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

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Summary

We investigated the relation of alcohol consumption to risk of non-Hodgkin’s lymphoma (NHL) in a cohort of 35 156 lowa women aged 55–69 years who participated in the lowa Women’s Health Study in 1986. Alcohol consumption at baseline was obtained using a mailed questionnaire. During the 9-year follow-up period, 143 incident cases of NHL were identified. Higher alcohol consumption was significantly associated with a decreased risk of NHL (P-trend = 0.03). Compared to non-drinkers, multivariate-adjusted relative risks (RRs) were decreased for women with intake of ≤ 3.4 g day–1 (RR = 0.78; 95% confidence interval (CI) 0.51–1.21) and > 3.4 g day–1 (RR = 0.59; 0.36–0.97). The inverse association could not be attributed to one particular type of alcoholic beverage, although red wine (RR = 0.21 for > 2 glasses per month vs non-drinker; 0.05–0.86; P-trend = 0.02) has the most distinct effect. The apparent protective effect was universal regardless of specific NHL grade or Working Formulation subtype, but was most pronounced for nodal NHL (RR = 0.48; 0.26–0.90; P-trend = 0.01) and low-grade NHL (RR = 0.52; 0.21–1.26; P-trend = 0.05). These data suggest that moderate alcohol consumption is inversely associated with the risk of NHL in older women and the amount of alcohol consumed, rather than the type of alcoholic beverages, appears to be the main effect determinant.

References

  1. Ballester, O. F., Moscinski, L., Spiers, A. & Balducci, L. (1993). Non-Hodgkin’s lymphoma in the older person: a review. J Am Geriatr Soc 41: 1245–1254.

  2. Bell, D. S. (1996). Alcohol and the NIDDM patient. Diabetes Care 19: 509–513.

  3. Bisgard, K. M., Folsom, A. R., Hong, C. P. & Sellers, T. A. (1994). Mortality and cancer rates in nonrespondents to a prospective cohort study of older women: 5-year follow-up. Am J Epidemiol 139: 990–1000.

  4. Bounds, W., Betzing, K. W., Stewart, R. M. & Holcombe, R. F. (1994). Social drinking and the immune response: impairment of lymphokine-activated killer activity. Am J Med Sci 307: 391–395.

  5. Breslow, N. E. & Day, N. E. (1987). Statistical Methods in Cancer Research. Vol. II. The Design and Analysis of Cohort Studies, International Agency for Research on Cancer Scientific Publication No. 88. IARC: Lyon

  6. Brown, L. M., Gibson, R., Burmeister, L. F., Schuman, L. M., Everett, G. D. & Blair, A. (1992). Alcohol consumption and risk of leukemia, non-Hodgkin’s lymphoma, and multiple myeloma. Leukemia Res 16: 979–984.

  7. Cantor, K. P., Blair, A., Everett, G., Van Lier, S., Burmeister, L., Dick, F. R., Gibson, R. W. & Schuman, L. (1988). Hair dye use and risk of leukemia and lymphoma. Am J Public Health 78: 570–571.

  8. Cartwright, R. A., McKinney, P. A., O’Brien, C., Richards, I. D. G., Roberts, B., Lauder, I., Darwin, C. M., Bernard, S. M. & Bird, C. C. (1988). Non-Hodgkin’s lymphoma: case control epidemiological study in Yorkshire. Leukemia Res 12: 81–88.

  9. Cerhan, J. R., Wallace, R. B., Folsom, A. R., Potter, J. D., Munger, R. G. & Prineas, R. J. (1993). Transfusion history and cancer risk in older women. Ann Intern Med 119: 8–15.

  10. Cerhan, J. R., Wallace, R. B., Folsom, A. R., Potter, J. D., Sellers, T. A., Zheng, W. & Lutz, C. T. (1997). Medical history risk factors for non-Hodgkin’s lymphoma in older women. J Natl Cancer Inst 89: 314–318.

  11. Chiu, BC-H, Cerhan, J. R., Folsom, A. R., Sellers, T. A., Kushi, L. H., Wallace, R. B., Zheng, W. & Potter, J. D. (1996). Diet and risk of non-Hodgkin lymphoma in older women. JAMA 275: 1315–1321.

  12. Cox, D. R. (1972). Regression models and life tables (with discussions). J R Stat Soc B 34: 187–220.

  13. De Stefani, E., Fierro, L., Barrios, E. & Ronco, A. (1998). Tobacco, alcohol, diet and risk of non-Hodgkin’s lymphoma: a case-control study in Uruguay. Leukemia Res 22: 445–452.

  14. Facchini, F., Chen, Y-DI & Reaven, G. M. (1994). Light-to-moderate alcohol intake is associated with enhanced insulin sensitivity. Diabetes Care 17: 115–119.

  15. Filipovich, A. H., Mathur, A., Kamat, D. & Shapiro, R. S. (1992). Primary immunodeficiencies: genetic risk factors for lymphoma. Cancer Res 52: 5465s–5467s.

  16. Folsom, A. R., Kaye, S. A., Prineas, R. J., Potter, J. D., Gapstur, S. M. & Wallace, R. B. (1990). Increased incidence of carcinoma of the breast associated with abdominal adiposity in postmenopausal women. Am J Epidemiol 131: 794–803.

  17. Folsom, A. R., Zhang, S., Sellers, T. A., Zheng, W., Kushi, L. H. & Cerhan, J. R. (1996). Cancer incidence among women living on farms: findings from the Iowa Women’s Health Study. J Occup Environ Med 38: 1171–1176.

  18. Franceschi, S., Serraino, D., Bidoli, E., Talamini, R., Tirelli, U., Carbone, A. & La Vecchia, C. (1989a). The epidemiology of non-Hodgkin’s lymphoma in the north-east of Italy: a hospital-based case-control study. Leukemia Res 13: 465–472.

  19. Franceschi, S., Serraino, D., Carbone, A., Talamini, R. & La Vecchia, C. (1989b). Dietary factors and non-Hodgkin’s lymphoma: a case-control study in the northeastern part of Italy. Nutr Cancer 12: 333–341.

  20. Freund, G. (1979). Possible relationships of alcohol in membranes to cancer. Cancer Res 39: 2899–2901.

  21. Gapstur, S. M., Potter, J. D., Sellers, T. A., Kushi, L. H. & Folsom, A. R. (1993). Alcohol consumption and postmenopausal endometrial cancer: results from the Iowa Women’s Health Study. Cancer Causes Control 4: 323–329.

  22. Giovannucci, E., Colditz, G., Stampfer, M. J., Rimm, E. B., Litin, L., Sampson, L. & Willett, W. C. (1991). The assessment of alcohol consumption by a simple self-administered questionnaire. Am J Epidemiol 133: 810–817.

  23. Hoover, R. N. (1992). Lymphoma risks in populations with talered immunity to – a search for a mechanism. Cancer Res 52: 5477s–5478s.

  24. Lazarus, R., Sparrow, D. & Weiss, S. T. (1997). Alcohol intake and insulin levels. The Normative Aging Study. Am J Epidemiol 145: 909–916.

  25. Lynch, C. F., Logsden-Sackett, N., Edwards, S. L. & Cantor, K. P. (1994). The driver’s license list as a population-based sampling frame in Iowa. Am J Public Health 84: 469–472.

  26. MacGregor, R. R. (1986). Alcohol and immune defense. JAMA 256: 1474–1479.

  27. Malvy, D. J., Burtschy, B., Arnaud, J., Sommelet, D., Laverger, G., Dostalova, L., Drucker, J. & Amedee-Manesme, O. (1993). Serum beta-carotene and antioxidant micronutrients in children with cancer: the Cancer in Children and Antioxidant Micronutrients French Study Group. Int J Epidemiol 22: 761–771.

  28. Mufti, S. I., Darban, H. R. & Watson, R. R. (1989). Alcohol, cancer, and immunomodulation. Critical Rev Oncol Hematol 9: 243–261.

  29. Munger, R. G., Folsom, A. R., Kushi, L. H., Kaye, S. A. & Sellers, T. A. (1992). Dietary assessment of older Iowa women with a food-frequency questionnaire: nutrient intake, reproducibility, and comparison to 24-hour dietary recall interviews. Am J Epidemiol 136: 192–200.

  30. Natazuka, T., Manabe, Y., Kono, M., Murayama, T., Matsui, T. & Chihara, K. (1994). Association between non-insulin dependent diabetes mellitus and non-Hodgkin’s lymphoma. Br Med J 309: 1269

  31. Nelson, R. A., Levine, A. M., Marks, G. & Bernstein, L. (1997). Alcohol, tobacco and recreational drug use and the risk of non-Hodgkin’s lymphoma. Br J Cancer 76: 1532–1537.

  32. Percy, C., Holten, V. & Muir, C. (1990). International Classification of Diseases for Oncology, 2nd Edn World Health Organization: Geneva

  33. Ragozzino, M., Melton, L. J., Chu, C. P. & Palumbo, P. J. (1982). Subsequent cancer risk in the incidence cohort of Rochester, Minnesota, residents with diabetes mellitus. J Chronic Dis 35: 13–9.

  34. Ries, L. A. G., Kosary, C. L., Hankey, B. F., Miller, B. A., Harras, A. & Edwards, B. K. (1997). SEER cancer statistics review, 1973–1994. NIH Pub. No. 97-2789, National Cancer Institute: Bethesda, MD

  35. Rimm, E. B., Chan, J., Stampfer, M. J., Colditz, G. A. & Willett, W. C. (1995). Prospective study of cigarette smoking, alcohol use, and the risk of diabetes in men. Br Med J 310: 555–559.

  36. Shaper, A., Wannamethee, G. & Walker, M. (1988). Alcohol and mortality in British men: explaining the U-shaped curve. Lancet 2: 1267–1273.

  37. Stampfer, M. J., Colditz, G. A., Willett, W. C., Manson, J. E., Arky, R. A., Hennekens, C. H. & Speizer, F. E. (1988). A prospective study of moderate alcohol drinking and risk of diabetes in women. Am J Epidemiol 128: 549–558.

  38. Tavani, A., Negri, E., Franceschi, S., Serraino, D. & La Vecchia, C. (1994). Smoking habits and non-Hodgkin’s lymphoma: a case-control study in northern Italy. Prev Med 23: 447–452.

  39. Tavani, A., Pregnolato, A., Negri, E., Franceschi, S., Serraino, D., Carbone, A. & La Vecchia, C. (1997). Diet and risk of lymphoid neoplasms and soft tissue sarcomas. Nutr Cancer 27: 256–260.

  40. Ward, M. H., Zahm, S. H., Weisenburger, D. D., Gridley, G., Cantor, K. P., Saal, R. C. F. & Blair, A. (1994). Dietary factors and non-Hodgkin’s lymphoma in Nebraska (United States). Cancer Causes Control 5: 422–432.

  41. Weisenburger, D. D. (1994). Epidemiology of non-Hodgkin’s lymphoma: recent findings regarding an emerging epidemic. Ann Oncol 5: s19–24.

  42. Whitehead, T. P., Robinson, D., Allaway, S., Syms, J. & Hale, A. (1995). Effect of red wine ingestion on the antioxidant capacity of serum. Clin Chem 41/1: 32–35.

  43. Willett, W. C. & Stampfer, M. J. (1986). Total energy intake: implications for epidemiologic analyses. Am J Epidemiol 124: 17–27.

  44. Willett WC Sampson, L., Stampfer, M. J., Rosner, B., Bain, C., Witschi, J., Hennekens, C. H. & Speizer, F. E. (1985). Reproducibility and validity of a semiquantitative food frequency questionnaire. Am J Epidemiol 122: 51–65.

  45. Zahm, S. H., Weisenburger, D. D., Saal, R. C., Vaught, J. B., Babbitt, P. A. & Blair, A. (1993). The role of agricultural pesticide use in the development of non-Hodgkin’s lymphoma in women. Arch Environ Health 48: 353–358.

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Correspondence to J R Cerhan.

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Keywords

  • lymphoma
  • alcohol
  • non-Hodgkin
  • cohort study

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