Lymphoid malignancies, including non-Hodgkin lymphoma (NHL), Hodgkin lymphoma (HL), and multiple myeloma (MM), comprise the fourth most commonly diagnosed cancer in the United States. Dietary and other modifiable behavioral changes may explain part of the striking increase in the incidence rate of NHL during recent decades. Previous epidemiological studies suggest that intake of alcohol, vitamin D, and plant foods are associated with lower risk of several types of lymphoma. Biological evidence of antilymphoproliferative effects of bioactive vitamin D, and anti-cancer effects of dietary antioxidants and certain phytonutrients, support a protective role against lymphoma development, whereas a chemoprotective effect of alcohol is less certain. To date, there have been few prospective studies of diet and NHL risk, and none of HL or MM risk;there has been no prospective investigation of sunlight and risk of these cancers. Therefore, we aim to investigate whether exposure to vitamin D from diet or sunlight;indices of dietary antioxidant intake;consumption of phytoestrogens or isothiocyanates;or consumption of alcohol at various ages is associated with reduced risk of lymphoid malignancies among 110,215 women in the large, prospective California Teachers Study cohort. Between completion of a baseline questionnaire in 1995-1996 and December 31, 2006, 515 cohort members were diagnosed with NHL, 32 with HL, and 84 with MM, making this the largest prospective study of lymphoma to date. We will use multivariate Cox proportional hazards analysis to estimate the relative risks of NHL, NHL subtypes, HL, and MM associated with baseline dietary intake of certain nutrients, phytonutrients, and foods;dietary antioxidant indices;alcohol consumption at various ages;frequency of severe sunburns;age at first severe sunburn;and skin sensitivity to sunlight. In addition, we will use a validated model based on nationwide ultraviolet-B radiation (UVB) measurements to compute average annual UVB exposure according to residential address. Our study's prospective design precludes recall bias, while collection of detailed exposure information enables adjustment for a wide range of potential confounders and modifiers. If vitamin D, dietary antioxidants, and/or phytonutrients indeed decrease the risk of lymphoma, then dietary modification could reduce the considerable morbidity and mortality due to these malignancies and their long-term adverse treatment effects.

Public Health Relevance

This study examines whether vitamin D intake from diet or sunlight exposure, antioxidant indices, phytonutrients, or alcohol drinking at various ages is associated with lower risk of lymphatic cancers among 110,209 women in the California Teachers Study. If vitamin D or certain plant-based chemicals do protect against lymphatic cancers, then changing dietary habits and nutritional guidelines could help prevent all women from developing and dying from these cancers.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Small Research Grants (R03)
Project #
Application #
Study Section
Special Emphasis Panel (ZCA1-SRRB-D (J1))
Program Officer
Su, Joseph
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Cancer Prevention Institute of California
United States
Zip Code
Chang, Ellen T; Canchola, Alison J; Clarke, Christina A et al. (2011) Dietary phytocompounds and risk of lymphoid malignancies in the California Teachers Study cohort. Cancer Causes Control 22:237-49
Chang, Ellen T; Canchola, Alison J; Cockburn, Myles et al. (2011) Adulthood residential ultraviolet radiation, sun sensitivity, dietary vitamin D, and risk of lymphoid malignancies in the California Teachers Study. Blood 118:1591-9
Chang, Ellen T; Clarke, Christina A; Canchola, Alison J et al. (2010) Alcohol consumption over time and risk of lymphoid malignancies in the California Teachers Study cohort. Am J Epidemiol 172:1373-83