Population-based research on occupational and environmental factors for leukemia and non-Hodgkin's lymphoma: The Northern Germany Leukemia and Lymphoma Study (NLL)

Institute for Community Medicine, Section of Health Care Epidemiology and Community Health, Ernst-Moritz-Arndt University of Greifswald, Greifswald, Germany.
American Journal of Industrial Medicine (Impact Factor: 1.74). 04/2008; 51(4):246-57. DOI: 10.1002/ajim.20551
Source: PubMed


The Northern Germany Leukemia and Lymphoma Study (NLL) is a population-based study designed to provide a quantitative basis for investigations into occupational and environmental risk factors for leukemia and lymphoma.
All incident cases of leukemia and lymphoma diagnosed between 1/1/1986 and 12/31/1998 in six counties in Northern Germany were actively ascertained. Controls were selected from population registries. Use of pesticides, sources of food supply, time spent at home and work, medical and family history were assessed via face-to-face interview. This self-reported information was used in conjunction with direct environmental measurements of pesticides in household dust and electromagnetic fields (EMFs). In addition, geographical information system (GIS) data were used to derive estimates of environmental exposure to pesticides, EMFs associated with transmission lines, and ionizing radiation from routine nuclear power reactor operations. Occupational exposure assessment was based on lifetime work history. For each job, information on branch of industry, company, job description, and duration of employment were ascertained.
Fourteen hundred thirty cases and 3041 controls were recruited. Lifetime residential and workplace histories totaled 49,628 addresses. Occupational exposure to pesticides was reported by 15% of the male participants (women: 16%). Four percent of the men (women: 8%) were occupationally exposed to ionizing radiation for >or=1 year over their lifetime. Sixty four percent of the participants had lived in the vicinity (20 km) of a nuclear power plant in operation.
The NLL illustrates the successful application of innovative methods to simultaneously assess occupational and environmental risk factors for leukemia and lymphoma including radiological hazards, pesticides, and EMFs.

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    • "This study is based on the Northern Germany Leukemia and Lymphoma Study (NLL), a large population-based epidemiologic case-control study on causes and risk factors for monoclonal malignant hematologic diseases [13]. All incident cases at ages younger than 75 years between 1986 and 1998 in six counties of Northern Germany were included. "
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    ABSTRACT: Our aim is to evaluate the relevance of different factors influencing lifetime accumulated red bone marrow dose, such as calendar year, age and sex. The lifetime dose was estimated for controls interviewed in person (N = 2811, 37.5% women) of the population-based representative Northern Germany Leukemia and Lymphoma Study. Data were assessed in standardized computer-assisted personal interviews. The calculation of doses is based on a comprehensive quantification model including calendar year, sex, kind of examination, and technical development. In multivariate regression models the annual red bone marrow dose was analyzed depending on age, sex and calendar year to consider simultaneously temporal changes in radiologic practice and individual risk factors. While the number of examinations continuously rises over time, the dose shows two peaks around 1950 and after 1980. Men are exposed to higher doses than woman. Until 1970 traditional examinations like conventional and mass screening examinations caused the main dose. They were then replaced by technically advanced examinations mainly computed tomography and cardiac catheter. The distribution of the red bone marrow dose over lifetime depends highly on the technical standards and radiation protection survey. To a lesser extent it is influenced by age and sex of the subjects. Thus epidemiological studies concerning the assessment of radiation exposure should consider the calendar year in which the examination was conducted.
    PLoS ONE 11/2013; 8(11):e78027. DOI:10.1371/journal.pone.0078027 · 3.23 Impact Factor
    • "Most studies of NHL have been conducted among male farmers and farm workers. There were relatively few studies that focused only on female farmers and farm workers[2122232425] or studies that focused on both male and female farm workers.[89262728] In Canada, incidence rates for NHL have increased modestly in males (0.8%) and have stabilized in females between 1998 and 2007. "
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    ABSTRACT: Objectives: The objective was to examine the association between non-Hodgkin's lymphoma (NHL) and farming-related activities, gender, pesticides exposure, and exposure to chemicals other than pesticides in Saskatchewan. Materials and Methods: Male and female study participants were taken from two separate case-control studies conducted in Saskatchewan province, Canada. A case was defined as any man or woman aged 19 years and older with a first diagnosis of NHL registered by the Saskatchewan Cancer Agency during the study period. Conditional logistic regression was used to fit the statistical models. Results: Farming exposure and exposure to pesticides-contaminated cloths were related to an increased risk of NHL. Exposure to pesticides was strongly associated with an increased risk of NHL, especially for men. Conclusion: For men, the incidence of NHL was associated with exposure to pesticides after adjusting for other independent predictors.
    Indian Journal of Occupational and Environmental Medicine 09/2013; 17(3):114-21. DOI:10.4103/0019-5278.130860
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    • "large number of potential risk factors (Keller-Byrne et al., 1997; Chang et al., 2005; Hoffmann et al., 2008; Khan et al., 2008; Geyer et al., 2010; Sangrajrang et al., 2011; Jiao et al., 2012), including personal and family medical histories (such as blood transfusion, alkylating drugs for cancer treatment, diagnostic X-rays, rheumatoid arthritis, retrovirus infection, and family history of blood disorders), lifestyle (such as use of tobacco, alcohol, and hair dye), and environmental exposures (such as living on a farm, living near electrical power transmission lines, benzene solvents, and radiation). Several of the NHL case-control studies have stratified their analyses and investigated the risk factors for DLBCL specifically (Smedby et al., 2006; Ekstrom Smedby et al., 2008; Frankenfeld et al., 2008; Monnereau et al., 2008). "
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    ABSTRACT: Background: Several potential risk factors have been identified for diffuse large B-cell lymphoma (DLBCL); however, epidemiological studies investigating the association between these risk factors and DLBCL have yielded inconsistent results. Objectives: To investigate potential medical, lifestyle, and environmental risk factors of DLBCL in Shanghai, China through a hospital-based case-control study. Method: One-hundred- and-forty-seven newly diagnosed DLBCL patients and 294 sex- and age-matched controls were recruited from 11 hospitals in Shanghai between 2003 and 2007. A standardized structured questionnaire was used to obtain patient data on demographics, medical history, family history, lifestyle, and environmental exposures. Conditional logistic regression models were used to estimate odds ratios (ORs), with 95% confidence intervals (CIs), for risk associated with each data category. Results: History of tuberculosis (TB) infection and "living on a farm" were positively associated with DLBCL (TB: OR=3.05, 95% CI: 1.19-7.80; farm: OR=1.82, 95% CI: 1.21-2.73). In contrast, taking traditional Chinese medicine was negatively associated with DLBCL (OR=0.36, 95% CI: 0.14- 0.89). No significant correlation with DLBCL risk was found for any of the other potential risk factors (p>0.05), including but not limited to hair dyes, alcohol drinking, smoking, and home/workplace renovation within one year. Conclusions: Consistent with results from previous studies in other DLBCL case populations, traditional Chinese medicine appeared to have a direct or indirect protective effect against DLBCL. However, this study also identified a possible predisposition for DLBCL in TB sufferers and farmers.
    Asian Pacific journal of cancer prevention: APJCP 07/2012; 13(7):3329-34. DOI:10.7314/APJCP.2012.13.7.3329 · 2.51 Impact Factor
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