 80% of cases and 75% of controls stated 
that they used no personal protective equipment, such as 
gloves, when handling the products. Similarly, in the group 
of women reporting agricultural use, 85.7% of cases and 
60% of controls used no protection when applying pesticide 
products (data not shown). A statistically significant differ-
ence was detected between the group that used pesticides for 
over 10 years relative to the groups which had never used 
the products or had used them for fewer years (p = 0.014).
The strength of the association of exposure to 
pest icides, and other selected r isk factors , with 
breast cancer in the final logistic regression model 
is presented in Table 3. After adjusting for all the 
var iables present in the model, the var iables age 
(p < 0.001), education (p = 0.019), number of chil-
dren (p = 0.003), and HRT (p = 0.039) remained 
statistically signif icant, whereas duration of pes-
ticide use showed a higher, non-signif icant, r isk 
(p = 0.177).
Table 1 Distribution of cases 
(n = 192) and controls (n = 188) 
according to selected variables, 
Petrópolis, Brazil, 2014–2020
Statistically significant values are shown in bold
OR, odds ratio; CI, confidence interval; HRT, hormone replacement therapy
a Totals differ due to missing data
b Chi-square test
Variables Cases
N (%)
Controls
N (%)
OR (95% CI) pb
Agea < 45 years 31 (16.1) 69 (36.9) 1.00 < 0.001
45–54 46 (24.0) 39 (20.9) 2.6 (1.4–4.8)
55–64 52 (27.1) 35 (18.7) 3.3 (1.8–6.0)
 ≥ 65 years 63 (32.8) 44 (23.5) 3.2 (1.8–5.6)
Skin colora White 129 (67.9) 110 (58.5) 1.00 0.059
Non-white 61 (32.1) 78 (41.5) 0.7 (0.4–1.02)
Educationa ≤ 8 years 99 (52.1) 114 (60.6) 1.00 0.094
 > 8 years 91 (47.9) 74 (39.4) 1.4 (0.9–2.1)
BMIa Underweight/normal 66 (35.7) 66 (43.1) 1.00 0.097
Overweight 53 (28.6) 49 (32.0) 1.08 (0.6–1.8)
Obese 66 (35.7) 38 (24.8) 1.7 (1.03–2.9)
Alcohol use Non-drinker 98 (51.0) 104 (55.3) 1.00 0.387
Former drinker 58 (30.2) 45 (23.9) 1.4 (0.8–2.2)
Drinker 36 (18.8) 39 (20.7) 0.9 (0.6–1.7)
Tobacco usea Non-smoker 134 (71.3) 123 (66.1) 1.00 0.032
Former smoker 47 (25.0) 43 (23.1) 1.0 (0.6–1.6)
Smoker 7 (3.7) 20 (10.8) 0.3 (0.1–0.8)
Menarchea ≤ 12 years 84 (44.2) 75 (40.3) 1.00 0.445
 > 12 years 106 (55.8) 111 (59.7) 0.8 (0.6–1.3)
Menopausea No 41 (22.0) 75 (40.8) 1.00 < 0.001
 ≤ 45 years 53 (28.5) 56 (30.4) 1.7 (1.01–2.9)
 > 45 years 92 (49.5) 53 (28.8) 3.2 (1.9–5.3)
Years using oral contraceptivesa Never used 36 (19.4) 39 (21.0) 1.00 0.816
 ≤ 5 years 65 (34.9) 68 (36.6) 1.04 (0.6–1.8)
 > 5 years 85 (45.7) 79 (42.5) 1.2 (0.7–2.0)
HRT usea No 154 (82.8) 170 (94.4) 1.00 < 0.001
Yes 32 (17.2) 10 (5.6) 3.5 (1.7–7.4)
Number of childrena 0–2 136 (71.6) 108 (58.1) 1.00 0.006
 > 2 54 (28.4) 78 (41.9) 0.5 (0.3–0.8)
Breastfeedinga Never breastfed 46 (25.1) 41 (22.5) 1.00 0.427
 ≤ 12 months 89 (48.6) 82 (45.1) 1.0 (0.6–1.6)
 > 12 months 48 (26.2) 59 (32.4) 0.7 (0.4–1.3)
Family history of cancer No 170 (88.5) 171 (91.0) 1.00 0.438
Yes 22 (11.5) 17 (9.0) 1.3 (0.7–2.5)
56536 Environmental Science and Pollution Research (2023) 30:56534–56541
1 3
Discussion
The self-reported use of pesticides for over 10 years was 
associated with a greater estimated risk of developing 
breast cancer compared to non-use or shorter periods of 
use, although this relationship was not significant after 
adjusting for selected variables. Some studies have shown 
a positive association between this type of exposure and 
breast cancer. A case–control study which included 1169 
cases and 1743 controls, interviewed in Australia from 
2009 to 2011, showed an increased risk (OR = 1.51; 95% 
CI 1.18–1.94) among women who reported noticing pes-
ticide spray drift, and who lived close to an agricultural 
area, for 10  years or more, compared to women who 
reported not observing pesticide use (El-Zaemey et al. 
2013). Another case–control study, involving 85 cases and 
266 controls recruited between 2017 and 2018 in Ron-
donópolis, Mato Grosso state, Brazil, also found a higher 
odds ratio (OR: 2.37; 95% CI 1.78–3.16) for the develop-
ment of breast cancer among women reporting residing 
close to agricultural areas in which pesticides were used, 
compared to women not living close to these sites (Silva 
et al. 2019). Similarly, a case–control study of 1505 cases 
and 1553 controls living in New York between 1996 and 
1997 found a higher risk of breast cancer (OR 1.39, 95 
CI% 1.15–1.68) among women reporting ever lifetime 
pesticide use compared with women who reported never 
having used pesticides (Teitelbaum et al. 2007).
A case–control study conducted in China found a higher 
chance (OR = 1.63; 95% CI 1.15–2.85) of DDE exposure 
in women who had breast cancer when comparing tissue 
concentrations of the compounds in cases and controls 
(Huang et al. 2019). Similarly, another case–control study 
also found a higher risk of DDE exposure (OR = 1.72; 95% 
CI 1.11–3.13) in breast cancer cases relative to controls 
(Arrebola et al. 2015).
However, some studies, including the present investiga-
tion, have identified greater estimated risk for developing 
breast cancer in women exposed to pesticides, but found this 
relationship to be non-significant on statistical analyses. This 
was the case for a case–control study conducted in Canada 
comparing women in the last quintile of exposure to DDT, 
with those in the first quintile (OR: 1.37; 95% CI 0.73–2.56) 
(Demers et al. 2000). A hospital-based case–control study 
comprising 447 cases and 758 controls, interviewed between 
1994 and 1996 in New York city, found a higher, non-sig-
nificant, risk (OR 1.25; 95% CI 0.79–1.98) among women 
reporting residential pesticide use compared to those who 
never used these products (Farooq et al. 2010).
Table 2 Distribution of cases 
(n = 192) and controls (n = 188) 
according to variables related to 
pesticide exposure, Petrópolis, 
Brazil, 2014–2020
Statistically significant values are shown in bold
OR, odds ratio; CI, confidence interval
a Totals differ due to missing data
b Chi-square test
Variables Cases
N (%)
Controls
N (%)
OR (95% CI) pb
Pesticide use Never used 60 (31.2) 52 (27.7) 1.00 0.744
Domestic 125 (65.1) 129 (68.6) 0.8 (0.5–1.3)
Agricultural 7 (3.6) 7 (3.7) 0.9 (0.3–2.6)
Time using pesticidesa 0–10 years 136(71.6) 153 (82.3) 1.00 0.014
 > 10 years 54 (28.4) 33 (17.7) 1.8 (1.1–3.0)
Lifetime pesticide usea < 30 days 92 (49.5) 91 (50.8) 1.00 0.810
30–235 49 (26.3) 42 (23.5) 1.1 (0.7–1.9)
 > 235 45 (24.2) 46 (25.7) 1.0 (0.6–1.6)
Table 3 Final model of association of pesticide exposure, and other 
variables of interest, with developing breast cancer, Petrópolis, Brazil, 
2014–2020
Statistically significant values are shown in bold
OR, odds ratio; CI, confidence interval; HRT, hormone replacement 
therapy
a Adjusted for all variables included in model
b Wald test
Variables Adjusted ORa 95% CI pb
Age 1.04 1.03–1.06 < 0.001
Time using pesticides ≤ 10 years 1.00
 > 10 years 1.40 0.85–2.49 0.177
Education ≤ 8 years 1.00
 > 8 years 1.81 1.10–2.97 0.019
Number of children 0–2 1.00
 > 2 0.47 0.29–0.78 0.003
HRT use No 1.00
Yes 2.29 1.04–5.03 0.039
56537Environmental Science and Pollution Research (2023) 30:56534–56541
1 3
A case–control study which included 787 cases and 
721 controls residing for at least 6 months in the city of 
Cape Cod, USA, between 1988 and 1995, found a slightly 
higher breast cancer risk (OR = 1.2; 95% CI 0.80–1.60) in 
women who reported using any type of pesticide 10 times 
or more compared to those who never used the products, 
although this association did not reach statistical signifi-
cance (Zota et al. 2010). Similar results were reported by 
a nested case–control study conducted in New York, where 
higher risk of developing breast cancer was found for the 
last quartile of DDE exposure (OR: 1.30; 95% CI 0.51–3.35) 
compared to the first quartile (Wolff et al. 2000).
Two cross-sectional studies reported a positive asso-
ciation between previous pesticide and the breast cancer, 
although this was not statistically significant. The first, a 
study by Xu et al. (2010) conducted in the USA, found a 
higher risk of breast cancer (OR = 1.19; 95% CI 0.40–3.50) 
among women in the last quartile of exposure to DDE, while 
a study by Engel et al. (2017), also in the USA, found a 
higher risk (OR = 1.5; 95% CI 0.70–2.90) for exposure to 
heptachlor, an organochlorine.
Regarding exposure to the other factors related to estro-
gen metabolism, such as HRT, in the present study, the 
odds of cases having used this treatment was higher relative 
to controls. Similarly, a cohort study in Denmark found a 
higher risk of breast cancer (OR 1.56; 95% CI 1.19–2.04) in 
women who reported having used HRT (Azam et al. 2018). 
This same relationship had previously been reported in the 
Nurses Health Study cohort, which found an elevated risk of 
breast cancer (OR 1.32; 95% CI 1.14–1.54) in women that 
used estrogen alone and in users of estrogen plus proges-
tin (OR = 1.41; 95% CI 1.15–1.74), compared to individu-
als that used no hormones (Colditz et al. 1995). The nested 
case–control study of Chen (2002) also found a higher risk 
(OR = 1.70; 95% CI 1.15–2.50) of developing breast cancer 
in women on HRT for longer than 4 years.
Number of pregnancies was also a factor associated with 
breast cancer but, unlike HRT, this acted as a protective fac-
tor, providing the body with a pause in exposure to estrogen 
(Liu et al. 2019). The present study found a lower chance of 
developing breast cancer among women who had more than 
two children, relative to those who had no children or two 
pregnancies to term. This finding corroborates the results 
of a cohort study performed in the USA, in which a lower 
risk (OR = 0.84; 95% CI 0.80–0.89) of breast cancer was 
evident in women who were mothers compared to those who 
had no children (Fortner et al. 2019). In another study, con-
ducted in Japan, a lower risk (OR = 0.43; 95% CI 0.19–0.97) 
was identified in women who had 5 children compared to 
those who had only one pregnancy (Liu et al. 2019). In a 
nested case–control study conducted in Norway, the chance 
of developing breast cancer was lower (OR = 0.59; 95% CI 
0.51–0.68) for women who had 4 or more pregnancies, each 
lasting at least 6 months, compared to women who had never 
been pregnant (Ellingjord-Dale et al. 2017).
The present study also found a higher odds ratio for 
women with > 8 years of education compared to those who 
had not studied or had ≤ 8 years of education. This result 
corroborates other studies showing greater risk for breast 
cancer among women with higher educational level, a char-
acteristic also associated with other factors related to the 
disease, such as later age at first pregnancy to term, fewer 
pregnancies, and use of HRT for menopausal symptoms 
(Fujino et al. 2008; Hussain et al. 2008; Larsen et al. 2011; 
Menvielle et al. 2011; Mouw et al. 2008). Additionally, the 
greater adherence to screening in this group explains the 
higher number of cases of cancer diagnosed in high-edu-
cated women (Damiani et al. 2015; Dong and Qin 2020).
Regarding associations with other risk factors, such as 
race, alcohol and tobacco use, radiation exposure, age at 
menarche, age at menopause, use of oral contraceptives, 
family history for cancer, and other characteristics, these 
either did not differ statistically between the two groups from 
the outset or lost statistical significance after adjusting for 
the other variables included in the logistic regression model.
The present case–control study has some limitations. 
The sample size was relatively small compared to other 
studies that identified greater, statistically significant, risk 
for developing breast cancer associated with self-reported 
pesticide exposure (El-Zaemey et al. 2013; Engel et al. 
2017; Farooq et al. 2010; Silva et al. 2019; Zota et al. 
2010). It was not possible to increase the sample size and 
to obtain an aged-frequency-matched distribution between 
cases and controls once the interviews of the subjects was 
interrupted by the COVID-19 pandemic. The estimation 
of exposure through self-report instead of quantifying 
actual levels of exposure using biological samples is also 
a limitation. Even so, in simple analyses, it was shown a 
higher odds of developing breast cancer among women 
who reported using pesticides that has been pointed as a 
risk for this type of cancer in literature (Wan et al. 2022; 
Darbre 2021; Kahn et al. 2020; Loomis et al. 2015). Con-
sidering the high use of pesticides in the region where 
the study was carried out, the association with breast 
cancer may be underestimated since both cases and con-
trols may be highly exposed to pesticides due to the broad 
background environmental contamination. On the other 
hand, recently, we show that the average concentrations 
of organochlorines, in no cancer hospitalized individu-
als of Petropolis city, are below those observed by other 
studies (de Rezende et al. 2023), which was unexpected 
since organochlorine pesticides continues to occur in the 
region, possibly obtained through illegal trade (Guida 
et al. 2021; Meire et al. 2012; Peres and Moreira 2007). 
This lower concentrations of organochlorines may not only 
explain, in part, the fact that the present study did not find 
56538 Environmental Science and Pollution Research (2023) 30:56534–56541
1 3
a statistically significant association between pesticide use 
and breast cancer after adjusting for potential confounders 
but also draws attention to the importance of future studies 
to make a more in-depth assessment of pesticides that dif-
ferentiate persistent pesticides that is known carcinogenic 
(Loomis et al. 2015) from those that are not persistent, 
more difficult to access and with less data in the literature 
(Fernández et al. 2020; Yildizdas et al. 2019; Bakke et al. 
2009).
Nonetheless, the present study assessed incident cases 
and hospital controls, conferring greater reliability of 
events reported by cases and lower likelihood of mem-
ory bias or lack of response by control subjects. Another 
strength of this study is its investigation of a population 
and region for which the relationship between pesticide 
exposure and breast cancer hadnot previously been 
studied.
Conclusion
The results showed a higher odds of developing breast 
cancer among women who reported using pesticides for 
over 10 years, although these findings were not statisti-
cally significant after adjusting for potential confounders. 
Moreover, a positive, statistically significant, association 
was found between breast cancer and higher educational 
level or previous HRT use, whereas more than 2 pregnan-
cies proved a protective factor against the disease. Fur-
ther studies involving larger samples and more in-depth 
assessment of pesticide exposure are needed to elucidate 
the contribution of this exposure to the development of 
breast cancer, given that current findings in the literature 
are conflicting.
Acknowledgements The authors thank the patients of the Hospital 
Municipal Alcides Carneiro and of the Centro de Terapia Oncológica 
de Petrópolis.
Author contribution All authors contributed to the study conception 
and design. Data collection was performed by Louise Moura Rezende 
and Gina Torres Rego Monteiro. Analysis was performed by Louise 
Moura Rezende and Sabrina da Silva Santos. The first draft of the 
manuscript was written by Louise Moura de Rezende. All authors com-
mented on previous versions and approved the final manuscript.
Funding This work was supported by the Fundação de Amparo 
à Pesquisa do Estado do Rio de Janeiro (FAPERJ—process no. 
110.287/2014 and project E-26./210.882/2021) and by the Sergio 
Arouca National School of Public Health (ENSP/FIOCRUZ—research 
grant bid 2016–2018).
Data availability The data that support the findings of this study are 
available on request from the corresponding author, SSS. The data are 
not publicly available due to their containing information that could 
compromise the privacy of research participants.
Declarations 
Ethics approval The procedures adopted in this project conformed 
with the recommendations of Resolution no. 466/12 of the National 
Board of Health, of 12th December 2012, and the study was approved 
by the Research Ethics Committee of the ENSP (CAAE permit: 
31126514.0.0000.5240) and by the committees of the participating 
hospitals.
Consent to participate All the participants signed a free and informed 
consent form.
Consent for publication All authors give Environmental Science and 
Pollution Research permission to publish these research findings.
Competing interests The authors declare no competing interests.
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	Exposure to pesticides and breast cancer in the city of Petrópolis, Brazil
	Abstract
	Introduction
	Materials and methods
	Study design and participants
	Statistical analysis
	Ethical considerations
	Results
	Discussion
	Conclusion
	Acknowledgements 
	References