Elsevier

The Lancet Oncology

Volume 6, Issue 7, July 2005, Pages 469-476
The Lancet Oncology

Fast track — Articles
Alcohol consumption and risk of non-Hodgkin lymphoma: a pooled analysis

https://doi.org/10.1016/S1470-2045(05)70214-XGet rights and content

Summary

Background

Previous epidemiological studies of the relation between alcohol consumption and risk of non-Hodgkin lymphoma (NHL) have been inconsistent, probably because of small sample sizes of individual studies that result from stratification by NHL subtype and type of alcoholic beverage. We aimed to assess the role of alcohol consumption in NHL with sufficient sample size to analyse by both type of alcoholic beverage and disease subtype.

Methods

We obtained original data from nine case-control studies from the USA, UK, Sweden, and Italy in the International Lymphoma Epidemiology Consortium (InterLymph), yielding a pooled study population of 15 175 individuals (6492 cases and 8683 controls). We derived odds ratios (OR) and 95% CI from unconditional logistic regression models, controlling for study centre and other confounding factors. Heterogeneity between studies was assessed by comparison of results from joint fixed-effects logistic regression and two-stage random-effects logistic regression, and by calculation of Wald χ2 statistics.

Findings

People who drank alcohol had a lower risk of NHL than did non-drinkers (OR 0·83 [95% CI 0·76–0·89]). Compared with non-drinkers, risk estimates were lower for current drinkers than for former drinkers (0·73 [0·64–0·84] vs 0·95 [0·80–1·14]), but risk did not decrease with increasing alcohol consumption. The protective effect of alcohol did not vary by beverage type, but did change with NHL subtype. The lowest risk estimates were recorded for Burkitt's lymphoma (0·51 [0·33–0·77]).

Interpretation

People who drink alcoholic beverages might have a lower risk of NHL than those who do not, and this risk might vary by NHL subtype. Further study designs are needed to determine whether confounding lifestyle factors or immunomodulatory effects of alcohol explain this association.

Introduction

Non-Hodgkin lymphoma (NHL) is a group of heterogeneous diseases characterised by the malignant transformation of healthy lymphoid cells.1 Incidence of NHL has risen worldwide in past decades,2, 3 and in developed countries, NHL is the sixth most common cancer in men and eighth most common in women.4

Several epidemiological studies have associated alcohol consumption with NHL, although results have been inconsistent. Six population-based case-control studies5, 6, 7, 8, 9, 10 and a cohort study11 have suggested that alcohol consumption reduces the risk of NHL, whereas four population-based12, 13, 14, 15 and five hospital-based16, 17, 18, 19, 20, 21, 22 case-control studies found no association between alcohol consumption and NHL. Furthermore, positive associations between alcohol consumption and NHL have been reported in men12 and in men with a family history of haemolymphoproliferative cancer5 in two population-based case-control studies, and in cigarette smokers in a cohort study.23 Epidemiological studies that have assessed alcohol consumption and NHL by type of alcoholic beverage5, 6, 7, 8, 9, 10, 11, 12, 14, 16, 17, 20, 21, 23, 24 or by subtype of NHL5, 6, 7, 9, 11, 12, 14, 15, 24 have reported conflicting results. If the association between NHL and alcohol consumption varies by disease subtype or by beverage type, individual epidemiological studies might have limited statistical power to analyse the relation.

The International Lymphoma Epidemiology Consortium (InterLymph) is a voluntary case-control consortium established in 2000 to facilitate collaboration among major epidemiological studies of lymphoma worldwide.25 We aimed to assess the role of alcohol consumption in NHL with sufficient sample size to analyse by type of alcoholic beverage and by disease subtype.

Section snippets

Study population

We did a pooled analysis of original data from nine case-control studies identified through InterLymph. Studies were eligible if they had been completed between Jan 1, 1990, and Jan 1, 2004; had available electronic data at May 1, 2004; and had data for alcohol consumption. Data were pooled from nine case-control studies six of which had been reported previously.8, 9, 10, 12, 14, 20, 21

Data gathering and exposure definitions

Data for the nine participating studies were obtained mainly by use of interviews with standardised,

Results

Table 1 shows selected characteristics for every study. The pooled study population of 8683 controls and 6492 cases consisted of 7864 men and 7311 women, 95% of whom were of white ethnic origin. The median age was 58 years (range 17–86). 2605 (30%) controls were in the highest category for socioeconomic status compared with 1690 (26%) cases (p<0·0001). By contrast, more cases than controls had a body-mass index of 27·5 kg/m2 or more (1206 of 4433 [27%] vs 1418 of 6505 [22%]; p<0·0001), history

Discussion

Our pooled analysis of 15 175 study participants from nine case-control studies suggests that people who drink alcoholic beverages have a lower risk of NHL than those who do not. In participants from the Connecticut, UCSF, Italy (Verona), and Sweden studies, current drinkers were 0·73 times as likely as non-drinkers to develop NHL. We found no dose-response relation for increasing frequency and duration of consumption, or total lifetime consumption. The type of alcoholic beverage consumed did

References (54)

  • JW Park et al.

    Chemopreventive agent resveratrol, a natural product derived from grapes, reversibly inhibits progression through S and G2 phases of the cell cycle in U937 cells

    Cancer Lett

    (2001)
  • S Percival et al.

    Wine modifies the effects of alcohol on immune cells of mice

    J Nutr

    (2000)
  • ES Jaffe et al.

    Pathology and genetics of tumours of haematopoietic and lymphoid tissues

  • F Groves et al.

    Cancer surveillance series: non-Hodgkin's lymphoma incidence by histologic subtype in the United States from 1978 through 1995

    J Natl Cancer Inst

    (2000)
  • P Hartge et al.

    Hodgkin's and non-Hodgkin's lymphomas

    Cancer Surv

    (1994)
  • J Ferlay et al.

    GLOBOCAN 2000: cancer incidence, mortality and prevalence worldwide, version 1.0. IARC CancerBase No 5

    (2001)
  • NC Briggs et al.

    Wine drinking and risk of non-Hodgkin's lymphoma among men in the United States: a population-based case-control study

    Am J Epidemiol

    (2002)
  • EA Holly et al.

    Case-control study of non-Hodgkin's lymphoma among women and heterosexual men in the San Francisco Bay Area, California

    Am J Epidemiol

    (1999)
  • LM Morton et al.

    Alcohol use and risk of non-Hodgkin's lymphoma among Connecticut women (United States)

    Cancer Causes Control

    (2003)
  • RA Nelson et al.

    Alcohol, tobacco and recreational drug use and the risk of non-Hodgkin's lymphoma

    Br J Cancer

    (1997)
  • ChiuBCH et al.

    Alcohol consumption and non-Hodgkin lymphoma in a cohort of older women

    Br J Cancer

    (1999)
  • ET Chang et al.

    Alcohol intake and risk of non-Hodgkin lymphoma in men and women

    Cancer Causes Control

    (2004)
  • DS Freedman et al.

    Relation of cigarette smoking to non-Hodgkin's lymphomas among middle-aged men

    Am J Epidemiol

    (1998)
  • EV Willett et al.

    Tobacco and alcohol consumption and the risk of non-Hodgkin lymphoma

    Cancer Causes Control

    (2004)
  • J Schroeder et al.

    A case-control study of tobacco use and other non-occupational risk factors for t(14;18) subtypes of non-Hodgkin's lymphoma (United States)

    Cancer Causes Control

    (2002)
  • S Franceschi et al.

    Dietary factors and non-Hodgkin's lymphoma: a case-control study in the northeastern part of Italy

    Nutr Cancer

    (1989)
  • A Tavani et al.

    Alcohol drinking and risk of non-Hodgkin's lymphoma

    Eur J Clin Nutr

    (2001)
  • Cited by (0)

    View full text