title: Exposure to UV radiation and risk of Hodgkin lymphoma: a pooled analysis.
abstract: Ultraviolet radiation (UVR) exposure has been inversely associated with Hodgkin lymphoma (HL) risk, but only inconsistently, only in a few studies, and without attention to HL heterogeneity. We conducted a pooled analysis of HL risk focusing on type and timing of UVR exposure and on disease subtypes by age, histology, and tumor-cell Epstein-Barr virus (EBV) status. Four case-control studies contributed 1320 HL cases and 6381 controls. We estimated lifetime, adulthood, and childhood UVR exposure and history of sunburn and sunlamp use. We used 2-stage estimation with mixed-effects models and weighted pooled effect estimates by inverse marginal variances. We observed statistically significant inverse associations with HL risk for UVR exposures during childhood and adulthood, sunburn history, and sunlamp use, but we found no significant dose-response relationships. Risks were significant only for EBV-positive HL (pooled odds ratio, 0.56; 95% confidence interval, 0.35 to 0.91 for the highest overall UVR exposure category), with a significant linear trend for overall exposure (P = .03). Pooled relative risk estimates were not heterogeneous across studies. Increased UVR exposure may protect against HL, particularly EBV-positive HL. Plausible mechanisms involving UVR induction of regulatory T cells or the cellular DNA damage response suggest opportunities for new prevention targets.
authors.affiliation: Environmental Epidemiology of Cancer Group, Centre for Research in Epidemiology and Population Health, Institut National de la Santé et de la Recherche Médicale U1018, Villejuif, France;
authors.forename: Alain
authors.initials: A
authors.lastname: Monnereau
authors.forename: Sally L
authors.initials: SL
authors.lastname: Glaser
authors.forename: Clayton W
authors.initials: CW
authors.lastname: Schupp
authors.forename: Karin
authors.initials: K
authors.lastname: Ekström Smedby
authors.forename: Silvia
authors.initials: S
authors.lastname: de Sanjosé
authors.forename: Eleanor
authors.initials: E
authors.lastname: Kane
authors.forename: Mads
authors.initials: M
authors.lastname: Melbye
authors.forename: Lenka
authors.initials: L
authors.lastname: Forétova
authors.forename: Marc
authors.initials: M
authors.lastname: Maynadié
authors.forename: Anthony
authors.initials: A
authors.lastname: Staines
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Becker
authors.forename: Alexandra
authors.initials: A
authors.lastname: Nieters
authors.forename: Paul
authors.initials: P
authors.lastname: Brennan
authors.forename: Paolo
authors.initials: P
authors.lastname: Boffetta
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Cocco
authors.forename: Ingrid
authors.initials: I
authors.lastname: Glimelius
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Clavel
authors.forename: Henrik
authors.initials: H
authors.lastname: Hjalgrim
authors.forename: Ellen T
authors.initials: ET
authors.lastname: Chang
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D015897:Comorbidity; D015986:Confounding Factors, Epidemiologic; D004249:DNA Damage; D004260:DNA Repair; D004307:Dose-Response Relationship, Radiation; D020031:Epstein-Barr Virus Infections / Q000453:epidemiology; D005060:Europe / Q000453:epidemiology; D005260:Female; D006689:Hodgkin Disease / Q000145:classification / Q000453:epidemiology* / Q000473:pathology / Q000517:prevention & control / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D018448:Models, Immunological; D012880:Skin Pigmentation; D055108:Sunbathing / Q000706:statistics & numerical data; D013471:Sunburn / Q000453:epidemiology; D013472:Sunlight; D050378:T-Lymphocytes, Regulatory / Q000276:immunology; D014466:Ultraviolet Rays; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult
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