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Occupational exposure to trichloroethylene and risk of non-Hodgkin lymphoma and its major subtypes: a pooled IinterLlymph analysis
  1. P Cocco1,
  2. R Vermeulen2,
  3. V Flore1,
  4. T Nonne1,
  5. M Campagna1,
  6. M Purdue3,
  7. A Blair3,
  8. A Monnereau4,
  9. L Orsi5,
  10. J Clavel5,
  11. N Becker6,
  12. S de Sanjosé7,8,
  13. L Foretova9,
  14. A Staines10,
  15. M Maynadié11,
  16. A Nieters12,
  17. L Miligi13,
  18. A ‘t Mannetje14,
  19. A Kricker15,
  20. P Brennan16,
  21. P Boffetta17,
  22. Q Lan3,
  23. N Rothman3
  1. 1Department of Public Health, Clinical and Molecular Medicine, Occupational Health Section, University of Cagliari, Monserrato, Italy
  2. 2Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands
  3. 3Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, Maryland, USA
  4. 4Centre régional de lutte contre le cancer, Institut Bergonié, Bordeaux, France
  5. 5Institut national de la santé et de la recherché médicale, Villejuif, France
  6. 6German Cancer Research Center, Heidelberg, Germany
  7. 7Unit of Infections and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain
  8. 8Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
  9. 9Department of Cancer Epidemiology and Genetics, Masaryk Memorial Cancer Institute, Brno, Czech Republic
  10. 10School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
  11. 11Dijon University Hospital, Dijon, France
  12. 12Centre of Chronic Immunodeficiency, University of Freiburg, Freiburg, Germany
  13. 13Environmental and Occupational Epidemiology Unit, ISPO Cancer Prevention and Research Institute, Florence, Italy
  14. 14Centre for Public Health Research, Massey University, Wellington, New Zealand
  15. 15Sydney Medical School, School of Public Health, The University of Sydney, Sydney, Australia
  16. 16International Agency for Research on Cancer, Lyon, France
  17. 17Tisch Cancer Institute, Mount Sinai School of Medicine, New York, New York, USA
  1. Correspondence to Professor Pierluigi Cocco, Department of Public Health, Clinical and Molecular Medicine, Occupational Health Section, University of Cagliari, Asse Didattico E, SS 554, km 4,500, Monserrato, Cagliari 09042, Italy; coccop{at}medicina.unica.it

Abstract

Objectives We evaluated the association between occupational exposure to trichloroethylene (TCE) and risk of non-Hodgkin lymphoma (NHL) in a pooled analysis of four international case-control studies.

Methods Overall, the pooled study population included 3788 NHL cases and 4279 controls. Risk of NHL and its major subtypes associated with TCE exposure was calculated with unconditional logistic regression and polytomous regression analysis, adjusting by age, gender and study.

Results Risk of follicular lymphoma (FL), but not NHL overall or other subtypes, increased by probability (p=0.02) and intensity level (p=0.04), and with the combined analysis of four exposure metrics assumed as independent (p=0.004). After restricting the analysis to the most likely exposed study subjects, risk of NHL overall, FL and chronic lymphocytic leukaemia (CLL) were elevated and increased by duration of exposure (p=0.009, p=0.04 and p=0.01, respectively) and with the combined analysis of duration, frequency and intensity of exposure (p=0.004, p=0.015 and p=0.005, respectively). Although based on small numbers of exposed, risk of all the major NHL subtypes, namely diffuse large B-cell lymphoma, FL and CLL, showed increases in risk ranging 2–3.2-fold in the highest category of exposure intensity. No significant heterogeneity in risk was detected by major NHL subtypes or by study.

Conclusions Our pooled analysis apparently supports the hypothesis of an increase in risk of specific NHL subtypes associated with occupational exposure to TCE.

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