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Occupation and risk of lymphoma: a multicentre prospective cohort study (EPIC)
  1. David Neasham1,
  2. Ahlem Sifi1,
  3. Kaspar Rene Nielsen2,
  4. Kim Overvad3,
  5. Ole Raaschou-Nielsen4,
  6. Anne Tjønneland4,
  7. Aurelio Barricarte5,
  8. Carlos A González6,
  9. Carmen Navarro7,8,
  10. Laudina Rodriguez Suarez9,
  11. Ruth C Travis10,
  12. Tim Key10,
  13. Jakob Linseisen11,
  14. Rudolf Kaaks11,
  15. Paolo Crosignani12,
  16. Franco Berrino13,
  17. Stefano Rosso14,
  18. Amalia Mattiello15,
  19. R C H Vermeulen16,
  20. H Bas Bueno-de-Mesquita17,
  21. Göran Berglund18,
  22. Jonas Manjer19,
  23. Sophia Zackrisson20,
  24. Goran Hallmans21,
  25. Beatrice Malmer21,
  26. Sheila Bingham22,
  27. Kay Tee Khaw23,
  28. Manuela M Bergmann24,
  29. Heiner Boeing24,
  30. Antonia Trichopoulou25,
  31. Giovanna Masala26,
  32. Rosario Tumino27,
  33. Eiliv Lund28,
  34. Nadia Slimani29,
  35. Pietro Ferrari29,
  36. Paolo Boffetta30,
  37. Paolo Vineis1,31,
  38. Elio Riboli1
  1. 1Department of Epidemiology and Public Health, Imperial College London, UK
  2. 2Department of Clinical Immunology, Aarhus University Hospital, Aalborg, Denmark
  3. 3Department of Clinical Epidemiology, Aarhus University Hospital, Aalborg, Denmark
  4. 4Institute of Cancer Epidemiology, Danish Cancer Society, København, Denmark
  5. 5Public Health Institute of Navarra, Pamplona, CIBERESP, Spain
  6. 6Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology, Barcelona, Spain
  7. 7Department of Epidemiology, Murcia, Spain
  8. 8CIBER Epidemiología y Salud Pública (CIBERESP), Spain
  9. 9Consejería de Salud y Servicios Sanitarios Principado de Asturias, Spain
  10. 10Cancer Epidemiology Unit, University of Oxford, Oxford, UK
  11. 11German Cancer Research Centre, Division of Cancer Epidemiology, Heidelberg, Germany
  12. 12Unità di Epidemiologia Ambientale e Registro Tumori Fondazione IRCCS Istituto Nazionale dei Tumori Via Venezian, Milano, Italy
  13. 13Etiologic Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori Via Venezian, Milano, Italy
  14. 14CPO - Registro Tumori Piemonte via San Francesco da Paola 31, Torino, Italy
  15. 15Department of Clinical and Experimental Medicine Federico II University, Naples, Italy
  16. 16Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
  17. 17Centre for Nutrition and Health, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
  18. 18Department of Clinical Sciences, Malmö University Hospital, Malmö, Sweden
  19. 19Department of Surgery, Malmö University Hospital, Malmö, Sweden
  20. 20Department of Clinical Sciences in Malmö, Medical Radiology, Lund University, Sweden
  21. 21Units of Nutritional Research and Oncology, University of Umeå, Sweden
  22. 22MRC Centre for Nutritional Epidemiology in Cancer Prevention and Survival, Department of Public Health and Primary Care, University of Cambridge, UK
  23. 23Clinical Gerontology, Department of Public Health and Primary Care, University of Cambridge, UK
  24. 24Department of Epidemiology, German Institute of Human Nutrition, Potsdam, Germany
  25. 25Department of Hygiene and Epidemiology, School of Medicine, University of Athens, Greece
  26. 26Molecular and Nutritional Epidemiology Unit, ISPO - Scientific Institute of Tuscany, Florence, Italy
  27. 27Cancer Registry, Azienda Ospedaliera “Civile MP Arezzo”, Ragusa, Italy
  28. 28Institute of Community Medicine, University of Tromsø, Tromsø, Norway
  29. 29Nutrition and Hormones Group, International Agency for Research on Cancer, Lyon, France
  30. 30The Tisch Cancer Institute Mount Sinai School of Medicine New York, NY, USA
  31. 31ISI Foundation, Torino, Italy
  1. Correspondence to Department of Epidemiology and Public Health, Imperial College London, Department of Epidemiology and Public Health, Imperial College Faculty of Medicine Building, Norfolk Place, London W2 1PG, UK; david.neasham{at}


Objectives Evidence suggests that certain occupations and related exposures may increase the risk of malignant lymphoma. Farming, printing and paper industry, wood processing, meat handling and processing, welding, shoe and leather manufacturing and teaching profession are among the categories that have been implicated in previous studies. The relationship between occupation and malignant lymphoma has been investigated in a large European prospective study.

Methods We investigated occupational risks for lymphomas in the European Prospective Investigation into Cancer and Nutrition (EPIC). The mean follow-up time for 348 555 subjects was 9 years (SD: 2 years). The analysis was based on 866 and 48 newly diagnosed cases of non-Hodgkin's lymphoma (NHL) and Hodgkin's lymphoma (HL). These were identified in the EPIC subcohorts with occupational data. Data on 52 occupations were collected through standardised questionnaires. Cox proportional hazard models were used to explore the association between occupation and risk of malignant lymphoma.

Results The following occupations were positively associated with malignant NHL after adjustment for study centre, age, sex, socioeconomic status (SES), smoking and alcohol: butchers (HR=1.53, 95% CI 1.05 to 2.48, including multiple myeloma/plasmacytoma; HR=1.30, 95% CI 1.00 to 2.66, excluding multiple myeloma/plasmacytoma) and car repair workers (HR=1.50, 95% CI 1.01 to 2.00, including multiple myeloma/plasmacytoma; HR=1.51, 95% CI 1.01 to 2.31, excluding multiple myeloma/plasmacytoma). HL was associated with gasoline station occupation (HR=4.59, 95% CI 1.08 to 19.6).

Conclusion The findings in this current study of a higher risk of NHL among car repair workers and butchers and a higher risk of HL among gasoline station workers suggest a possible role from occupationally related exposures, such as solvents and zoonotic viruses, as risk factors for malignant lymphoma.

  • Epidemiology
  • cancer
  • longitudinal studies
  • animal workers
  • solvents

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  • Funding Europe Against Cancer Program of the European Commission (SANCO), Deutsche Krebshilfe Deutsches Krebsforschungszentrum German Federal Ministry of Education and Research, Danish Cancer Society Health Research Fund (FIS) of the Spanish Ministry of Health Spanish Regional Governments of Andalucia, Asturias, Basque Country, Murcia and Navarra Grant ISCIII, Red de Centros RCESP, C03/09, Spain Cancer Research, United Kingdom Stroke Association, United Kingdom British Heart Foundation, United Kingdom Department of Health, United Kingdom Food Standards Agency, United Kingdom Wellcome Trust, United Kingdom Greek Ministry of Education and Ministry of Health Italian Association for Research on Cancer (AIRC), Italian National Research Council Dutch Ministry of Public Health, Welfare and Sports, World Cancer Research Fund, Swedish Cancer Society, Swedish Scientific Council Regional Government of Skåne, Sweden Norwegian Cancer Society Research Council of Norway. Other funders: Wellcome Trust.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the IARC ethical committee and all the local IRBs.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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