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Cigarette Smoking and Risk of Non-Hodgkin's Lymphoma—A Population-Based Case-Control Study

¹ Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark; ² Department of Medical Epidemiology and Biostatistics and ³ Department of Pathology and Oncology, Karolinska Institutet; ⁴ Department of Pathology, Karolinska University Hospital, Stockholm, Sweden; ⁵ Department of Medicine, Vejle Hospital, Vejle, Denmark; ⁶ Department of Medical Biosciences, Pathology, Umeå University, Umeå, Sweden; and ⁷ Department of Oncology, Radiology, and Clinical Immunology, Uppsala University, Uppsala, Sweden

Requests for reprints: Claudia Schöllkopf, Department of Epidemiology Research, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen, Denmark; Phone: 45-3268-3222; Fax: 45-3268-3165. E-mail: CKO{at}SSI.dk

Background: Epidemiologic evidence of an association between tobacco smoking and non-Hodgkin's lymphoma has been conflicting. This may reflect that non-Hodgkin's lymphoma comprises several distinct disease entities with different etiologies, as some studies have indicated an association between smoking and follicular lymphoma.

Objective: To investigate the association between cigarette smoking and non-Hodgkin's lymphoma risk, overall and by subtype.

Methods: As part of a nationwide Danish-Swedish population-based case-control study, we interviewed 3,055 incident non-Hodgkin's lymphoma patients and 3,187 population controls. All lymphomas were uniformly classified according to the WHO classification. We used unconditional logistic regression to estimate adjusted odds ratios (OR) and 95% confidence intervals (95% CI) for the association between cigarette smoking and risk of non-Hodgkin's lymphoma.

Results: Cigarette smoking was not associated with the risk of non-Hodgkin's lymphoma overall (OR, 0.97; 95% CI, 0.87-1.08) nor with the major subgroups such as diffuse large B-cell lymphoma (OR, 0.94; 95% CI, 0.79-1.10), chronic lymphocytic leukemia (OR, 0.86; 95% CI, 0.72-1.02), or follicular lymphoma (OR, 1.03; 95% CI, 0.85-1.24). Female smokers were at a marginally increased risk of follicular lymphoma (OR, 1.41; 95% CI, 1.04-1.92). Men who had ever smoked had a significantly increased risk of T-cell lymphoma (OR, 1.67; 95% CI, 1.11-2.51). No dose-response association with cigarette smoking could be established for any lymphoma subgroup.

Conclusion: We found little evidence of an association between cigarette smoking and non-Hodgkin's lymphoma risk overall. Although increased risks of follicular lymphoma in female smokers and of T-cell lymphoma in male smokers were suggested, no dose-response relationship was observed, leaving limited support for causality.

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