Pesticides are of interest in etiologic studies of breast cancer because many mimic estrogen, a known breast cancer risk factor, or cause mammary tumors in animals, but most previous studies have been limited by using one-time tissue measurements of residues of only a few pesticides long banned in the United States. As an alternative method to assess historical exposures to banned and current-use pesticides, we used geographic information system (GIS) technology in a population-based case-control study of 1,165 women residing in Cape Cod, Massachusetts, who were diagnosed with breast cancer in 1988-1995 and 1,006 controls. We assessed exposures dating back to 1948 (when DDT was first used there) from pesticides applied for tree pests (e.g., gypsy moths), cranberry bogs, other agriculture, and mosquito control on wetlands. We found no overall pattern of association between pesticide use and breast cancer. We found modest increases in risk associated with aerial application of persistent pesticides on cranberry bogs and less persistent pesticides applied for tree pests or agriculture. Adjusted odds ratios for these exposures were 1.8 or lower, and, with a few exceptions, confidence intervals did not exclude the null. The study is limited by uncertainty about locations of home addresses (particularly before 1980) and unrecorded tree pest and mosquito control events as well as lack of information about exposures during years when women in the study lived off Cape Cod and about women with potentially important early life exposures on Cape Cod who were not included because they moved away. Mortality has not been elevated on Cape Cod. Although this suggests the logical possibility that increased incidence could be due to a higher rate of diagnoses through greater mammography use rather than to a higher underlying rate of disease, existing evidence does not support this explanation. A Massachusetts state survey in the mid-1990s showed that 88% of Cape Cod women had ever had a mammogram compared with 89% in the rest of Massachusetts, and Cape Cod women were about 6% less likely to report a mammogram within the last year (Massachusetts Department of Public Health 1997). The proportion of cases diagnosed at earlier stages (an indicator of mammography use) was lower on Cape Cod than in the rest of the state in years when incidence was most elevated (Silent Spring Institute 1998).Previous research also has shown that pesticides were applied widely on Cape Cod to support tourism, cranberry cultivation, and other agriculture (Brody et al. 2002). Forests were repeatedly sprayed for gypsy moths and other tree pests, and wetlands were sprayed for mosquito control. Other wide-area uses include golf course and rights-of-way management. Persistent organochlorine chemicals were used from the late 1940s to the mid-1970s, and less persistent compounds, including carbaryl, malathion, and carbamates, have been applied in more recent years (Brody et al. 2002). Table 1 lists pesticides applied by type of use. Maps of pesticide use areas an...