Is cigarette smoking a risk factor for non-Hodgkin's lymphoma or multiple myeloma? Results from the lutheran brotherhood cohort study

Among 17 633 U.S. white male insurance policy holders whose use of tobacco was characterized in a 1966 self-administered questionnaire, there were 49 deaths from non-Hodgkin's lymphoma (NHL) and 21 from multiple myeloma (MM) during a 20-year follow-up. Men who had ever smoked cigarettes had an elevated mortality from NHL (RR = 2.1; CI = 0.9–4.9), with risk almost four-fold greater among the heaviest smokers (RR = 3.8; CI = 1.4–10.1) compared with those who used no tobacco. In contrast, risk of MM was only slightly elevated among those who had ever smoked cigarettes (RR = 1.3; CI = 0.4–3.9) and without evidence of a dose-response trend. Since this is the first cohort study suggesting a link between cigarette smoking and NHL and findings from case-control studies have been inconsistent, additional clarification should be sought from larger incidence-based cohort investigations.