Associations Between Anthropometry, Cigarette Smoking, Alcohol Consumption, and Non-Hodgkin Lymphoma in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial

Department of Epidemiology and Biostatistics, School of Public Health and Health Services, George Washington University, Washington, DC, USA.
American journal of epidemiology (Impact Factor: 5.23). 06/2010; 171(12):1270-81. DOI: 10.1093/aje/kwq085
Source: PubMed


Prospective studies of lifestyle and non-Hodgkin lymphoma (NHL) are conflicting, and some are inconsistent with case-control
studies. The Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial was used to evaluate risk of NHL and its
subtypes in association with anthropometric factors, smoking, and alcohol consumption in a prospective cohort study. Lifestyle
was assessed via questionnaire among 142,982 male and female participants aged 55–74 years enrolled in the PLCO Trial during
1993–2001. Hazard ratios and 95% confidence intervals were calculated using Cox proportional hazards regression. During 1,201,074
person-years of follow-up through 2006, 1,264 histologically confirmed NHL cases were identified. Higher body mass index (BMI;
weight (kg)/height (m)2) at ages 20 and 50 years and at baseline was associated with increased NHL risk (Ptrend < 0.01 for all; e.g., for baseline BMI ≥30 vs. 18.5–24.9, hazard ratio = 1.32, 95% confidence interval: 1.13, 1.54). Smoking
was not associated with NHL overall but was inversely associated with follicular lymphoma (ever smoking vs. never: hazard
ratio = 0.62, 95% confidence interval: 0.45, 0.85). Alcohol consumption was unrelated to NHL (drinks/week: Ptrend = 0.187). These data support previous studies suggesting that BMI is positively associated with NHL, show an inverse association
between smoking and follicular lymphoma (perhaps due to residual confounding), and do not support a causal association between
alcohol and NHL.

Download full-text


Available from: Graham A Colditz
  • Source
    • "Main characteristics of the 18 studies, eight case–control studies (Boffetta et al., 1989; Brown et al., 1992; Glass et al., 2003; Vlajinac et al., 2003; Deandrea et al., 2007; Monnereau et al., 2008; Andreotti et al., 2013; Wang et al., 2013) and 10 cohort investigations (Blair et al., 2005; Ozasa, 2007; Klatsky et al., 2009; Chang et al., 2010; Kanda et al., 2010; Troy et al., 2010; Neasham et al., 2011; Gapstur et al., 2012; Kroll et al., 2012; Heinen et al., 2013), included in the meta-analysis are summarized in Table 1. A total of 5694 patients with MM were included, among whom 1584 (28%) were from the UK Million Women Study (Kroll et al., 2012) and 1567 (28%) were from the recent pooled analysis in the 'International Multiple Myeloma Consortium' (Andreotti et al., 2013). "
    [Show abstract] [Hide abstract]
    ABSTRACT: The role of alcohol intake in the risk for multiple myeloma (MM) is unclear, although some recent findings suggest an inverse relationship. To summarize the information on the topic, we carried out a systematic review and a dose-risk meta-analysis of published data. Through the literature search until August 2013, we identified 18 studies, eight case-control and 10 cohort studies, carried out in a total of 5694 MM patients. We derived pooled meta-analytic estimates using random-effects models, taking into account the correlation between estimates, and we carried out a dose-risk analysis using a class of nonlinear random-effects meta-regression models. The relative risk for alcohol drinkers versus non/occasional drinkers was 0.97 [95% confidence interval (CI), 0.85-1.10] overall, 0.96 (95% CI, 0.74-1.24) among case-control studies, and 1.00 (95% CI, 0.89-1.13) among cohort studies. Compared with nondrinkers, the pooled relative risks were 0.96 (95% CI, 0.81-1.13) for light (i.e. ≤1 drink/day) and 0.89 (95% CI, 0.74-1.07) for moderate-to-heavy (i.e. >1 drink/day) alcohol drinkers. The dose-risk analysis revealed a model-based MM risk reduction of about 15% at two to four drinks/day (i.e. 25-50 g of ethanol). The present meta-analysis of published data found no strong association between alcohol drinking and MM risk, although a modest favorable effect emerged for moderate-to-heavy alcohol drinkers.
    Full-text · Article · Mar 2014 · European journal of cancer prevention: the official journal of the European Cancer Prevention Organisation (ECP)
  • Source
    • "A small meta-analysis of five prospective studies of Hodgkin lymphoma reported an increase in the relative risk of disease for obese but not for overweight individuals (Larsson and Wolk, 2011); in contrast, we found increased risk in both overweight and obese women, probably reflecting greater statistical power. Our results are also consistent with the few previous studies of diagnostic groups not included in the meta-analyses: individual cohort studies reported positive associations with plasma cell neoplasms (Engeland et al, 2007; Troy et al, 2010) and myelodysplastic syndromes (Ma et al, 2009), but not mature T-cell malignancies (Lim et al, 2007). Using the ICD-10 classification, our results for NHL, myeloma, and leukaemia are consistent with an earlier report from the same cohort with only 5.4 years of follow-up (Reeves et al, 2007), and with meta-analyses that included it (Renehan et al, 2008; Wallin and Larsson, 2011). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Greater adiposity and height have been associated with increased risk of haematological malignancies. Associations for disease subtypes are uncertain. Methods: A cohort of 1.3 million middle-aged UK women was recruited in 1996–2001 and followed for 10 years on average. Potential risk factors were assessed by questionnaire. Death, emigration, and incident cancer were ascertained by linkage to national registers. Adjusted relative risks were estimated by Cox regression. Results: During follow-up, 9162 participants were diagnosed with lymphatic or haematopoietic cancers. Each 10 kg m−2 increase in body mass index was associated with relative risk of 1.20 (95% confidence interval: 1.13–1.28) for lymphoid and 1.37 (1.22–1.53) for myeloid malignancy (P=0.06 for heterogeneity); similarly, Hodgkin lymphoma 1.64 (1.21–2.21), diffuse large B-cell lymphoma 1.36 (1.17–1.58), plasma cell neoplasms 1.21 (1.06–1.39), acute myeloid leukaemia 1.47 (1.19–1.81), and myeloproliferative/myelodysplastic syndromes 1.32 (1.15–1.52). Each 10 cm increase in height was associated with relative risk of 1.21 (1.16–1.27) for lymphoid and 1.11 (1.02–1.21) for myeloid malignancy (P=0.07 for heterogeneity); similarly, mature T-cell malignancies 1.36 (1.03–1.79), diffuse large B-cell lymphoma 1.28 (1.14–1.43), follicular lymphoma 1.28 (1.13–1.44), plasma cell neoplasms 1.12 (1.01–1.24), chronic lymphocytic leukaemia/small lymphocytic lymphoma 1.23 (1.08–1.40), and acute myeloid leukaemia 1.22 (1.04–1.42). There was no significant heterogeneity between subtypes. Conclusion: In middle-aged women, greater body mass index and height were associated with modestly increased risks of many subtypes of haematological malignancy.
    Full-text · Article · May 2013 · British Journal of Cancer
  • Source
    • "Studies conducted in Connecticut and among women living in Iowa, for instance, have suggested decreased risks of NHL associated with higher consumption of red wine [33] [44]. Higher consumption of wine has also been inversely associated with NHL in a large population-based case-control study [45], but other studies suggest null or elevated risks [10] [20] [40]. Red wine is a source of a variety of phytochemicals, including resveratrol which has antiinflammatory properties and may aid in the inhibition of tumor proliferation [46], including for human lymphoma cells specifically [47]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The incidence rates of non-Hodgkin lymphoma (NHL) have steadily increased over the last several decades in the United States, and the temporal trends in incidence can only be partially explained by the HIV epidemic. In 1992, an international workshop sponsored by the United States National Cancer Institute concluded that there was an "emerging epidemic" of NHL and emphasized the need to investigate the factors responsible for the increasing incidence of this disease. Over the past two decades, numerous epidemiological studies have examined the risk factors for NHL, particularly for putative environmental and lifestyle risk factors, and international consortia have been established in order to investigate rare exposures and NHL subtype-specific associations. While few consistent risk factors for NHL aside from immunosuppression and certain infectious agents have emerged, suggestive associations with several lifestyle and environmental factors have been reported in epidemiologic studies. Further, increasing evidence has suggested that the effects of these and other exposures may be limited to or stronger for particular NHL subtypes. This paper examines the progress that has been made over the last twenty years in elucidating the etiology of NHL, with a primary emphasis on lifestyle factors and environmental exposures.
    Full-text · Article · Sep 2012 · Journal of Cancer Epidemiology
Show more