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Level of education and the risk of lymphoma in the European prospective investigation into cancer and nutrition

Hermann, Silke ; Rohrmann, Sabine ; Linseisen, Jakob ; Nieters, Alexandra ; Khan, Aneire ; Gallo, Valentina ; Overvad, Kim ; Tjønneland, Anne ; Raaschou-Nielsen, Ole ; Bergmann, Manuela ; Boeing, Heiner ; Becker, Nikolaus ; Kaaks, Rudolf ; Bas Bueno-de-Mesquita, H. ; May, Anne ; Vermeulen, Roel ; Bingham, Sheila ; Khaw, Kay-Tee ; Key, Timothy ; Travis, Ruth ; Trichopoulou, Antonia ; Georgila, Christina ; Triantafylou, Dimitra ; Celentano, Egidio ; Krogh, Vittorio ; Masala, Giovanna ; Tumino, Rosario ; Agudo, Antonio ; Altzibar, Jone ; Ardanaz, Eva ; Martínez-García, Carmen ; Suárez, Marcial ; Tormo, Maria ; Braaten, Tonje ; Lund, Eiliv ; Manjer, Jonas ; Zackrisson, Sophia ; Hallmans, Göran ; Malmer, Beatrice ; Boffetta, Paolo ; Brennan, Paul ; Slimani, Nadia ; Vineis, Paolo ; Riboli, Elio

Journal of Cancer Research and Clinical Oncology, 2010, Vol.136(1), pp.71-77 [Peer Reviewed Journal]

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  • Title:
    Level of education and the risk of lymphoma in the European prospective investigation into cancer and nutrition
  • Author/Creator: Hermann, Silke ; Rohrmann, Sabine ; Linseisen, Jakob ; Nieters, Alexandra ; Khan, Aneire ; Gallo, Valentina ; Overvad, Kim ; Tjønneland, Anne ; Raaschou-Nielsen, Ole ; Bergmann, Manuela ; Boeing, Heiner ; Becker, Nikolaus ; Kaaks, Rudolf ; Bas Bueno-de-Mesquita, H. ; May, Anne ; Vermeulen, Roel ; Bingham, Sheila ; Khaw, Kay-Tee ; Key, Timothy ; Travis, Ruth ; Trichopoulou, Antonia ; Georgila, Christina ; Triantafylou, Dimitra ; Celentano, Egidio ; Krogh, Vittorio ; Masala, Giovanna ; Tumino, Rosario ; Agudo, Antonio ; Altzibar, Jone ; Ardanaz, Eva ; Martínez-García, Carmen ; Suárez, Marcial ; Tormo, Maria ; Braaten, Tonje ; Lund, Eiliv ; Manjer, Jonas ; Zackrisson, Sophia ; Hallmans, Göran ; Malmer, Beatrice ; Boffetta, Paolo ; Brennan, Paul ; Slimani, Nadia ; Vineis, Paolo ; Riboli, Elio
  • Language: English
  • Subjects: Lymphomas ; SES ; Education ; Cohort study
  • Is Part Of: Journal of Cancer Research and Clinical Oncology, 2010, Vol.136(1), pp.71-77
  • Description: Byline: Silke Hermann (1), Sabine Rohrmann (1,31), Jakob Linseisen (1), Alexandra Nieters (1), Aneire Khan (2), Valentina Gallo (2), Kim Overvad (3,4), Anne Tjonneland (5), Ole Raaschou-Nielsen (5), Manuela M. Bergmann (6), Heiner Boeing (6), Nikolaus Becker (1), Rudolf Kaaks (1), H. Bas Bueno-de-Mesquita (7), Anne M. May (7,8), Roel C. H. Vermeulen (8,9), Sheila Bingham (10), Kay-Tee Khaw (11), Timothy J. Key (12), Ruth C. Travis (12), Antonia Trichopoulou (13), Christina Georgila (13), Dimitra Triantafylou (13), Egidio Celentano (14), Vittorio Krogh (15), Giovanna Masala (16), Rosario Tumino (17), Antonio Agudo (18), Jone M. Altzibar (19,32), Eva Ardanaz (20,32), Carmen Martinez-Garcia (21,32), Marcial Vicente Arguelles Suarez (22), Maria Jose Tormo (23,32), Tonje Braaten (24), Eiliv Lund (24), Jonas Manjer (25), Sophia Zackrisson (26), Goran Hallmans (27), Beatrice Malmer (28), Paolo Boffetta (29), Paul Brennan (29), Nadia Slimani (29), Paolo Vineis (2), Elio Riboli (30) Keywords: Lymphomas; SES; Education; Cohort study Abstract: Introduction Lymphomas belong to the few cancer sites with increasing incidence over past decades, and only a few risk factors have been established. We explored the association between education and the incidence of lymphoma in the prospective EPIC study. Materials and methods Within 3,567,410 person-years of follow-up, 1,319 lymphoma cases [1,253 non-Hodgkin lymphomas (NHL) and 66 Hodgkin lymphomas (HL)] were identified. Cox proportional hazard regression was used to examine the association between highest educational level (primary school or less, technical/professional school, secondary school, university) and lymphoma risk. Results Overall, no consistent associations between educational level and lymphoma risk were observed however, associations were found for sub-groups of the cohort. We observed a higher risk of B-NHL (HR = 1.31, 95% CI = 1.02--1.68 n = 583) in women with the highest education level (university) but not in men. Concerning sub-classes of B-NHL, a positive association between education and risk of B cell chronic lymphatic leukaemia (BCLL) was observed only in women. In both genders, the risk of diffuse large B cell lymphoma (DLBCL) was significantly lower for subjects with university degree (HR = 0.46, 95% CI = 0.27--0.79) versus lowest educational level. No association was found for HL. Conclusion We could not confirm an overall consistent association of education and risk of HL or NHL in this large prospective study although, education was positively related to the incidence of BCLL and B-NHL (in women) but inversely to incidence of DLBCL. Due to limited number of cases in sub-classes and the large number of comparisons, the possibility of chance findings can not be excluded. Author Affiliation: (1) Division of Cancer Epidemiology (C020), German Cancer Research Center, Heidelberg, Germany (2) Department of Environmental Epidemiology, Imperial College London, London, UK (3) Department of Cardiology, Aarhus University Hospital, Aalborg, Denmark (4) Department of Clinical Epidemiology, Aarhus University Hospital, Aalborg, Denmark (5) Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark (6) Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrucke, Germany (7) National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands (8) Julius Center, Utrecht Medical Center, Utrecht, The Netherlands (9) Institute for Risk Assessment Sciences, University of Utrecht, Utrecht, The Netherlands (10) MRC Dunn Human Nutrition Unit, Cambridge, UK (11) Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK (12) Cancer Research UK Epidemiology Unit, University of Oxford, Oxford, UK (13) Department of Hygiene and Epidemiology, University of Athens Medical School, Athens, Greece (14) Istituto Nazionale Tumori, Naples, Italy (15) Nutritional Epidemiology Unit, National Cancer Institute, Milan, Italy (16) Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute (ISPO), Florence, Italy (17) Cancer Registry, Azienda Ospedaliera "Civile M.P.Arezzo", Ragusa, Italy (18) Unit of Nutrition, Environment, and Cancer, Catalan Institute of Oncology, Barcelona, Spain (19) Public Health Division of Gipuzkoa, Basque Government, San Sebastian, Spain (32) CIBER en Epidemiologia y Salud Publica (CIBERESP), Barcelona, Spain (20) Public Health Institute of Navarra, Pamplona, Spain (21) Andalusian School of Public Health, Granada, Spain (22) Health and Health Services Council of Asturias, Public Health Directorate Asturias, Asturias, Spain (23) Epidemiology Department, Murcia Health Council, Murcia, Spain (24) Institute of Community Medicine, University of Tromso, Tromso, Norway (25) Department of Surgery, Malmo University Hospital, Malmo, Sweden (26) Department of Radiology, Malmo University Hospital, Malmo, Sweden (27) Department of Public Health and Clinical Medicine, Nutrition, Umea University, Umea, Sweden (28) Department of Radiation Sciences, Oncology, Umea University, Umea, Sweden (29) International Agency for Research on Cancer, Lyon, France (30) Elio Riboli, Department of Epidemiology and Public Health, Imperial College London, London, UK (31) Division of Clinical Epidemiology (C020), German Cancer Research Center, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany Article History: Registration Date: 19/06/2009 Received Date: 20/03/2009 Accepted Date: 19/06/2009 Online Date: 07/07/2009
  • Identifier: ISSN: 0171-5216 ; E-ISSN: 1432-1335 ; DOI: 10.1007/s00432-009-0638-9