Journal of Cancer Epidemiology

Review Article

Current Understanding of Lifestyle and Environmental Factors and Risk of Non-Hodgkin Lymphoma: An Epidemiological Update

Table 1

Primary results from NHL consortia studies for selected environmental and lifestyle risk factors, for overall NHL and common subtypes.


Reference, consortium	Total cases	Total controls	Exposure	Exposure metric	Overall NHL (OR, 95% CI)	Diffuse (OR, 95% CI)	FL (OR, 95% CI)	CLL/SLL (OR, 95% CI)	Reference

Morton et al., InterLymph	6594	8892	Smoking	Ever smoker	1.07 (1.00–1.15)	1.09 (0.99–1.20)	1.15 (1.02–1.29)	1.01 (0.86–1.18)	[15]
				≥31 cigs/day	1.07 (0.93–1.23)	1.13 (0.92–1.38)	0.95 (0.73–1.23)	0.82 (0.59–1.14)
				≥36 years	1.16 (1.05–1.28)	1.13 (0.97–1.31)	1.28 (1.08–1.53)	1.16 (0.95–1.42)
				≥36 pack-yrs	1.21 (1.09–1.34)	1.24 (1.06–1.44)	1.30 (1.08–1.56)	1.11 (0.89–1.38)

Besson et al., EpiLymph	1742	2465	Smoking	Ever smoker	1.06 (0.92–1.21)	0.88 (0.72–1.09)	1.16 (0.87–1.56)	1.08 (0.83–1.39)	[17]
				≥20 cigs/day	1.05 (0.88–1.26)	0.95 (0.72–1.24)	1.21 (0.83–1.78)	0.89 (0.64–1.22)
				>32 years	1.15 (0.96–1.39)	0.91 (0.68–1.22)	1.39 (0.94–2.06)	1.10 (0.81–1.50)
				≥27 pack-yrs	1.13 (0.94–1.37)	1.04 (0.78–1.38)	1.21 (0.81–1.82)	1.01 (0.73–1.39)

Morton et al., InterLymph	6492	8683	Alcohol	Ever drinker	0.83 (0.76–0.89)	0.75 (0.66–0.84)	0.84 (0.73–0.97)	0.94 (0.79–1.13)	[22]
				≥28 servings/week	0.87 (0.76–0.99)	0.73 (0.60–0.90)	0.82 (0.63–1.07)	1.16 (0.88–1.52)
				≥401 kg lifetime consumption	0.80 (0.68–0.95)
				≥41 years	0.81 (0.69–0.95)	0.67 (0.53–0.85)	0.84 (0.63–1.12)	0.81 (0.58–1.15)

Besson et al., EpiLymph	1742	2465	Alcohol	Ever regular drinker	0.99 (0.84–1.18)	0.89 (0.69–1.15)	0.96 (0.65–1.44)	1.18 (0.87–1.59)	[17]
				>730 grams per month	0.90 (0.71–1.15)	0.74 (0.51–1.07)	1.15 (0.67–1.99)	0.94 (0.62–1.41)
				≥ 378 kg lifetime consumption	0.99 (0.78–1.26)	0.82 (0.57–1.19)	1.12 (0.63–2.00)	1.04 (0.69–1.55)
				> 42 years duration	0.88 (0.68–1.12)	0.68 (0.46–1.02)	1.20 (0.67–2.16)	1.06 (0.73–1.55)

Kricker et al., InterLymph	8243	9697	Sun exposure	Composite total sun exposure	0.87 (0.71–1.05)¹				[23]
				Composite recreational sun exposure	0.76 (0.63–0.91)	0.69 (0.55–0.87)	0.73 (0.62–0.86)	0.83 (0.59–1.17)
				Composite nonrecreational sun exposure	1.01 (0.89–1.15)
				Lifetime, total exposure	0.88 (0.69–1.11)
				Lifetime, recreational	0.79 (0.54–1.14)
				Lifetime, nonrecreational	0.98 (0.84–1.15)
				Age 10–17, total exposure	0.76 (0.56–1.03)
				Age 10–17, recreational	0.85 (0.62–1.16)
				Age 10–17, nonrecreational	0.87 (0.66–1.15)
				Age 18–40, total exposure	0.93 (0.82–1.06)
				Age 18–40, recreational	0.80 (0.68–0.94)
				Age 18–40, nonrecreational	0.97 (0.85–1.10)
				10 years before diagnosis, total	0.84 (0.72–0.97)
				10 years before diagnosis, recreational	0.74 (0.62–0.88)
				10 years before diagnosis, nonrecreational	0.98 (0.85–1.14)

Boffetta et al., EpiLymph	1518	2124	UV radiation	Personal exposure, free days childhood	1.07 (0.81–1.43)¹	0.88 (0.60–1.28)	1.35 (0.80–2.26)	1.17 (0.70–1.97)	[24]
				Personal exposure, school days childhood	1.01 (0.76–1.35)	0.71 (0.45–1.14)	0.90 (0.46–1.77)	1.44 (0.89–2.34)
				Personal exposure, free days adulthood	0.76 (0.61–0.95)	0.62 (0.44–0.87)	0.78 (0.47–1.27)	0.76 (0.44–1.31)
				Personal exposure, workdays adulthood	0.97 (0.73–1.29)	0.93 (0.60–1.43)	0.81 (0.37–1.77)	0.91 (0.47–1.73)
				Occupational exposure, duration years (UV natural)	0.97 (0.73–1.30)	0.63 (0.37–1.04)	0.61 (0.33–1.11)	1.27 (0.89–1.82)
				Occupational exposure, duration years (UV artificial)	1.14 (0.77–1.70)	0.90 (0.45–1.79)	1.92 (0.85–4.31)	0.90 (0.45–1.78)
				Sunlamp use	0.69 (0.51–0.93)	0.63 (0.38–1.03)	0.71 (0.41–1.24)	0.99 (0.58–1.70)

Cocco et al., EpiLymph	2348	2462	Solvents	Ever exposed	B-NHL: 1.1 (1.0–1.3); T-lymphoma: 0.9 (0.7–1.4)	1.0 (0.8–1.2)	1.3 (1.0–1.7)	1.3 (1.1–1.6)	[25]
				High frequency of exposure	B-NHL: 1.5 (1.2–1.8); T-lymphoma: 1.7 (0.9–3.0)	1.1 (0.7–1.6)	2.0 (1.3–3.2)	1.5 (1.0–2.3)
				High exposure intensity	B-NHL: 1.2 (0.9–1.7); T-lymphoma: 1.6 (0.8–3.3)	1.2 (0.7–1.8)	1.4 (0.7–2.6)	1.2 (0.7–2.0)
				High duration of exposure	B-NHL: 1.2 (1.0–1.4); T-lymphoma: 1.1 (0.6–1.8)	1.0 (0.8–1.4)	1.3 (0.8–1.9)	1.3 (1.0–1.8)
				High cumulative exposure	B-NHL: 1.3 (1.1–1.6); T-lymphoma: 1.2 (0.7–2.0)	1.3 (0.9–1.7)	1.7 (1.1–2.5)	1.5 (1.1–2.1)

Zhang et al., InterLymph	4461	5799	Hair dye	Ever use	1.1 (1.0–1.3)²	1.0 (0.9–1.2)	1.3 (1.0–1.6)	1.3 (1.0–1.6)	[26]
				Permanent dye	1.1 (1.0–1.3)	1.0 (0.8–1.2)	1.3 (1.1–1.7)	1.2 (0.9–1.6)
				Nonpermanent	1.2 (1.0–1.4)	1.1 (0.9–1.4)	1.3 (1.0–1.7)	1.3 (0.9–1.7)
				Permanent dark	1.1 (0.9–1.3)	0.9 (0.7–1.1)	1.4 (1.1–1.8)	1.3 (0.9–1.7)
				Permanent light	1.2 (1.0–1.4)	1.0 (0.8–1.3)	1.3 (1.0–1.7)	1.3 (0.9–1.8)
				Nonpermanent dark	1.2 (1.0–1.5)	1.1 (0.9–1.4)	1.4 (1.0–1.8)	1.3 (0.9–1.8)
				Nonpermanent light	1.2 (0.9–1.5)	1.1 (0.8–1.6)	1.2 (0.8–1.9)	1.7 (1.0–2.7)
				<1980, ever	1.3 (1.1–1.4)	1.1 (0.9–1.3)	1.4 (1.1–1.9)	1.5 (1.1–2.0)
				<1980, permanent dark	1.3 (1.0–1.5)	1.0 (0.8–1.3)	1.4 (1.0–1.9)	1.5 (1.0–2.2)
				<1980, permanent light	1.3 (1.1–1.6)	1.1 (0.9–1.5)	1.6 (1.2–2.2)	1.5 (1.0–2.2)
				<1980, nonpermanent dark	1.2 (1.0–1.6)	1.0 (0.7–1.4)	1.2 (0.8–1.8)	1.6 (1.0–2.5)
				<1980, nonpermanent light	1.3 (0.9–1.9)	1.0 (0.6–1.7)	1.7 (1.0–3.0)	1.9 (1.1–3.6)
				≥1980, ever	1.1 (0.9–1.2)	1.0 (0.8–1.2)	1.3 (1.0–1.7)	1.1 (0.8–1.5)
				≥1980, permanent dark	1.0 (0.8–1.2)	0.7 (0.5–1.0)	1.5 (1.1–2.1)	1.1 (0.7–1.8)
				≥1980, permanent light	1.0 (0.8–1.3)	1.0 (0.7–1.3)	1.2 (0.8–1.8)	0.9 (0.5–1.7)
				≥1980, nonpermanent dark	1.3 (1.0–1.6)	1.2 (0.9–1.6)	1.7 (1.1–2.4)	1.3 (0.8–2.1)
				≥1980, nonpermanent light	1.1 (0.7–1.6)	1.1 (0.6–1.9)	1.0 (0.5–2.1)	1.8 (0.9–3.7)

de Sanjosé et al., EpiLymph	2302	2417	Hair dye	Ever use	1.24 (1.01–1.53)³	0.96 (0.72–1.27)	1.33 (0.90–1.96)	1.43 (1.01–2.03)	[27]
				Dark dye	1.26 (1.00–1.58)
				Light dye	1.27 (1.00–1.60)
				Permanent	1.24 (1.00–1.53)
				Wash-out (rinse)	1.38 (1.07–1.77)
				≥18 years use	1.31 (1.02–1.67)
				≥14 years use, dark	1.50 (1.10–2.05)
				≥12 uses per year	1.33 (1.02–1.74)
				Ever, <1980	1.37 (1.09–1.72)⁴
				Ever, ≥1980	1.11 (0.92–1.34)
				Dark, <1980	1.33 (1.01–1.75)
				Dark, ≥1980	1.17 (0.93–1.47)
				Light, <1980	1.27 (0.96–1.68)
				Light, ≥1980	1.13 (0.88–1.45)
				Permanent, <1980	1.27 (1.00–1.62)
				Permanent, ≥1980	1.14 (0.92–1.41)
				Wash-out, <1980	1.62 (1.16–2.27)
				Wash-out, ≥1980	1.14 (0.89–1.47)
				>10 years use, <1980	1.34 (1.04–1.71)
				>10 years use, ≥1980	1.24 (0.94–1.64)

Willett et al., InterLymph	10453	16507	Obesity	<18.5 BMI	0.88 (0.71–1.08)	0.90 (0.65–1.24)	0.96 (0.62–1.48)	1.19 (0.69–2.03)	[28]
				25–29.99 BMI	0.95 (0.85–1.07)	0.97 (0.81–1.15)	0.99 (0.84–1.15)	0.96 (0.81–1.15)
				30–39.99 BMI	0.97 (0.81–1.15)	1.02 (0.82–1.26)	1.07 (0.86–1.33)	1.09 (0.84–1.42)
				≥40 BMI	0.99 (0.70–1.41)	1.80 (1.23–2.62)	1.34 (0.69–2.63)	1.11 (0.56–2.19)
				Per 5 mg/k² +	0.96 (0.89–1.04)	1.00 (0.90–1.10)

¹ORs are for highest versus lowest categories; ²results shown are for women, no significant effects in men; ³results are for lymphoma overall and for women, unless indicated; ⁴Stratified results for the year hair dye use was started include all study subjects.