Level of education and the risk of lymphoma in the European prospective investigation into cancer and nutrition.
BACKGROUND
Lymphomas belong to the few cancer sites with increasing incidence over past decades, and only a few risk factors have been established. We explored the association between education and the incidence of lymphoma in the prospective EPIC study.


METHODS
Within 3,567,410 person-years of follow-up, 1,319 lymphoma cases [1,253 non-Hodgkin lymphomas (NHL) and 66 Hodgkin lymphomas (HL)] were identified. Cox proportional hazard regression was used to examine the association between highest educational level (primary school or less, technical/professional school, secondary school, university) and lymphoma risk.


RESULTS
Overall, no consistent associations between educational level and lymphoma risk were observed; however, associations were found for sub-groups of the cohort. We observed a higher risk of B-NHL (HR = 1.31, 95% CI = 1.02–1.68; n = 583) in women with the highest education level (university) but not in men. Concerning sub-classes of B-NHL, a positive association between education and risk of B cell chronic lymphatic leukaemia (BCLL) was observed only in women. In both genders, the risk of diffuse large B cell lymphoma (DLBCL) was significantly lower for subjects with university degree (HR = 0.46, 95% CI = 0.27–0.79) versus lowest educational level. No association was found for HL.


CONCLUSIONS
We could not confirm an overall consistent association of education and risk of HL or NHL in this large prospective study; although, education was positively related to the incidence of BCLL and B-NHL (in women) but inversely to incidence of DLBCL. Due to limited number of cases in sub-classes and the large number of comparisons, the possibility of chance findings can not be excluded.
Hermann
Silke
S
Division of Cancer Epidemiology (C020), German Cancer Research Center, Heidelberg, Germany.
Rohrmann
Sabine
S
Linseisen
Jakob
J
Nieters
Alexandra
A
Khan
Aneire
A
Gallo
Valentina
V
Overvad
Kim
K
Tjønneland
Anne
A
Raaschou-Nielsen
Ole
O
Bergmann
Manuela M
MM
Boeing
Heiner
H
Becker
Nikolaus
N
Kaaks
Rudolf
R
Bueno-de-Mesquita
H Bas
HB
May
Anne M
AM
Vermeulen
Roel C  H
RC
Bingham
Sheila
S
Khaw
Kay-Tee
KT
Key
Timothy J
TJ
Travis
Ruth C
RC
Trichopoulou
Antonia
A
Georgila
Christina
C
Triantafylou
Dimitra
D
Celentano
Egidio
E
Krogh
Vittorio
V
Masala
Giovanna
G
Tumino
Rosario
R
Agudo
Antonio
A
Altzibar
Jone M
JM
Ardanaz
Eva
E
Martínez-García
Carmen
C
Suárez
Marcial Vicente Argüelles
MV
Tormo
Maria José
MJ
Braaten
Tonje
T
Lund
Eiliv
E
Manjer
Jonas
J
Zackrisson
Sophia
S
Hallmans
Göran
G
Malmer
Beatrice
B
Boffetta
Paolo
P
Brennan
Paul
P
Slimani
Nadia
N
Vineis
Paolo
P
Riboli
Elio
E
D000328:Adult; D004032:Diet; D004522:Educational Status; D005060:Europe / Q000453:epidemiology; D005260:Female; D006689:Hodgkin Disease / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000453:epidemiology; D016403:Lymphoma, Large B-Cell, Diffuse / Q000453:epidemiology; D008228:Lymphoma, Non-Hodgkin / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment / Q000706:statistics & numerical data; D012307:Risk Factors; D012737:Sex Factors; D011795:Surveys and Questionnaires