Abstract
BackgroundRisk factors for B-cell non-Hodgkin lymphoma (B-NHL) have not been assessed among Palestinian Arabs (PA) and Israeli Jews (IJ).MethodsIn a case-control study we investigated self-reported medical and lifestyle exposures, reporting odds ratios (ORs) and 95% confidence intervals [CIs], by ethnicity, for overall B-NHL and subtypes.ResultsWe recruited 823 cases and 808 healthy controls. Among 307 PA/516 IJ B-NHL cases (mean age at diagnosis = 51 [±17] versus 60 [±15] years, respectively) subtype distributions differed, with diffuse large B-cell lymphoma (DLBCL) being prominent among PA (71%) compared to IJ (41%); follicular lymphoma (FL), was observed in 14% versus 28%, and marginal zone lymphoma, in 2% versus 14%, respectively. Overall B-NHL in both populations was associated with recreational sun exposure OR = 1.43 [CI:1.07–1.91], black hair-dye use OR = 1.70 [CI:1.00–2.87], hospitalization for infection OR = 1.68 [CI:1.34–2.11], and first-degree relative with hematopoietic cancer, OR = 1.69 [CI:1.16–2.48]. An inverse association was noted with alcohol use, OR = 0.46 [CI:0.34–0.62]. Subtype-specific exposures included smoking (FL, OR = 1.46 [CI:1.01–2.11]) and >monthly indoor pesticide use (DLBCL, OR = 2.01 [CI:1.35–3.00]). Associations observed for overall B-NHL in PA only included: gardening OR = 1.93 [CI:1.39–2.70]; history of herpes, mononucleosis, rubella, blood transfusion (OR>2.5, P<0.01 for all); while for IJ risk factors included growing fruits and vegetables, OR = 1.87 [CI:1.11–3.15]; and self-reported autoimmune diseases, OR = 1.99 [CI:1.34–2.95].ConclusionsIn these geographically proximate populations we found some unique risk factors for B-NHL. Heterogeneity in the observed associations by ethnicity could reflect differences in lifestyle, medical systems, and reporting patterns, while variations by histology infer specific etiologic factors for lymphoma subtypes.
Highlights
Non-Hodgkin lymphomas (NHL) are histologically and molecularly heterogeneous malignancies originating from B and T lymphocytes
Overall B-cell non-Hodgkin lymphoma (B-NHL) in both populations was associated with recreational sun exposure odds ratios (ORs) = 1.43 [confidence interval (CI):1.07–1.91], black hair-dye use OR = 1.70 [CI:1.00–2.87], hospitalization for infection OR = 1.68 [CI:1.34–2.11], and PLOS ONE | DOI:10.1371/journal.pone
An inverse association was noted with alcohol use, OR = 0.46 [CI:0.34–0.62]
Summary
Non-Hodgkin lymphomas (NHL) are histologically and molecularly heterogeneous malignancies originating from B and T lymphocytes. They account for approximately 3% of the worldwide cancer burden showing global variations in patterns of occurence[1]. NHL incidence rates increased worldwide[2,3] from 1950–2000, tripling in those aged >65[4]. According to the Palestinian Cancer Registry as of 2014, NHL is the seventh among West Bank Palestinian men and ninth among women[7]. The epidemiology of this important disease has remained relatively unstudied in both these populations. Risk factors for B-cell non-Hodgkin lymphoma (B-NHL) have not been assessed among Palestinian Arabs (PA) and Israeli Jews (IJ)
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