title: Smoking and lymphoma risk in the European prospective investigation into cancer and nutrition.
abstract: 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.
authors.affiliation: Division of Cancer Epidemiology, Deutsches Krebsforschungszentrum, Heidelberg, Germany. a.nieters@dkfz.de
authors.forename: Alexandra
authors.initials: A
authors.lastname: Nieters
authors.forename: Sabine
authors.initials: S
authors.lastname: Rohrmann
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Becker
authors.forename: Jakob
authors.initials: J
authors.lastname: Linseisen
authors.forename: Thomas
authors.initials: T
authors.lastname: Ruediger
authors.forename: Kim
authors.initials: K
authors.lastname: Overvad
authors.forename: Anne
authors.initials: A
authors.lastname: Tjønneland
authors.forename: Anja
authors.initials: A
authors.lastname: Olsen
authors.forename: Naomi E
authors.initials: NE
authors.lastname: Allen
authors.forename: Ruth C
authors.initials: RC
authors.lastname: Travis
authors.forename: Sheila
authors.initials: S
authors.lastname: Bingham
authors.forename: Kay-Tee
authors.initials: KT
authors.lastname: Khaw
authors.forename: Eva
authors.initials: E
authors.lastname: Ardanaz
authors.forename: M L
authors.initials: ML
authors.lastname: Redondo
authors.forename: Mikel
authors.initials: M
authors.lastname: Basterrechea
authors.forename: Carmen
authors.initials: C
authors.lastname: Martinez
authors.forename: María-José
authors.initials: MJ
authors.lastname: Tormo
authors.forename: Stefano
authors.initials: S
authors.lastname: Rosso
authors.forename: Giovanna
authors.initials: G
authors.lastname: Tagliabue
authors.forename: Giovanna
authors.initials: G
authors.lastname: Masala
authors.forename: Amalia
authors.initials: A
authors.lastname: Mattiello
authors.forename: Rosario
authors.initials: R
authors.lastname: Tumino
authors.forename: Heiner
authors.initials: H
authors.lastname: Boeing
authors.forename: Manuela
authors.initials: M
authors.lastname: Bergmann
authors.forename: Rudolf
authors.initials: R
authors.lastname: Kaaks
authors.forename: Antonia
authors.initials: A
authors.lastname: Trichopoulou
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Trichopoulos
authors.forename: Petra H
authors.initials: PH
authors.lastname: Peeters
authors.forename: Bas
authors.initials: B
authors.lastname: Bueno-de-Mesquita
authors.forename: Paolo
authors.initials: P
authors.lastname: Boffetta
authors.forename: Paul
authors.initials: P
authors.lastname: Brennan
authors.forename: Pietro
authors.initials: P
authors.lastname: Ferrari
authors.forename: David
authors.initials: D
authors.lastname: Neasham
authors.forename: Eiliv
authors.initials: E
authors.lastname: Lund
authors.forename: Göran
authors.initials: G
authors.lastname: Berglund
authors.forename: Jonas
authors.initials: J
authors.lastname: Manjer
authors.forename: Göran
authors.initials: G
authors.lastname: Hallmans
authors.forename: Ingegerd
authors.initials: I
authors.lastname: Johansson
authors.forename: Paolo
authors.initials: P
authors.lastname: Vineis
authors.forename: Elio
authors.initials: E
authors.lastname: Riboli
mesh_terms: 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