Prediagnostic serum organochlorine insecticide concentrations and primary liver cancer: A case–control study nested within two prospective cohorts

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Although experimental evidence indicates that certain organochlorine insecticides are hepatocarcinogens, epidemiologic evidence for most of these chemicals is very limited. We estimated associations, using prospectively collected sera, between organochlorine insecticide concentrations and cancer registry-identified primary liver cancer in two cohorts, one from the United States and one from Norway. In nested case–control studies, we used sera collected in the 1960s-1980s from 136 cases and 408 matched controls from the Kaiser Permanente Northern California Multiphasic Health Checkup (MHC) cohort and 84 cases and 252 matched controls from the population-based Norwegian Janus cohort. We measured concentrations of nine organochlorine insecticides/metabolites and markers of hepatitis B and C in sera. Adjusted odds ratios (OR) and 95% confidence intervals (CI) for tertiles of lipid-corrected organochlorines were calculated for each cohort using conditional logistic regression. Among MHC participants with sera from the 1960s, there was a suggestive exposure-response trend for trans-nonachlor (second and third tertile of analyte ORs = 1.63 and 1.95, respectively; p-trend = 0.08) and a nonsignificantly elevated risk for the highest tertile of oxychlordane (OR = 1.87). Among Janus participants with sera from the 1970s, we observed an apparent trend for p,p’-DDT (second and third tertile ORs = 1.70 and 2.14, respectively; p-trend = 0.15). We observed little consistency in patterns of association between the cohorts. We found limited evidence that exposure to p,p’-DDT and chlordane-related oxychlordane and trans-nonachlor may be associated with increased risk of primary liver cancer. However, the modest strength of these associations and their lack of concordance between cohorts necessitate caution in their interpretation.


  • Lawrence S. Engel
  • Emily C. Zabor
  • Jaya Satagopan
  • Anders Widell
  • Nathaniel Rothman
  • Thomas R. O'Brien
  • Mingdong Zhang
  • Stephen K. Van Den Eeden
  • Tom K. Grimsrud
External organisations
  • University of North Carolina
  • Memorial Sloan-Kettering Cancer Center
  • National Cancer Institute, USA
  • Cancer Registry of Norway Institute of Population-Based Cancer Research
  • Kaiser Permanente
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Cancer and Oncology


  • cohort, liver cancer, nested case-control study, organochlorines, persistent organic pollutants, pesticides, prospective
Original languageEnglish
Pages (from-to)2360-2371
JournalInternational Journal of Cancer
Issue number9
Early online date2019
Publication statusPublished - 2019
Publication categoryResearch