{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T03:20:49Z","timestamp":1793330449048,"version":"4.5.0"},"reference-count":81,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T00:00:00Z","timestamp":1770249600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Carlos Chagas Institute, Fiocruz\/PR"},{"DOI":"10.13039\/501100004612","name":"Funda\u00c3\u00a7\u00c3\u00a3o Arauc\u00c3\u00a1ria","doi-asserted-by":"publisher","award":["639\/2022"],"award-info":[{"award-number":["639\/2022"]}],"id":[{"id":"10.13039\/501100004612","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Conselho Nacional de Desenvolvimento Cient\u00c3fico e Tecnol\u00c3\u00b3gico \u00e2\u20ac\u201c CNPq","award":["402364\/2021-0, 441017\/2023-1, and 305335\/2021-9"],"award-info":[{"award-number":["402364\/2021-0, 441017\/2023-1, and 305335\/2021-9"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>Human pesticide exposure is a common event in countries with strength conventional agriculture, such as Brazil. Despite evidence on the negative impact of pesticides on human health, the country stands out among the top three pesticide consumers globally. The implications of this scenario on rural workers health, particularly women, is completely neglected, resulting in chronic illness such as breast cancer. Objective: In this study, we analyzed the impact of occupational\/household chronic exposure to pesticides on the clinicopathological profile of breast cancer in rural women from Paran\u00e1 southwest, a predominantly rural landscape with large pesticide uses. Methods: A total of 349 women were included in the study. After a structured interview, women were categorized as exposed (n\u2009=\u2009208) or unexposed (n\u2009=\u2009141) to pesticides. Clinicopathological data were collected from medical records. Descriptive and inferential statistical methods were used to characterize and compare the sample. The Chi-square test and Fisher\u2019s exact test were used to evaluate differences between the molecular subtypes and clinicopathological variables of patients. Results: Exposed patients had a prevalence of the Luminal B subtype (32.83%), while unexposed patients had a prevalence of the Luminal A molecular subtype (37.78%, p\u2009&lt;= 0.05). Exposed patients also had higher disease recurrence (10.19%), chemoresistance (21.26%), than unexposed patients (p\u2009&lt;= 0.05). Breast cancer patients exposed to pesticides were also more likely to have distant metastases (1.4 times) and lymph node invasion (1.3 times) compared to patients not exposed. Conclusions: These findings indicate that pesticide exposure favors the occurrence of more aggressive breast cancer.<\/jats:p>","DOI":"10.1371\/journal.pone.0339471","type":"journal-article","created":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T18:22:52Z","timestamp":1770315772000},"page":"e0339471","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Hidden risks associated with occupational pesticide exposure in women with breast cancer: High frequency of the Luminal B molecular subtype and occurrence of poor prognostic features"],"prefix":"10.1371","volume":"21","author":[{"given":"Isabella C.","family":"Cazagranda","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafaela Frederico","family":"de Almeida","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucca L.","family":"Smaniotto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Paula","family":"de Andrade Berny","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolina","family":"Coradi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Rech","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolina","family":"Panis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1866-0563","authenticated-orcid":true,"given":"Guilherme F.","family":"Silveira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,2,5]]},"reference":[{"key":"pone.0339471.ref001","article-title":"O uso 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Hokanson","year":"2007","journal-title":"Hum Exp Toxicol"},{"key":"pone.0339471.ref037","doi-asserted-by":"crossref","first-page":"110789","DOI":"10.1016\/j.mce.2020.110789","article-title":"Relationship between agrochemical compounds and mammary gland development and breast cancer","volume":"508","author":"L Kass","year":"2020","journal-title":"Mol Cell Endocrinol"},{"issue":"2","key":"pone.0339471.ref038","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1002\/bdrb.20110","article-title":"Atrazine and reproductive function: mode and mechanism of action studies","volume":"80","author":"RL Cooper","year":"2007","journal-title":"Birth Defects Res B Dev Reprod Toxicol"},{"key":"pone.0339471.ref039","doi-asserted-by":"crossref","DOI":"10.1590\/1414-431x2023e13060","article-title":"Occupational exposure to pesticides deregulates systemic cortisol levels in women with breast cancer and correlates with poor prognosis features","volume":"57","author":"JJ 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Calaf","year":"2023"},{"issue":"5","key":"pone.0339471.ref072","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1289\/ehp.01109471","article-title":"A rat mammary tumor model induced by the organophosphorous pesticides parathion and malathion, possibly through acetylcholinesterase inhibition","volume":"109","author":"G Cabello","year":"2001","journal-title":"Environ Health Perspect"},{"issue":"1","key":"pone.0339471.ref073","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1631\/jzus.B1400221","article-title":"Hypoxia-inducible factor 1 and breast cancer metastasis","volume":"16","author":"Z-J Liu","year":"2015","journal-title":"J Zhejiang Univ Sci B"},{"key":"pone.0339471.ref074","unstructured":"Li Y, Zhang X, Qiu J, Pang T, Huang L, Zeng Q. Comparisons of p53, KI67 and BRCA1 expressions in patients. 2019."},{"issue":"1","key":"pone.0339471.ref075","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1007\/s11356-021-15573-z","article-title":"Farmers exposed to pesticides have almost five times more DNA damage: a meta-analysis study","volume":"29","author":"A Nascimento F de","year":"2022","journal-title":"Environ Sci Pollut Res"},{"key":"pone.0339471.ref076","article-title":"Occupational exposure to pesticides dysregulates systemic Th1\/Th2\/Th17 cytokines and correlates with poor clinical outcomes in breast cancer patients","author":"SBG dos Santos","year":"2023","journal-title":"Front Immunol"},{"issue":"4","key":"pone.0339471.ref077","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3892\/or.2021.7975","article-title":"Signs of carcinogenicity induced by parathion, malathion, and estrogen in human breast epithelial cells (Review)","volume":"45","author":"GM Calaf","year":"2021","journal-title":"Oncol Rep"},{"issue":"1","key":"pone.0339471.ref078","first-page":"1","article-title":"Molecular principles of metastasis: a hallmark of cancer revisited","volume":"5","author":"J Fares","year":"2020","journal-title":"Signal Transduct Target Ther"},{"issue":"3","key":"pone.0339471.ref079","doi-asserted-by":"crossref","first-page":"198","DOI":"10.4048\/jbc.2011.14.3.198","article-title":"The role of lymphovascular invasion as a prognostic factor in patients with lymph node-positive operable invasive breast cancer","volume":"14","author":"YJ Song","year":"2011","journal-title":"J Breast Cancer"},{"issue":"4","key":"pone.0339471.ref080","first-page":"773","article-title":"Metastasis: quantitative analysis of distribution and fate of tumor emboli labeled with 125I-5-iodo-2\u2032-deoxyuridine","volume":"45","author":"IJ Fidler","year":"1970","journal-title":"JNCI J Natl Cancer Inst"},{"issue":"6024","key":"pone.0339471.ref081","doi-asserted-by":"crossref","first-page":"1559","DOI":"10.1126\/science.1203543","article-title":"A perspective on cancer cell metastasis","volume":"331","author":"CL Chaffer","year":"2011","journal-title":"Science"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0339471","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T18:23:05Z","timestamp":1770315785000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0339471"}},"subtitle":[],"editor":[{"given":"Elingarami","family":"Sauli","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,2,5]]},"references-count":81,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2,5]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0339471","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,5]]}}}