Personal use of hair dye and the risk of certain subtypes of non-Hodgkin lymphoma

Personal use of hair dye has been inconsistently linked to risk of non-Hodgkin lymphoma (NHL), perhaps because of small samples or a lack of detailed information on personal hair-dye use in previous studies. This study included 4,461 NHL cases and 5,799 controls from the International Lymphoma Epidemiology Consortium 1988-2003. Increased risk of NHL (odds ratio (OR) = 1.3, 95% confidence interval (CI): 1.1, 1.4) associated with hair-dye use was observed among women who began using hair dye before 1980. Analyses by NHL subtype showed increased risk for follicular lymphoma (FL) and chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) but not for other NHL subtypes. The increased risks of FL (OR = 1.4, 95% CI: 1.1, 1.9) and CLL/SLL (OR = 1.5, 95% CI: 1.1, 2.0) were mainly observed among women who started using hair dyes before 1980. For women who began using hair dye in 1980 or afterward, increased FL risk was limited to users of dark-colored dyes (OR = 1.5, 95% CI: 1.1, 2.0). These results indicate that personal hair-dye use may play a role in risks of FL and CLL/SLL in women who started use before 1980 and that increased risk of FL among women who started use during or after 1980 cannot be excluded.

Non-Hodgkin lymphoma and obesity: a pooled analysis from the InterLymph Consortium

Nutritional status is known to alter immune function, a suspected risk factor for non-Hodgkin lymphoma (NHL). To investigate whether long-term over, or under, nutrition is associated with NHL, self-reported anthropometric data on weight and height from over 10,000 cases of NHL and 16,000 controls were pooled across 18 case-control studies identified through the International Lymphoma Epidemiology Consortium. Study-specific odds ratios (OR) were estimated using logistic regression and combined using a random-effects model. Severe obesity, defined as BMI of 40 kg m(-2) or more, was not associated with NHL overall (pooled OR = 1.00, 95% confidence interval (CI) 0.70-1.41) or the majority of NHL subtypes. An excess was however observed for diffuse large B-cell lymphoma (pooled OR = 1.80, 95% CI 1.24-2.62), although not all study-specific ORs were raised. Among the overweight (BMI 25-29.9 kg m(-2)) and obese (BMI 30-39.9 kg m(-2)), associations were elevated in some studies and decreased in others, while no association was observed among the underweight (BMI < 18.5 kg m(-2)). There was little suggestion of increasing ORs for NHL or its subtypes with every 5 kg m(-2) rise in BMI above 18.5 kg m(-2). BMI components height and weight were also examined, and the tallest men, but not women, were at marginally increased risk (pooled OR = 1.19, 95% CI 1.06-1.34). In summary, whilst we conclude that there is no evidence to support the hypothesis that obesity is a determinant of all types of NHL combined, the association between severe obesity and diffuse large B-cell lymphoma may warrant further investigation.

Autoimmune disorders and risk of non-Hodgkin lymphoma subtypes: a pooled analysis within the InterLymph Consortium

Some autoimmune disorders are increasingly recognized as risk factors for non-Hodgkin lymphoma (NHL) overall, but large-scale systematic assessments of risk of NHL subtypes are lacking. We performed a pooled analysis of self-reported autoimmune conditions and risk of NHL and subtypes, including 29 423 participants in 12 case-control studies. We computed pooled odds ratios (OR) and 95% confidence intervals (CI) in a joint fixed-effects model. Sjögren syndrome was associated with a 6.5-fold increased risk of NHL, a 1000-fold increased risk of parotid gland marginal zone lymphoma (OR = 996; 95% CI, 216-4596), and with diffuse large B-cell and follicular lymphomas. Systemic lupus erythematosus was associated with a 2.7-fold increased risk of NHL and with diffuse large B-cell and marginal zone lymphomas. Hemolytic anemia was associated with diffuse large B-cell NHL. T-cell NHL risk was increased for patients with celiac disease and psoriasis. Results for rheumatoid arthritis were heterogeneous between studies. Inflammatory bowel disorders, type 1 diabetes, sarcoidosis, pernicious anemia, and multiple sclerosis were not associated with risk of NHL or subtypes. Thus, specific autoimmune disorders are associated with NHL risk beyond the development of rare NHL subtypes in affected organs. The pattern of associations with NHL subtypes may harbor clues to lymphomagenesis.

Family cancer history and risk of brain tumors in children: results of the SEARCH international brain tumor study

OBJECTIVE

To examine whether childhood brain tumors (CBTs) are associated with a family history of brain tumors or other cancers in an international case-control study.

METHODS

Cancers in children's first- and second-degree relatives were ascertained by interview with parents of 620 children with astroglial tumors, 255 with primitive neuroectodermal tumors, 324 with other CBTs, and 2,218 controls from Australia, Canada, France, Israel, Italy, Spain, and the US. These were used with histories of neurofibromatosis or tuberous sclerosis to exclude in subanalyses children with Li-Fraumeni or other hereditary syndromes predisposing to brain tumors.

RESULTS

A first- or second-degree relative of 4% of children with astroglial tumors, 6% with PNET, 5% with other CBTs, and 5% of controls had had a brain tumor. Any potential differences were statistically non-significant, including when focusing on relatives diagnosed in childhood. In the US, where anatomical sites of relatives' other cancers were known, CBT occurrence was not associated with any other specific site. Results were not markedly altered by exclusion of children with hereditary syndromes.

CONCLUSION

Consistent with most prior studies using these methods, we observed no strong relationship between CBT occurrence and cancers in family members.

Anthropometric factors and risk of melanoma in women: a pooled analysis

Anthropometric factors such as height, weight and body mass index are related to the occurrence of certain malignancies in women including cancers of the breast, ovary and endometrium. Several studies have investigated the relation between height and weight or body mass and the risk of cutaneous melanoma in women, but results have been inconsistent. We conducted a collaborative analysis of these factors using the original data from 8 case-control studies of melanoma in women (2,083 cases and 2,782 controls), with assessment of the potential confounding effects of socioeconomic, pigmentary and sun exposure-related factors. Women in the highest quartile of height had an increased risk of melanoma [pooled odds ratio (pOR) 1.3, 95% confidence interval (CI) 1.1-1.6]. We also found an elevated risk associated with weight gain in adult life of 2 kg or more (pOR 1.5, 95% CI 1.1-2.0). Stratifying by age at melanoma diagnosis (<50, >or=50 yr), we found this risk greater among women <50 yr of age. Associations were unaffected by adjustment for other known risk factors for melanoma. There was no evidence that the effects varied for different histologic subtypes of cutaneous melanoma. There was no association with body weight per se, body mass index, or body surface area, either recent or in young adulthood. In aggregate, data from these studies suggest that greater height and weight gain may be risk factors for cutaneous melanoma in women.

Whole grains and risk of pancreatic cancer in a large population-based case-control study in the San Francisco Bay Area, California

Epidemiologic data suggest that consumption of whole-grain products may be inversely associated with risk of pancreatic cancer. Grain intake was examined in a population-based case-control study of pancreatic cancer in the San Francisco Bay Area (1995-1999). A 131-item semiquantitative food frequency questionnaire was administered to 532 cases and 1,701 controls. Odds ratios and 95% confidence intervals were computed as estimates of relative risk. Persons who consumed > or =2 servings of whole grains daily had a lower risk of pancreatic cancer than persons who consumed <1 serving/day (odds ratio (OR) = 0.60, 95% confidence interval (CI): 0.31, 1.2; trend-p = 0.04). Similar results were observed for brown rice (OR = 0.72, 95% CI: 0.44, 1.2; trend-p = 0.01) and tortillas (OR = 0.56, 95% CI: 0.35, 0.89; trend-p = 0.02). Consumption of doughnuts (> or =2 servings/week vs. <1 serving/month) conferred increased risk (OR = 1.8, 95% CI: 1.2, 2.7; trend-p = 0.003). Consumption of cooked breakfast cereals (> or =2 servings/week vs. <1 serving/month) was positively associated with risk (for oatmeal/oat bran, OR = 1.3, 95% CI: 1.0, 1.7; for other cooked breakfast cereals, OR = 2.1, 95% CI: 1.4, 3.3). Dietary fiber was inversely associated with risk (for highest quartile vs. lowest, OR = 0.65, 95% CI: 0.47, 0.89; trend-p = 0.02). These data provide some support for the hypothesis that consuming more whole-grain or high-fiber foods may reduce the risk of pancreatic cancer. Refined grains were not associated with risk.

Pancreatic cancer, animal protein and dietary fat in a population-based study, San Francisco Bay Area, California

OBJECTIVE

The associations between animal protein or fat and risk of pancreatic cancer have been reported previously with inconsistent results. A population-based case-control study of pancreatic cancer was conducted in the San Francisco Bay Area to examine these associations.

METHODS

A semi-quantitative food-frequency questionnaire was administered to 532 cases and 1,701 controls between 1995 and 1999. Odds ratios (OR) and 95% confidence intervals (CI) were computed as estimates of the relative risk of pancreatic cancer.

RESULTS

When comparing highest versus lowest levels of intake in multivariable adjusted models, positive associations were observed for several beef/lamb and individual animal protein items, including beef/lamb as a main dish (OR = 2.2, 95% CI: 1.0-4.5), regular hamburger (OR = 1.7, 95% CI: 1.2-2.4), whole eggs (OR = 1.6, 95% CI: 1.0-2.4), butter (OR = 2.4, 95% CI: 1.6-3.5), and total dairy not including butter (OR = 2.6, 95% CI: 1.8-3.7). Some high-fat/processed-meat products (i.e., sausage, salami, bacon), but not all (i.e., beef, pork, or poultry hot dogs), also were positively associated with risk. An inverse association was noted for greater chicken/turkey consumption (OR = 0.7, 95% CI: 0.5-1.0). The risk comparing the highest versus lowest quartiles for fats and cholesterol consumption were: total fat (OR = 1.6, 95% CI: 1.2-2.1); animal fat (OR = 1.9, 95% CI: 1.4-2.5); saturated fat (OR = 1.9, 95% CI: 1.4-2.6); monounsaturated fat (OR = 1.3, 95% CI: 1.0-1.8); and dietary cholesterol (OR = 1.5, 95% CI: 1.1-2.0, all p-trends < or = 0.02).

CONCLUSIONS

These data provide some evidence that beef or lamb, eggs, dairy, fat, or cholesterol may increase the risk of pancreatic cancer.

Pancreatic cancer and medical history in a population-based case-control study in the San Francisco Bay Area, California

OBJECTIVE

To determine the association between pancreatic cancer and medical conditions.

METHODS

A large population-based case-control study identified pancreatic cancer cases in the San Francisco Bay Area between 1995 and 1999. A total of 1,701 controls were randomly selected from the same population and were frequency-matched to 532 cases by sex and age. In-person interviews were conducted with no proxy interviews.

RESULTS

Prior history of gallbladder disease was associated with increased risk of pancreatic cancer (OR = 1.6, 95% CI = 1.2-2.2), with the highest risk occurring for gallbladder disease not caused by cholelithiasis (OR = 2.1, 95% CI = 1.1-3.7). Risk was associated with cholelithiasis only for participants diagnosed within the year before their pancreatic cancer (OR = 15, 95% CI = 6.2-34), and for those with cholelithiasis and cholecystectomy within the same time frame (OR = 28, 95% CI = 8.2-96). Gastric and/or duodenal ulcers were associated with increased risk of pancreatic cancer for individuals with ulcers of <or=two years duration (OR = 2.3, 95% CI = 1.1-4.6). Hyperthyroidism (OR = 2.1, 95% CI = 1.0-4.2) and "other" thyroid conditions (OR = 2.2, 95% CI = 1.1-4.2) were associated with increased risk. Participants with at least one first-degree relative with pancreatic cancer had an increased risk (OR = 1.6, 95% CI = 1.1-2.5).

CONCLUSION

History of recent gallbladder conditions, gastric and/or duodenal ulcers may represent an early manifestation of pancreatic cancer rather than an independent risk factor. These results warrant further investigation in pooled analyses.

Screening the human serum proteome for genotype-phenotype associations: an analysis of the IL6 -174G>C polymorphism

Interleukin (IL)-6 is a circulatory, pleiotropic cytokine with multiple roles in the immune system. Both IL-6 and the IL6 -174G>C promoter polymorphism have been linked to various diseases associated with inflammation. However, the mechanism by which the polymorphism influences disease risk is unclear. We postulated that serum proteome analysis of individuals with different IL6 -174G>C genotypes would provide insight on genotype-phenotype associations of this polymorphism and its role in disease susceptibility. Serum from a random sample of control participants in an ongoing population-based case-control study of non-Hodgkin lymphoma was pooled by IL6 genotype and used to screen for the optimal SELDI-TOF MS arrays for analysis. We report differences in serum protein expression of individuals with specific genotypes based on pooled and individual sample analysis. In particular, we report an association of the -174C allele with increased apolipoprotein C-I (ApoC-I). Additionally, we corroborate previous findings of an association of the -174C allele with lower autoantibodies to heat shock protein 60 and confirm the absence of any association between the IL6 -174G>C genotype and serum IL-6 levels. This study illustrates that proteome analysis can enhance our understanding of genotype-phenotype relationships. Additional studies are needed to clarify the interaction between the IL6 -174G>C polymorphism and ApoC-I.

Family history of hematopoietic malignancies and risk of non-Hodgkin lymphoma (NHL): a pooled analysis of 10 211 cases and 11 905 controls from the International Lymphoma Epidemiology Consortium (InterLymph)

A role for genetic susceptibility in non-Hodgkin lymphoma (NHL) is supported by the accumulating evidence of common genetic variations altering NHL risk. However, the pattern of NHL heritability remains poorly understood. We conducted a pooled analysis of 10 211 NHL cases and 11 905 controls from the International Lymphoma Epidemiology Consortium (InterLymph) to evaluate NHL risk among those with hematopoietic malignancies in first-degree relatives. Odds ratios (ORs) and 95% confidence intervals (CIs) of NHL and its subtypes were estimated from unconditional logistic regression models with adjustment for confounders. NHL risk was elevated for individuals who reported first-degree relatives with NHL (OR = 1.5; 95% CI = 1.2-1.9), Hodgkin lymphoma (OR = 1.6; 95% CI = 1.1-2.3), and leukemia (OR = 1.4; 95% CI = 1.2-2.7). Risk was highest among individuals who reported a brother with NHL (OR = 2.8; 95% CI = 1.6-4.8) and was consistent for all NHL subtypes evaluated. If a first-degree relative had Hodgkin lymphoma, NHL risk was highest if the relative was a parent (OR = 1.7; 95% CI = 1.0-2.9). If a first-degree relative had leukemia, NHL risk was highest among women who reported a sister with leukemia (OR = 3.0; 95% CI = 1.6-5.6). The pattern of NHL heritability appeared to be uniform across NHL subtypes, but risk patterns differed by specific hematopoietic malignancies and the sex of the relative, revealing critical clues to disease etiology.

Reproductive risk factors for cutaneous melanoma in women: a case-control study

Reproductive hormonal factors may have a potential role in cutaneous melanoma. This study estimated the risk of melanoma in women related to self-reported changes in nevi during pregnancy, while using oral contraceptives and/or hormone replacement therapy. Trained interviewers administered a questionnaire obtaining information about oral contraceptive use, hormone replacement therapy, reproductive history, sun exposure, occupation, and medical history from 318 Caucasian women newly diagnosed between 1991 and 1992 from two pigmented lesion clinics in San Francisco, California, and Philadelphia, Pennsylvania. A total of 395 frequency-matched control participants were recruited from hospital-affiliated outpatient clinics. Clinicians conducted skin examinations to assess the number and type of nevi, extent of freckling, solar damage, and skin type. For women aged less than 55 years, there was an association between a livebirth 5 years before diagnosis (odds ratio = 2.6, 95% confidence interval: 1.3, 5.3) and between number of births and melanoma risk (for > or = 3 births: odds ratio = 3.3, 95% confidence interval: 1.7, 6.5; ptrend < 0.001). Changes in nevi during recent pregnancies were a risk factor for melanoma, based upon small numbers (odds ratio = 2.9, 95% confidence interval: 1.1, 8.1). Oral contraceptive use and hormone replacement therapy were not associated with melanoma risk.

Highly elevated PSA and dietary PhIP intake in a prospective clinic-based study among African Americans

African-American men die from prostate cancer (PC) nearly twice as often as white US men and consume about twice as much of the predominant US dietary heterocyclic amine, 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine (PhIP), a genotoxic rat-prostate carcinogen found primarily in well-cooked chicken and beef. To investigate the hypothesis that PhIP exposure increases PC risk, an ongoing prospective clinic-based study compared PC screening outcomes with survey-based estimates of dietary PhIP intake among 40-70-year-old African-American men with no prior PC in Oakland, CA. They completed food-frequency and meat-cooking/consumption questionnaires and had a prostate-specific antigen (PSA) test and digital-rectal exam. Results for 392 men indicated a 17 (+/-17) ng/kg day mean (+/-1 s.d.) daily intake of PhIP, about twice that of white US men of similar age. PhIP intake was attributable mostly to chicken (61%) and positively associated (R(2)=0.32, P<0.0001) with saturated fat intake. An odds ratio (95% confidence interval) of 31 (3.1-690) for highly elevated PSA > or =20 ng/ml was observed in the highest 15% vs lowest 50% of estimated daily PhIP intake (> or =30 vs < or =10 ng/kg day) among men 50+ years old (P=0.0002 for trend) and remained significant after adjustment for self-reported family history of (brother or father) PC, saturated fat intake and total energy intake. PSA measures were higher in African-American men with positive family history (P=0.007 all men, P<0.0001 highest PSA quartile). These preliminary results are consistent with a positive association between PhIP intake and highly elevated PSA, supporting the hypothesis that dietary intervention may help reduce PC risk.

Diabetes mellitus and pancreatic cancer in a population-based case-control study in the San Francisco Bay Area, California

BACKGROUND

Diabetes has been postulated to be both a risk factor and a consequence of pancreatic cancer, but the degree of risk and associated clinical factors remain unclear.

METHODS

We conducted a population-based case-control study of pancreatic cancer in the San Francisco Bay Area between 1995 and 1999. Rapid case ascertainment through the Surveillance, Epidemiology and End Results registry for cases and random selection from the general population for controls were employed to identify study participants with no proxy interviews.

RESULTS

Five hundred thirty-two cases and 1,701 controls were interviewed. Participants with pancreatic cancer were more likely to report a history of diabetes (13%) than were controls [9%; odds ratio (OR), 1.5; 95% confidence interval (95% CI), 1.1-2.1]. Compared with diabetics in the control group, diabetics in the case group had a shorter duration of diabetes (P = 0.0003) and a larger proportion of insulin users (P = 0.002). Risk for pancreatic cancer varied with duration of diabetes (OR, 2.4; 95% CI, 1.4-4.0 for 1-4 years; OR, 2.0; 95% CI, 1.2-3.4 for 5-9 years; and OR, 0.86; 95% CI, 0.52-1.4 for >or=10 years diabetes duration; P(trend) = 0.004). Among diabetics, use of oral diabetes medication or insulin for >or=5 years was not associated with pancreatic cancer, but insulin use of <5 years was associated with a 6.8-fold risk for pancreatic cancer (95% CI, 3.7-12).

CONCLUSION

Recent-onset diabetes may be a complication or an early marker of pancreatic cancer. Diabetes of short duration with insulin use conferred a substantially elevated risk for pancreatic cancer and may reflect insulin resistance that is elicited by pancreatic cancer.

Residential history, family characteristics and non-Hodgkin lymphoma, a population-based case-control study in the San Francisco Bay Area

A population-based, case-control study (N = 1,593 cases, N = 2,515 controls) was conducted in the San Francisco Bay Area, California, to determine risk factors for non-Hodgkin lymphoma (NHL). This report examines residential characteristics, number of siblings, childhood infections, and allergic rhinitis to evaluate the association between NHL and the hygiene hypothesis. Adjusted unconditional logistic regression analyses included HIV-negative participants (N = 1,304 cases, N = 2,402 controls) ages 21 to 74 years, who completed in-person interviews. At childhood ages, odds ratios (OR) for NHL decreased with increasing number of household rooms (age 8 years, P(trend) = 0.08; age 15 years, P(trend) < 0.0001) and increased with more crowded living conditions (quartiles of no. people/no. rooms; age 8 years, P(trend) < 0.0001; age 15 years, P(trend) = 0.0004), whereas at older ages a greater number of people in the household and greater number of household rooms were positively associated with NHL. ORs increased with increasing number of siblings (P(trend) = 0.0003) and increasing birth order (P(trend) = 0.01). Participants with five or more younger siblings had a 50% increased OR for NHL. ORs for NHL decreased with an increasing number of different infections during childhood (age 8 years, P(trend) < 0.0001; age 15 years, P(trend) = 0.0003) and with history of allergic rhinitis (P < 0.0001). Our results are somewhat consistent with the hygiene hypothesis that less crowding and better sanitation results in fewer infections early in life and an increased incidence of immune-related conditions later in life. The role of the complex relationship between residential history, family characteristics, childhood infections, and immune function in the development of NHL warrants further investigation in pooled analyses.

Inflammation, genetic polymorphisms in proinflammatory genes TNF-A, RANTES, and CCR5, and risk of pancreatic adenocarcinoma

Adenocarcinoma of the exocrine pancreas is the fourth leading cause of cancer-related death in men and women in the U.S. Cytokines and other proinflammatory mediators have been implicated in inflammatory pancreatic diseases including pancreatitis and cancer. We analyzed cytokine gene polymorphisms as risk factors for pancreatic cancer using questionnaire data obtained by in-person interviews and germ line DNA collected in a population-based case-control study of pancreatic cancer (532 cases and 1,701 controls) conducted in the San Francisco Bay Area. We used mass spectrometry and gel-based methods to genotype 308 cases and 964 population-based controls. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using logistic regression analysis and included adjustment for age, sex, and smoking. We assessed potential interactions between these polymorphisms, proinflammatory conditions (e.g., pancreatitis, ulcer, and obesity), and smoking as risk factors for pancreatic cancer. There was no overall association between pancreatic cancer risk and tumor necrosis factor-alpha (TNF-A -308G/A), regulated upon activation, normally T cell-expressed, and presumably secreted (RANTES -403G/A), and CC chemokine receptor 5 (CCR5-Delta32) polymorphisms. There was a nearly 7-fold increased relative risk estimate for pancreatic cancer in individuals with a history of pancreatitis (adjusted OR, 6.9; 95% CI, 3.4-14.1). Among patients with pancreatic cancer, pancreatitis was significantly associated with TNF-A -308 GA + AA (OR, 3.1; 95% CI, 1.3-7.4) and with RANTES -403 GA + AA (OR, 2.3; 95% CI, 1.0-5.4). There was evidence for a possible interaction between current active smoking and CCR5-32del. Our results lend support for the hypothesis that proinflammatory gene polymorphisms, in combination with proinflammatory conditions, may influence the development of pancreatic cancer.

Survival among patients with adenocarcinoma of the pancreas: a population-based study (United States)

OBJECTIVE

The purpose of the current study was to evaluate survival of patients diagnosed in California with adenocarcinoma of the pancreas by demographic and tumor-related factors.

METHODS

Through the California Cancer Registry (CCR) we identified all California residents diagnosed with invasive pancreatic adenocarcinoma between 1994 and 2000. Demographic, tumor and treatment information was extracted from the CCR, and socioeconomic status (SES) was assigned based on census block group of residence.

RESULTS

A total of 10,612 eligible patients were identified of whom 1674 (15.8%) underwent surgical resection. Patients of lower SES were less likely to undergo resection and somewhat less likely to survive. Median survival was 3.5 months for patients who were not resected and 13.3 months for those who underwent resection. Adjuvant therapy was associated with a decreased risk of death among patients who underwent resection.

CONCLUSIONS

This study is the largest population-based study to date to explore survival from pancreatic cancer among all age groups in a racially diverse population. Median survival was shorter than that reported from other series. Race/ethnicity did not have a significant effect on survival. However patients residing in poor neighborhoods were less likely to undergo resection and somewhat less likely to survive this disease.

Polymorphisms in the oxidative stress genes, superoxide dismutase, glutathione peroxidase and catalase and risk of non-Hodgkin's lymphoma

BACKGROUND AND OBJECTIVES

The risk of non-Hodgkin's lymphoma (NHL) has been associated with inflammation. One possible mechanism may involve oxidative stress as reactive oxygen species (ROS) can generate pro-inflammatory signals. Anti-oxidant enzymes including superoxide dismutase, glutathione peroxidase and catalase protect against the harmful effects of ROS. Genetic variation in the genes coding for these enzymes (SOD2, GPX1, and CAT, respectively) alters ROS production and therefore may provide a mechanism for the relationship between inflammation and NHL.

DESIGN AND METHODS

Data from two population-based, case-control studies of lymphoma in the UK (700 cases and 915 controls) and USA (1593 cases and 2517 controls) were pooled to analyze polymorphisms in genes involved in the oxidative stress response (SOD2 Val16Ala, CAT C-262T and GPX1 Pro197Leu).

RESULTS

No associations were observed between SOD2 Val16Ala and CAT C-262T and total NHL, diffuse large-B cell lymphoma or follicular lymphoma. However, when we looked at marginal zone lymphoma, a specific subtype of lymphoma characterised by inflammation, we found that homozygosity for the SOD2 16Ala allele was associated with a decreased risk among UK study participants. The GPX1 197Leu allele was weakly associated with NHL and follicular lymphoma.

INTERPRETATION AND CONCLUSION

Analysis of genetic variation in oxidative stress genes in two lymphoma case-control studies suggests a possible role for oxidative stress in the risk of NHL. The risk modification is seen predominantly for marginal zone lymphomas which frequently arise in the context of chronic inflammation. However, in order to clarify the role of oxidative stress in the etiology of NHL analyses of additional polymorphisms and haplotypes in these and other genes involved in the oxidative stress response are needed.

Use of nonsteroidal antiinflammatory drugs and non-Hodgkin lymphoma: a population-based case-control study

The association between long-term use of nonsteroidal antiinflammatory drugs (NSAIDs) and non-Hodgkin lymphoma (NHL) was examined using data collected between October 2001 and May 2004 in an ongoing population-based case-control study in the San Francisco Bay Area. NHL cases were identified using rapid case ascertainment and Surveillance, Epidemiology, and End Results registry data. Control participants were frequency-matched to cases by age, sex, and county of residence. Participants completed in-person interviews designed to measure potential NHL risk factors. Questions were asked regarding use during the past 20 years of aspirin, prescription and over-the-counter nonselective NSAIDs, and cyclooxygenase-2 (COX-2) inhibitors. A total of 1,000 cases and 1,060 controls contributed data for these interim analyses. Analyses were carried out for men and women and for both sexes combined. After adjustment for age and sex, there was no consistent association between long-term use and NHL for all NSAIDs combined, aspirin, nonselective NSAIDs, and COX-2 inhibitors. For women, long-term aspirin use may be associated with a decreased risk of NHL (for 3-<9 years of use, odds ratio=0.41, 95% confidence interval: 0.18, 0.94). Conversely, although the confidence intervals were wide, the adjusted odds ratios for COX-2 inhibitor use were nearly twofold for women, indicating a possible increase in NHL risk associated with regular use of COX-2 inhibitors.

Identifying Individuals at High Risk of Melanoma: A Practical Predictor of Absolute Risk

Purpose

We developed a model to estimate the 5-year absolute risk of melanoma to efficiently identify individuals at increased risk of melanoma for potential interventions.

Patients and Methods

We used data from a case-control study with 718 non-Hispanic white patients with invasive cutaneous melanoma from melanoma clinics in Philadelphia, PA and San Francisco, CA; matched controls were 945 patients from outpatient clinics with similar catchment areas. All participants underwent extensive interviews and skin examinations. We selected easily obtained clinical characteristics and responses to simple questions for study in order to develop sex-specific relative risk models. These models were combined with incidence and mortality rates by United States geographic areas to develop estimates of the absolute risk of developing melanoma within 5 years.

Results

Relative risk models yielded an attributable risk of 86% for men and 89% for women, using at most seven variables. Attributable risks did not vary by age, ultraviolet B flux or hours outdoors. The absolute individual risks varied widely, depending on age, other host characteristics, and geographic area. Individual absolute risk can be estimated using a program available online.

Conclusion

Our procedures allow for estimating the absolute risk of developing melanoma to assist in the identification of patients at high risk. Such high-risk individuals could undergo interventions including a complete skin examination, counseling to avoid sun exposures, regular self and professional surveillance, or participation in prevention trials. It is important to emphasize that these projections are not intended to identify current melanoma cases.

Polymorphisms in innate immunity genes and risk of non-Hodgkin lymphoma

Genetic variation in innate immunity may alter host-pathogen defence mechanisms and promote aberrant immune responses and non-Hodgkin lymphoma (NHL). To test this hypothesis, we investigated polymorphisms in innate immune genes in a pooled analysis of two population-based case-control studies of NHL from the San Francisco Bay Area (308 cases, 684 controls) and UK (596 cases, 758 controls). The caspase recruitment domain-containing protein 1007fs homozygote variant was positively associated with NHL risk (odds ratios (OR) = 3.1, 95% confidence intervals (CI) 1.1-8.8), whereas the toll-like receptor 4 1063A>G variant allele was inversely associated with diffuse large cell lymphoma (OR = 0.67, 95% CI 0.45-0.99). These results suggest that variation in innate immune genes may alter NHL susceptibility.

Changes in Cancer Registry Coding for Lymphoma Subtypes: Reliability Over Time and Relevance for Surveillance and Study

Because lymphoma comprises numerous histologic subtypes, understanding the reasons for ongoing increases in its incidence requires surveillance and etiologic study of these subtypes. However, this research has been hindered by many coexisting classification schemes. The Revised European American classification of Lymphoid Neoplasms (REAL)/WHO system developed in 1994 and now used in clinical settings was not incorporated into the International Classification of Diseases-Oncology (ICD-O), used by cancer registries, until the release of the third edition (ICD-O-3) in 2001. Studies including patients diagnosed before 2001 may have codes from earlier ICD-O versions that must be converted to ICD-O-3 and have higher proportions of unclassified (e.g., lymphoma and not otherwise specified) cases. To better understand (a) the agreement of computer-converted ICD-O-3 codes to ICD-O-3 codes generated directly from diagnostic pathology reports and (b) the reproducibility of unclassified status, we reviewed a population-based series of diagnostic pathology reports for lymphoma patients diagnosed before (1988-1994; n = 1,493) and after (1998-2000; n = 1,527) the REAL/WHO scheme was introduced. Overall, computer- and coder-assigned ICD-O-3 codes agreed for 77% of patients in both groups and improved slightly (82%) when codes were grouped. The most common lymphoma subtypes, diffuse large B cell and follicular, had relatively good reliability (84-89%) throughout the study period. T-cell and natural killer cell lymphomas had worse agreement than B-cell lymphomas, even when grouped. Many (42-43%) lymphomas reported as unclassifiable could be assigned a subtype upon pathology report review. These findings suggest that the study of lymphoma subtypes could be improved by (a) use of more standardized terminology in pathology reports, (b) grouping individual ICD-O-3 codes to reduce misclassification bias, and (c) routine secondary editing of unclassified lymphomas by central cancer registries.

Maternal medication use and the risk of brain tumors in the offspring: the SEARCH international case-control study

N-nitroso compounds (NOC) have been associated with carcinogenesis in a wide range of species, including humans. There is strong experimental data showing that nitrosamides (R(1)NNO.COR(2)), a type of NOC, are potent neuro-carcinogens when administered transplacentally. Some medications are a concentrated source of amides or amines, which in the presence of nitrites under normal acidic conditions of the stomach can form NOC. Therefore, these compounds, when ingested by women during pregnancy, may be important risk factors for tumors of the central nervous system in the offspring. The aim of the present study was to test the association between maternal use of medications that contain nitrosatable amines or amides and risk of primary childhood brain tumors (CBT). A case-control study was conducted, which included 1,218 cases and 2,223 population controls, recruited from 9 centers across North America, Europe and Australia. Analysis was conducted for all participants combined, by tumor type (astroglial, primitive neuroectodermal tumors and other glioma), and by age at diagnosis (< or =5 years; >5 years). There were no significant associations between maternal intake of medication containing nitrosatable amines or amides and CBT, for all participants combined and after stratification by age at diagnosis and histological subtype. This is the largest case-control study of CBT and maternal medications to date. Our data provide little support for an association between maternal use of medications that may form NOC and subsequent development of CBT in the offspring.

Anthropometric factors and pancreatic cancer in a population-based case-control study in the San Francisco Bay area

OBJECTIVE

To investigate the association between pancreatic cancer, anthropometric factors, physical activity and caloric intake.

METHODS

Participants in our population-based case-control study of adenocarcinoma of the exocrine pancreas (532 cases, 1701 frequency-matched controls) in the San Francisco Bay Area were accrued between 1995 and 1999 and interviewed in-person. Data were analyzed by sex in age-adjusted unconditional logistic models and main effects were considered significant for two-sided p-values < or = 0.05.

RESULTS

Odds ratios were elevated for body mass index (BMI) at age 25 years (4th versus 1st quartile: odds ratio (OR) = 2.0, 95% confidence interval (CI): 1.4-3.1), maximum BMI (OR = 1.8, 95% CI: 1.2-2.7) and usual adult BMI (OR = 2.1, 95% CI: 1.4-3.2) among men. Odds ratios were elevated for increased caloric intake among men (4th versus 1st quartile: OR = 2.6, 95% C: 1.7-3.8). Increased physical activity was suggestive of decreased risk in men and women although CIs included unity. Our results suggest that increased BMI and caloric intake are associated with pancreatic cancer among men.

CONCLUSIONS

These results are consistent with other cancer studies and support further research to determine the mechanism by which increased BMI may influence the development of pancreatic cancer.

Pregnancy History and Incidence of Melanoma in Women: A Pooled Analysis

There is evidence that pregnancy history including age at first birth and parity may play a role in risk of cutaneous melanoma in women, although, epidemiological findings are inconsistent. We conducted a collaborative analysis of these factors using the original data from ten completed case-control studies (2391 cases and 3199 controls), and assessed the potential confounding effects of socioeconomic, pigmentary, and sun exposure-related factors. We found no overall association with ever having a live birth (pooled odds ratio (pOR) 0.95, 95% confidence interval (CI) 0.67-1.35). However, we detected a reduced risk of melanoma among women with higher parity (> or = 5 versus no live births pOR 0.76, 95% CI 0.49-1.18, each live birth pOR 0.95, 95% CI 0.91-0.99, p trend = 0.05). Women with both earlier age at first birth (e.g., <20 years) and higher parity (e.g., > or = 5 live births) had a particularly lower risk than women with later age at first birth (e.g., > or = 25 years) and lower parity (e.g., <5 live births) (pOR 0.33, 95% CI 0.14-0.75). The results are compatible with an effect of reproductive history-related factors on melanoma risk, but also could reflect differences in other factors, such as sun exposure history.

Genetic variation in TNF and IL10 and risk of non-Hodgkin lymphoma: a report from the InterLymph Consortium

BACKGROUND

Common genetic variants in immune and inflammatory response genes can affect the risk of developing non-Hodgkin lymphoma. We aimed to test this hypothesis using previously unpublished data from eight European, Canadian, and US case-control studies of the International Lymphoma Epidemiology Consortium (InterLymph).

METHODS

We selected 12 single-nucleotide polymorphisms for analysis, on the basis of previous functional or association data, in nine genes that have important roles in lymphoid development, Th1/Th2 balance, and proinflammatory or anti-inflammatory pathways (IL1A, IL1RN, IL1B, IL2, IL6, IL10, TNF, LTA, and CARD15). Genotype data for one or more single-nucleotide polymorphisms were available for 3586 cases of non-Hodgkin lymphoma and for 4018 controls, and were assessed in a pooled analysis by use of a random-effects logistic regression model.

FINDINGS

The tumour necrosis factor (TNF) -308G-->A polymorphism was associated with increased risk of non-Hodgkin lymphoma (p for trend=0.005), particularly for diffuse large B-cell lymphoma, the main histological subtype (odds ratio 1.29 [95% CI 1.10-1.51] for GA and 1.65 [1.16-2.34] for AA, p for trend <0.0001), but not for follicular lymphoma. The interleukin 10 (IL10) -3575T-->A polymorphism was also associated with increased risk of non-Hodgkin lymphoma (p for trend=0.02), again particularly for diffuse large B-cell lymphoma (p for trend=0.006). For individuals homozygous for the TNF -308A allele and carrying at least one IL10 -3575A allele, risk of diffuse large B-cell lymphoma doubled (2.13 [1.37-3.32], p=0.00083).

INTERPRETATION

Common polymorphisms in TNF and IL10, key cytokines for the inflammatory response and Th1/Th2 balance, could be susceptibility loci for non-Hodgkin lymphoma. Moreover, our results underscore the importance of consortia for investigating the genetic basis of chronic diseases like cancer.