Body mass index, body mass change, and risk of oral cavity cancer: results of a large population-based case–control study, the ICARE study

Objective

The association between body mass index (BMI) and the risk of oral cavity cancer, suggested by the few available studies, is controversial because of weight loss preceding cancer diagnosis and possible confounding by tobacco and alcohol consumption. The aim of this study was to evaluate in France, a high-incidence country, the association between the risk of oral cavity cancer and body mass index at interview, 2 years before the interview and at age 30, as well as BMI change.

Methods

We used data from a population-based case–control study, the Investigation of occupational and environmental CAuses of REspiratory cancers study, with personal interviews and standardized questionnaires including 689 cases of oral cavity squamous cell carcinoma and 3,481 controls. Odds ratios (ORs) and 95 % confidence intervals (95 % CI) were estimated by unconditional logistic regression and were adjusted for gender, age, area of residence, education, tobacco smoking, and alcohol drinking.

Results

ORs were increased in underweight subjects at interview (OR 6.25, 95 % CI 3.74–10.45). No association with underweight 2 years before the interview and at age 30 was found. Overweight and obesity at interview, 2 years before the interview and at age 30 were associated with decreased ORs (ranging from 0.13 to 0.60). BMI gain greater than 5 % between age 30 and 2 years before the interview was inversely associated with oral cavity cancer (OR 0.42, 95 % CI 0.33–0.54). These associations were stronger in men, and in smokers and drinkers.

Conclusion

These results add further support to the existence of a reduced risk of oral cavity cancer among overweight and obese people or among people who increased their BMI in adulthood. The underlying mechanisms remain to be clarified.     

Anthropometric factors, physical activity, and breast cancer risk in relation to hormone receptor and menopausal status in Japanese women: a case–control study

Purpose

The associations between anthropometric factors, physical activity (PA), and breast cancer risk in terms of estrogen-receptor/progesterone-receptor (ER/PgR) status have been unclear in Japanese women. This case–control study was designed to evaluate these associations.

Methods

From among female patients aged 30 years and over admitted to a single hospital in Japan between 1997 and 2009, 1,017 breast cancer cases (538ER+/PgR+, 125ER+/PgR?, 23 ER?/PgR+, 249 ER?/PgR?, and 82 missing) and 2,902 controls were selected. Height, weight, body mass index (BMI) (kg/m²), and time spent exercising (hours/week) were assessed using a self-administered questionnaire. Polytomous logistic regression analysis and tests for heterogeneity across ER+/PgR+ and ER?/PgR? were conducted.

Results

Higher BMI was associated with a higher risk of ER+/PgR+ cancer among women overall [odds ratio (OR) = 2.41, 95 % confidence interval (CI) 1.37–4.23 for BMI ≥30.0; P _trend = 0.0001] and postmenopausal women (OR = 6.24, 95 % CI 2.68–14.53 for BMI ≥30.0; P _trend < 0.0001). A longer time spent exercising (more than 5 h/week) showed a decreased risk for any type of breast cancer among overall and pre- and postmenopausal women, although this did not reach statistical significance. Height was not associated with any risk.

Conclusions

Higher BMI is associated with an increased risk of ER+/PgR+ cancer among women overall and postmenopausal women. PA might be associated with a decreased risk of any type. To prevent breast cancer, weight control and PA are important.     

Case–control study of lifetime total physical activity and endometrial cancer risk

A population-based case–control study of physical activity and endometrial cancer risk was conducted in Alberta between 2002 and 2006. Incident, histologically confirmed cases of endometrial cancer (n = 542) were frequency age-matched to controls (n = 1,032). The Lifetime Total Physical Activity Questionnaire was used to measure occupational, household, and recreational activity levels. Multivariable logistic regression analyses were conducted. Total lifetime physical activity reduced endometrial cancer risk (odds ratio [OR] for >129 vs. <82 MET-h/week/year = 0.86, 95% confidence interval [95% CI]: 0.63, 1.18). By type of activity, the risks were significantly decreased for greater recreational activity (OR = 0.64, 95% CI: 0.47, 0.87), but not for household activity (OR = 1.09, 95% CI: 0.75, 1.58) and/or occupational activity (OR = 0.90, 95% CI: 0.67, 1.20) when comparing the highest to lowest quartiles. For activity performed at different biologically defined life periods, some indication of reduced risks with activity done between menarche and full-term pregnancy and after menarche was observed. When examining the activity by intensity of activity (i.e., light <3, moderate 3–6, and vigorous >6 METs), light activity slightly decreased endometrial cancer risk (OR = 0.68, 95% CI: 0.48, 0.97) but no association with moderate or vigorous intensity activity was found. Endometrial cancer risk was increased with sedentary occupational activity by 28% (95 CI%: 0.89, 1.83) for >11.3 h/week/year versus ≤2.4 h/week/year or by 11% for every 5 h/week/year spent in sedentary behavior. This study provides evidence for a decreased risk between lifetime physical activity and endometrial cancer risk and a possible increased risk associated with sedentary behavior.     

Case–control study of diabetes, obesity, physical activity and risk of endometrial cancer among Mexican women

Objectives: Obesity, hypertension and diabetes are closely associated with endometrial cancer (EC). This study evaluates the relationship between diabetes and risk of EC on the basis of obesity. Methods: A case–control study was carried out in Mexico City from 1995 to 1997. Eighty-five histologically confirmed cases were compared with 668 population-based controls obtained through frequency matching. Diabetes status, weight, height and other factors were determined through personal interviews among both cases and controls. Results: Compared to women without diabetes, those with diabetes had an adjusted odds ratio of 3.6 (95% CI = 1.7, 7.4) for EC. This association was modified by body mass index (p interaction < 0.001). Compared to non-overweight and non-diabetic women, non-overweight (OR = 3.9, 95% CI = 0.88, 18.0) and overweight (OR = 5.9, 95% CI = 1.6, 21.1) diabetic women had a non-significant elevated risk of EC. However, elevated risk estimates were observed for obese diabetic women (OR = 8.0, 95% CI = 2.8, 22.7). Conclusions: Our results strongly suggest an interaction effect between obesity and diabetes that significantly increases the risk of EC. This, in turn, may explain the growing number of new EC cases recently observed in developing countries with reduced birth rates and an increased incidence of both obesity and diabetes mellitus.     

Weekday of gastrectomy for cancer in relation to mortality and oncological outcomes – A Dutch population-based cohort study

Background

Some studies demonstrate that high-complex surgeries performed later in the week are associated with higher postoperative mortality and worse long-term survival. The aim of this cohort study was to determine whether weekday influences outcomes in patients undergoing gastrectomy for cancer.

Physical activity and risk of pancreatic cancer in a central European multicenter case–control study

Purpose

Findings from epidemiological studies examining physical activity in relation to pancreatic cancer risk have suggested decreased risks for physical activity; however, the results are inconsistent.

Methods

The association between occupational and leisure-time physical activity and risk of pancreatic cancer was examined among 826 pancreatic cancer cases and 930 age-, sex- and center-matched controls from a large multicenter central European study in Czech Republic and Slovakia recruited between 2004 and 2012. Data on physical activity including type and dose (frequency, intensity, and duration) were examined using multivariable-adjusted logistic regression models.

Results

Occupational physical activity was not significantly associated with risk of pancreatic cancer [odds ratio (OR) 0.90, 95 % confidence interval (CI) 0.71–1.15]. A 35 % decrease in risk of pancreatic cancer was observed for regular leisure-time physical activity (OR 0.65, 95 % CI 0.52–0.87). The risk estimates were significant for low and moderate intensity of activity with the strongest protective effect among individuals who exercised during more than 40 weeks per year. The results for cumulated leisure-time physical activity assessed 1 year prior to diagnosis achieved the same level of risk reduction. In addition, stronger risk estimates for leisure-time physical activity were observed among women (men: OR 0.74, 95 % CI 0.54–1.01; women: OR 0.53, 95 % CI 0.37–0.75). The findings for female participants were stronger for intensity and frequency of leisure-time physical activity, in particular for light and moderate activity (OR 0.43, 95 % CI 0.25–0.75; and OR 0.57, 95 % CI 0.37–0.88, respectively).

Conclusion

These results provide evidence for a decreased risk of pancreatic cancer associated with regular leisure-time physical activity.     

The systemic immune-inflammation index is associated with an increased risk of incident cancer—A population-based cohort study

Several studies found that the systemic immune-inflammation index (SII) is a prognostic factor for mortality in patients with solid tumors. It is unknown whether an increased SII in generally healthy individuals reflects a risk for developing cancer. Our objective was to investigate the association between the SII and incident cancers in a prospective cohort study. Data were obtained from the Rotterdam Study; a population-based study of individuals aged ≥45 years, between 2002 and 2013. The SII at baseline was calculated from absolute blood counts. The association between the SII and the risk of any solid incident cancer during follow-up was assessed using Cox proportional hazard models. Individuals with a prior cancer diagnosis were excluded. Data of 8,024 individuals were included in the analyses. The mean age at baseline was 65.6 years (SD 10.5 years) and the majority were women. During a maximum follow-up period of 10.7 years, 733 individuals were diagnosed with cancer. A higher SII at baseline was associated with a 30% higher risk of developing a solid cancer (HR of 1.30 [95% CI; 1.11–1.53]), after adjustment for age, sex, socioeconomic status, smoking, BMI and type 2 diabetes. The absolute cumulative 10-year cancer risk increased from 9.7% in the lowest quartile of SII to 14.7% in the highest quartile (p-value = 0.009). The risk of developing cancer was persistent over time and increased for individuals with the longest follow-up. In conclusion, a high SII is a strong and independent risk indicator for developing a solid cancer.     

Sweets, sweetened beverages, and risk of pancreatic cancer in a large population-based case–control study

Objective  We examined the associations between sweets, sweetened and unsweetened beverages, and sugars and pancreatic cancer risk. Methods  We conducted a population-based case–control study (532 cases, 1,701 controls) and used multivariate logistic regression models to calculate odds ratios (OR) and 95% confidence intervals (CI). Because associations were often different by sex, we present results for men and women combined and separately. Results  Among men, greater intakes of total and specific sweets were associated with pancreatic cancer risk (total sweets: OR = 1.9, 95% CI: 1.0, 3.6; sweet condiments: OR = 1.9, 95% CI: 1.2, 3.1; chocolate candy: OR = 2.4, 95% CI: 1.1, 5.0; other mixed candy bars: OR = 3.3, 95% CI: 1.5, 7.3 for 1 + servings/day versus none/rarely). Sweets were not consistently associated with risk among women. Sweetened beverages were not associated with increased pancreatic cancer risk. In contrast, low-calorie soft drinks were associated with increased risk among men only; while other low-/non-caloric beverages (e.g., coffee, tea, and water) were unassociated with risk. Of the three sugars assessed (lactose, fructose, and sucrose), only the milk sugar lactose was associated with pancreatic cancer risk (OR = 2.0, 95% CI: 1.5, 2.7 comparing extreme quartiles). Conclusion  These results provide limited support for the hypothesis that sweets or sugars increase pancreatic cancer risk.     

Occupation and keratinocyte cancer risk: a population-based case–control study

Objective The aim of our study was to identify occupations associated with increased risk of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Methods We conducted a population-based case–control study of BCC and SCC in New Hampshire. Cases (n = 599 BCC, n = 290 SCC) and controls (n = 524) completed a self-administered residence and work history questionnaire and personal interview regarding major risk factors for skin cancer. Reported jobs were coded using the Standardized Occupational Classification system (SOC). Odds ratios (ORs) and confidence intervals (CIs) for BCC and SCC were calculated for men and women separately using unconditional logistic regression models taking into account age, education, skin reaction to sun, history of painful sunburns, time spent outdoors, and for SCC, smoking. Results Among men, we observed elevated risks of both BCC and SCC among groundskeepers and gardeners, except farm (SOC 5622). We also found that garage and service station-related occupations (SOCs 873) and to some extent food/beverage preparation/service occupations (SOC 521) were associated with BCC risk among men. Women in health services occupations (SOC 523) had elevated risks for both tumors, especially for BCC. Additionally, administrative support (SOC 46/47) occupations were related to BCC risk among women. Other occupations were associated with excess risks, but without consistent trends by duration of employment. Conclusion We observed several occupations associated with elevated BCC and SCC risk. These results resemble reported findings for cutaneous melanoma and are generally consistent with the few available studies on keratinocyte cancers.     

A case–control study of lifetime light intensity physical activity and breast cancer risk

Purpose

Physical activity reduces breast cancer risk, although most evidence is for activity in the moderate-to-vigorous intensity range. The effect of light intensity physical activity (LIPA) is unknown. We aimed to determine the association between self-reported lifetime LIPA and pre- and post-menopausal breast cancer risk. Our secondary objective was to analyze risk stratified by estrogen and progesterone tumor receptor status.

Methods

Data were from a case–control study of 1,110 incident breast cancer cases (388 pre-menopausal; 722 post-menopausal) and 1,172 controls (442 pre-menopausal; 730 post-menopausal) recruited at two Canadian sites. Lifetime leisure-time, household, and occupational physical activity and covariates were assessed by questionnaire. Mean minutes per day of LIPA for each of the age periods 12–17, 18–34, 35–49, ≥50, and the total lifetime were calculated. Odds ratios were calculated using unconditional logistic regression for overall breast cancer risk and using polytomous logistic regression for estrogen receptor (ER)/progesterone receptor (PR)-defined tumor subtypes and were adjusted for moderate-to-vigorous physical activity and other confounders.

Results

LIPA was not associated with breast cancer risk at any age period across the life course: odds ratio (OR) = 0.81; 95 % CI 0.53–1.24 for pre-menopausal women and OR = 0.87; 95 % CI 0.64–1.19 for post-menopausal women in the highest vs. lowest categories of total lifetime LIPA. No heterogeneity in risk by ER/PR tumor status was observed.

Conclusions

Our results suggest that light intensity physical activity is not associated with breast cancer risk reduction. This finding is important for physical activity recommendations for breast cancer prevention.     

Lifetime body size and prostate cancer risk in a population-based case–control study in Sweden

Purpose

The role of body size in prostate cancer etiology is unclear and potentially varies by age and disease subtype. We investigated whether body size in childhood and adulthood, including adult weight change, is related to total, low–intermediate-risk, high-risk, and fatal prostate cancer.

Methods

We used data on 1,499 incident prostate cancer cases and 1,118 population controls in Sweden. Body figure at age 10 was assessed by silhouette drawings. Adult body mass index (BMI) and weight change were based on self-reported height and weight between ages 20 and 70. We estimated odds ratios (ORs) with 95 % confidence intervals (CIs) by unconditional logistic regression.

Results

Height was positively associated with prostate cancer. Overweight/obesity in childhood was associated with a 54 % increased risk of dying from prostate cancer compared to normal weight, whereas a 27 % lower risk was seen in men who were moderately thin (drawing 2) in childhood (P _trend = 0.01). Using BMI <22.5 as a reference, we observed inverse associations between BMI 22.5 to <25 at age 20 and all prostate cancer subtypes (ORs in the range 0.72–0.82), and between mean adult BMI 25 to <27.5 and low–intermediate-risk disease (OR 0.75, 95 % CI 0.55–1.02). Moderate adult weight gain increased the risk of disease in men with low BMI at start and in short men.

Conclusions

Our comprehensive life-course approach revealed no convincing associations between anthropometric measures and prostate cancer risk. However, we found some leads that deserve further investigation, particularly for early-life body size. Our study highlights the importance of the time window of exposure in prostate cancer development.     

Physical activity and endometrial cancer in a population-based case–control study

Introduction  

Published studies of physical activity, BMI, and endometrial cancer risk show conflicting results and many do not report on reliability or validity of physical activity questionnaires.     

Smoking,alcohol, diabetes,obesity, socioeconomic status,and the risk of colorectal cancer in a population-based case–control study

Purpose

Although previous research has identified factors that may determine willingness to participate in research, relatively few studies have attempted to quantify the impact non-participation may have on exposure–disease associations. The aims of this study were to (a) investigate the associations between smoking, alcohol, diabetes, obesity, and socioeconomic status and the risk of colorectal cancer in a case–control study (59.7 and 47.2 % response fractions among cases and controls, respectively); and (b) perform sensitivity analyses to examine the possible influence of non-participation.

Methods

Logistic regression was used to estimate the exposure–disease associations. We then investigated the associations between various demographic and health factors and the likelihood that an individual would participate in the case–control study and then performed two sensitivity analyses (sampling weights and multiple imputation) to examine whether non-participation bias may have influenced the exposure–disease associations.

Results

The exposures alcohol, smoking, and diabetes were associated with an increased risk of colorectal cancer. We found some differences between cases and controls when examining the factors associated with the participation in the study, and in the sensitivity analyses, the exposure–disease associations were slightly attenuated when compared with those from the original analysis.

Conclusion

Non-participation may have biased the risk estimates away from the null, but generally not enough to change the conclusions of the study.     

Subtype of dietary fat in relation to risk of Hodgkin lymphoma: a population-based case–control study in Connecticut and Massachusetts

Few epidemiological studies have examined the relationship between dietary fat, which may affect immune function and risk of Hodgkin lymphoma (HL). The aim of this study was to test the hypothesis that high dietary intake of fat and specific subtypes of fat is associated with the risk of HL among 486 HL cases and 630 population-based controls recruited between 1997 and 2000 in Connecticut and Massachusetts. Unconditional logistic regression was used to calculate odds ratios (ORs) and 95 % confidence intervals (CIs) stratified by age and gender. Among younger adults, HL risk was significantly and positively associated with higher intake of saturated fat [ORs for increasing quartiles = 1.3, 1.8, and 2.1; p trend = 0.04] and negatively associated with higher intake of monounsaturated fat [ORs for increasing quartiles = 0.5, 0.5, and 0.4; p trend = 0.03), after adjustment for potential confounders including lifestyle and other dietary factors. The associations with saturated fat (ORs for increasing quartile = 2.4, 3.2, and 4.4; p trend < 0.01] and monounsaturated fat (ORs for increasing quartile = 0.3, 0.6, and 0.3; p trend = 0.04) were most apparent in younger women, whereas there was no significant association between intake of total fat or any type of fat and risk of HL in older females or younger or older males. These findings show that the associations between dietary fat and risk of HL may vary by gender and age and require confirmation in other populations.     

Use of oral anticoagulants and risk of prostate cancer: a population-based case–control study in Montreal,Canada

Purpose

A few recent epidemiological observations suggest that anticoagulant medications may protect against prostate cancer development. Most studies have been small or subjected to methodological issues, including potential confounding. We provide here new evidence on this association in the context of a population-based case–control study of prostate cancer conducted in Montreal, Canada.

Methods

Cases were 1,588 men with incident prostate cancer, aged ≤75 years, diagnosed across French hospitals in the Montreal area between 2005 and 2009. Concurrently, 1,618 population controls from the same residential area and age distribution (±5 years) were randomly selected from the electoral list of French-speaking men. In-person interviews elicited information on socio-demographic, lifestyle and environmental factors, along with a detailed medical history. Unconditional logistic regression was used to assess the association between lifetime use of anticoagulants and prostate cancer risk.

Results

102 subjects (2.6 % of cases and 3.7 % of controls) reported a history of oral anticoagulant therapy. After controlling for age, ancestry, education, family history of prostate cancer, prostate cancer screening frequency, diabetes, body mass index and statin use, ever use of oral anticoagulants showed a weak inverse, non-statistically significant association with prostate cancer (odds ratio 0.76, 95% confidence interval 0.50–1.16). Similar results were observed in analyses considering duration of use or indication for use, restricted to subjects recently screened or stratified by cancer aggressiveness.

Conclusions

Our findings provide weak support for a protective effect of oral anticoagulant therapy against prostate cancer. Further confirmation is required, especially in light of potential bleeding complications associated with anticoagulants.     

Proanthocyanidins and other flavonoids in relation to endometrial cancer risk: a case–control study in Italy

Background:

Because of their antioxidant and antimutagenic properties, flavonoids may reduce cancer risk. Some flavonoids have antiestrogenic effects that can inhibit the growth and proliferation of endometrial cancer cells.

Methods:

In order to examine the relation between dietary flavonoids and endometrial cancer, we analysed data from an Italian case–control study including 454 incident, histologically confirmed endometrial cancers and 908 hospital-based controls. Information was collected through a validated food-frequency questionnaire. We applied data on food and beverage composition to estimate the intake of flavanols, flavanones, flavonols, anthocyanidins, flavones, isoflavones, and proanthocyanidins. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated from multiple logistic regression models conditioned on age and study centre and adjusted for major confounding factors.

Results:

Women in the highest quartile category of proanthocyanidins with ⩾3 mers vs the first three quartile categories had an OR for endometrial cancer of 0.66 (95% CI=0.48–0.89). For no other class of flavonoids, a significant overall association was found. There was a suggestion of an inverse association for flavanones and isoflavones among women with body mass index <25 kg m⁻², and, for flavanones, among parous or non-users of hormone-replacement therapy women.

Conclusion:

High consumption of selected proanthocyanidins may reduce endometrial cancer risk.     

Nonsteroidal anti-inflammatory drugs,statins, and pancreatic cancer risk: a population-based case–control study

Purpose

Studies suggest that aspirin, other nonsteroidal anti-inflammatory drugs (NSAIDs), and statins may reduce risk of some cancers. However, findings have been conflicting as to whether these agents reduce the risk of pancreatic cancer.

Methods

We used data from the Queensland Pancreatic Cancer Study, a population-based case–control study. In total, 704 cases and 711 age- and sex-matched controls were recruited. Participants completed an interview in which they were asked about history of NSAID and statin use. We included 522 cases and 653 controls who had completed the medication section of the interview in this analysis. Unconditional multivariable logistic regression was used to estimate associations between medication use and pancreatic cancer.

Results

We found no consistent evidence of an association between use of NSAIDs or statins and risk of pancreatic cancer. There was some suggestion of a protective effect in infrequent users of selective COX-2 inhibitors, but no association in more frequent users. We did not find evidence of protective effects in analyses stratified by sex, smoking status, time between diagnosis and interview, or presence/absence of metastases.

Conclusions

Overall, our results do support the hypothesis that use of NSAIDs or statins may reduce the odds of developing pancreatic cancer.

     

Circulating sex hormone levels and colorectal cancer risk in Japanese postmenopausal women: The JPHC nested case–control study

Previous epidemiological studies evaluated endogenous sex hormone levels and colorectal cancer (CRC) risk have yielded inconsistent results. Also, it is unknown if consumption of dietary isoflavones may influence the endogenous sex hormones and CRC relationships. We conducted a nested case–control study within the JPHC Study Cohort II wherein 11,644 women provided blood samples at the 5-year follow-up survey. We selected two matched controls for each case from the cohort (185 CRC cases and 361 controls). Multivariable conditional logistic regression was used to estimate odds ratios (ORs), 95% confidence intervals (CIs) for the association between circulating sex hormone levels and CRC risk. Comparing extreme tertiles, circulating testosterone levels were positively associated with CRC risk (OR = 2.10, 95% CI = 1.11–3.99, p for trend = 0.03). Levels of estradiol, SHBG, and progesterone were not associated with CRC risk. In a subgroup analysis by dietary isoflavone intake, SHBG levels were positively associated with CRC risk among those with low total isoflavone intake (p for trend = 0.03), with a statistically nonsignificant inverse association among those with high total isoflavone intake (p for trend = 0.22; p for interaction = 0.002). Endogenous levels of testosterone were positively associated with CRC among postmenopausal women. The association of endogenous SHBG with CRC development may be altered by the level of dietary isoflavone intake.     

Vaccination history and risk of non-hodgkin lymphoma: a population-based, case–control study

Objective  As factors that alter the immune system have been implicated in non-Hodgkin lymphoma (NHL) etiology, it is of interest to explore the association between vaccination and risk of NHL. Results of few epidemiologic studies conducted thus far are inconsistent, and only one has examined the association by histologic subtype. Subjects  A population-based, case–control study of 387 patients with NHL and 535 controls conducted in Nebraska between 1999 and 2002. Methods  Information on vaccination for tetanus, polio, influenza, smallpox, and tuberculosis, as well as important environmental factors, was collected by telephone interview. Risk was estimated by odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for confounders. Results  We found that NHL risk was inversely associated with ever receiving a polio (OR = 0.59, CI = 0.40–0.87) or smallpox (OR = 0.71, CI = 0.51–0.98) vaccination, and positively associated with influenza vaccination (OR = 1.53, CI = 1.14–2.06). No significant association was found for tetanus or tuberculosis vaccination. The patterns of association were similar between men and women. Analysis by histologic subtypes showed that polio vaccination was associated with a lower risk of follicular (OR = 0.54, CI = 0.31–0.92) and chronic lymphocytic leukemia/small lymphocytic lymphomas (OR = 0.29, CI = 0.12–0.69) and smallpox vaccination was associated with a lower risk of marginal zone lymphoma (OR = 0.41, CI = 0.19–0.88). In contrast, ever receiving an influenza vaccination was associated with a higher risk of follicular (OR = 1.98, CI = 1.23–3.18) and diffuse large B cell lymphomas (OR = 1.88, CI = 1.13–3.12). Conclusion  Risk of NHL is inversely associated with polio and smallpox vaccination and positively associated with influenza vaccination. These associations appear to differ by histologic subtype. Specific contributions of all authors to published work: HAL provided input into the statistical analyses and drafted and revised this report. BCC designed and oversaw conduct of the epidemiologic case–control study and provided input into the statistical analyses. DDW was responsible for reviewing cases. HAL, AJF, AME, BCC, and DDW provided input into the data analyses and interpretation. All authors contributed to the final version of this report.