Smoking and lymphoma risk in the European prospective investigation into cancer and nutrition.
Lymphomas are one of the few cancers that have been increasing in incidence over the past decades. So far, only a few established risk factors have been identified, including immunosuppression and viral infections. Recent evidence suggests etiologic heterogeneity of different lymphoma subtypes. Smoking may affect risk differently, depending on the lymphoma entity. The European Prospective Investigation into Cancer and Nutrition was used to study the role of smoking in the etiology of lymphomas and individual subtypes within a prospective study. Information on baseline and lifetime tobacco smoking by 478,590 participants was collected between 1992 and 2000. Cox proportional hazards regression was used to calculate multivariate-adjusted hazard ratios and 95% confidence intervals. During 3,567,410 person-years of follow-up, 1,371 lymphoma cases (1,304 non-Hodgkin's lymphomas and 67 Hodgkin's lymphomas) were identified. Relative risk for smokers at recruitment was more than twofold higher for Hodgkin's lymphoma (hazard ratio = 2.14, 95% confidence interval: 1.18, 3.87) but was not elevated for non-Hodgkin's lymphoma (hazard ratio = 1.06, 95% confidence interval: 0.94, 1.19) and individual B-cell non-Hodgkin's lymphoma subtypes. In this prospective study, smoking appeared to increase Hodgkin's lymphoma risk consistently in both genders, whereas B-cell non-Hodgkin's lymphoma risk was not associated. Future analysis should involve viral biomarkers and genetic susceptibility markers to elucidate potential mechanisms of smoking-induced carcinogenesis, particularly for Hodgkin's lymphoma.
Nieters
Alexandra
A
Division of Cancer Epidemiology, Deutsches Krebsforschungszentrum, Heidelberg, Germany. a.nieters@dkfz.de
Rohrmann
Sabine
S
Becker
Nikolaus
N
Linseisen
Jakob
J
Ruediger
Thomas
T
Overvad
Kim
K
Tjønneland
Anne
A
Olsen
Anja
A
Allen
Naomi E
NE
Travis
Ruth C
RC
Bingham
Sheila
S
Khaw
Kay-Tee
KT
Ardanaz
Eva
E
Redondo
M L
ML
Basterrechea
Mikel
M
Martinez
Carmen
C
Tormo
María-José
MJ
Rosso
Stefano
S
Tagliabue
Giovanna
G
Masala
Giovanna
G
Mattiello
Amalia
A
Tumino
Rosario
R
Boeing
Heiner
H
Bergmann
Manuela
M
Kaaks
Rudolf
R
Trichopoulou
Antonia
A
Trichopoulos
Dimitrios
D
Peeters
Petra H
PH
Bueno-de-Mesquita
Bas
B
Boffetta
Paolo
P
Brennan
Paul
P
Ferrari
Pietro
P
Neasham
David
D
Lund
Eiliv
E
Berglund
Göran
G
Manjer
Jonas
J
Hallmans
Göran
G
Johansson
Ingegerd
I
Vineis
Paolo
P
Riboli
Elio
E
D005060:Europe / Q000453:epidemiology; D005260:Female; D006689:Hodgkin Disease / Q000145:classification / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D008019:Life Style; D008228:Lymphoma, Non-Hodgkin / Q000145:classification / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D015596:Nutrition Assessment; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D011795:Surveys and Questionnaires