Cigarette smoking and risk of Hodgkin's disease: a population-based case-control study

Previous reports offer limited support for an association between cigarette smoking and Hodgkin's disease. The authors investigated dose-response effects for smoking in relation to the risk of Hodgkin's disease using data from the Selected Cancers Study. Cases (n = 343) were men aged 32-60 years identified from eight US population-based cancer registries in 1984-1988. Controls (n = 1,910) were men recruited by random digit telephone dialing and frequency matched to cases by age and registry. Conditional logistic regression was used to calculate odds ratios and 95% confidence intervals adjusted for age, registry, race/ethnicity, Jewish upbringing, education, and childhood domicile. Compared with never smokers, current smokers had a significantly increased risk of Hodgkin's disease (odds ratio (OR) = 1.8, 95% confidence interval (CI): 1.3, 2.9). Risks increased linearly (p < 0.001) with increasing packs per day (OR(>or=2) = 2.5, 95% CI: 1.6, 4.0), years (OR(>or=30) = 2.4, 95% CI: 1.5, 3.9), and pack-years (OR(>40) = 2.7, 95% CI: 1.8, 4.3) of smoking. These associations were significant for the nodular sclerosis and mixed cellularity subtypes but were much stronger for mixed cellularity. Stratified analyses by age (42 years) and subtype suggested that the effects of smoking are more closely related to histology than age. In contrast to findings from previous studies, these data suggest that smoking is an important preventable risk factor for Hodgkin's disease.