Level of education and the risk of lymphoma in the European prospective investigation into cancer and nutrition.
Hermann S., Rohrmann S., Linseisen J., Nieters A., Khan A., Gallo V., Overvad K., Tjønneland A., Raaschou-Nielsen O., Bergmann MM., Boeing H., Becker N., Kaaks R., Bueno-de-Mesquita HB., May AM., Vermeulen RC., Bingham S., Khaw KT., Key TJ., Travis RC., Trichopoulou A., Georgila C., Triantafylou D., Celentano E., Krogh V., Masala G., Tumino R., Agudo A., Altzibar JM., Ardanaz E., Martínez-García C., Suárez MV., Tormo MJ., Braaten T., Lund E., Manjer J., Zackrisson S., Hallmans G., Malmer B., Boffetta P., Brennan P., Slimani N., Vineis P., Riboli E.
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.