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.
During the past few decades, the incidence of nonHodgkin's lymphoma (NHL) increased in most Western countries. [1][2][3][4] Only recent data indicate a leveling off of this trend. In Germany, NHL made up an estimated 3% of the male and 3.4% of the female incident cancer cases in 2000.
5The aetiology of malignant lymphoma is still largely unknown. Strong evidence exists for the association between NHL and congenital or acquired immunosuppression, especially AIDS.6-10 Immune factors also seem to play a role in the aetiology of Hodgkin's lymphoma:7 an excess has been found after transplantations 11 12 as well as among HIV infected patients.
14The known risk factors explain only a small proportion of malignant lymphoma. Several studies point to a potential aetiological role of occupational factors to malignant lymphoma. Hodgkin The aim of the present multicentre, population based case control study is to identify occupati...