Aims: To identify occupations suspected to be associated with malignant lymphoma and to generate new hypotheses about occupational risks in a multicentre, population based case control study.
Methods: Male and female patients with malignant lymphoma (n = 710) aged 18–80 years of age were prospectively recruited in six study regions in Germany. For each newly recruited lymphoma case, a sex, region, and age matched control was drawn from the population registers. Odds ratios and 95% confidence intervals for major occupations and industries were calculated using conditional logistic regression analysis, adjusted for smoking (in pack-years) and alcohol consumption. Patients with specific lymphoma subentities were additionally compared with the entire control group using unconditional logistic regression analysis.
Results: The following economic/industrial sectors were positively associated with lymphoma: food products, beverages, tobacco; paper products, publishing and printing; and metals. Chemicals; real estate, renting, and business activities were negatively associated with lymphoma diagnosis. The authors observed an increased overall lymphoma risk among architects; maids; farmers; glass formers; and construction workers. Shoemaking and leather goods making was negatively associated with the lymphoma diagnosis (although based on small numbers). In the occupational group analysis of lymphoma subentities, Hodgkin’s lymphoma was significantly associated only with rubber and plastic products making; diffuse large B cell lymphoma risk was considerably increased among metal processors; follicular lymphoma showed highly significant risk increases for several occupational groups (medical, dental, and veterinary workers; sales workers; machinery fitters; and electrical fitters); and multiple myeloma showed a particularly pronounced risk increase for farmers as well as for agriculture and animal husbandry workers.
Conclusions: The results partly confirm previously defined occupational risks. Occupational risk factors for follicular lymphomas might differ from the overall risk factors for malignant lymphoma.
- CLL, chronic lymphocytic leukaemia
- JEM, job exposure matrix
- NHL, non-Hodgkin’s lymphoma
- SLL, small lymphocytic lymphoma
- malignant lymphoma
- case control study
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The study was funded by the Federal Office for Radiation Protection (StSch4261 and StSch4420). The European Community supported the set up of a common protocol for assessment of occupational exposures (SOC 98 201307 05F02) and implementation of additional study areas (QLK4-CT-2000-00422). A recent workshop of the industrial hygienists in Heidelberg was funded by the German Research Foundation (4850/161/03).
The authors declare that they do not have any competing interests.
The study protocol has been approved by the ethics committees of Ruprecht-Karls University Heidelberg, Landesärztekammer Rheinland-Pfalz, Würzburg University, Ärztekammer Hamburg, and Bielefeld University.