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Residential proximity to industrial combustion facilities and risk of non-Hodgkin lymphoma: a case–control study

Anjoeka Pronk12, John R Nuckols3, Anneclaire J De Roos45, Matthew Airola6, Joanne S Colt1, James R Cerhan7, Lindsay Morton1, Wendy Cozen8, Richard Severson9, Aaron Blair1, David Cleverly10 and Mary H Ward111*

Author Affiliations

1 Division of Cancer Epidemiology and Genetics, National Cancer Institute, Department of Health and Human Services, Rockville, MD, USA

2 TNO, Zeist, The Netherlands

3 Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA

4 Fred Hutchinson Cancer Research Center, Seattle, WA, USA

5 University of Washington Department of Epidemiology, Seattle, WA, USA

6 Westat, Inc., Rockville, MD, USA

7 Mayo Clinic College of Medicine, Rochester, MN, USA

8 Departments of Preventive Medicine, Pathology, and Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

9 Department of Family Medicine and Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA

10 National Center for Environmental Assessment , Office of Research and Development, United States Environmental Protection Agency (retired), Washington, DC, USA

11 Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 6120 Executive Blvd, EPS 8006, 20892, Bethesda, MD, USA

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Environmental Health 2013, 12:20  doi:10.1186/1476-069X-12-20

Published: 22 February 2013



Residence near municipal solid waste incinerators, a major historical source of dioxin emissions, has been associated with increased risk of non-Hodgkin lymphoma (NHL) in European studies. The aim of our study was to evaluate residence near industrial combustion facilities and estimates of dioxin emissions in relation to NHL risk in the United States.


We conducted a population-based case–control study of NHL (1998–2000) in four National Cancer Institute-Surveillance Epidemiology and End Results centers (Detroit, Iowa, Los Angeles, Seattle). Residential histories 15 years before diagnosis (similar date for controls) were linked to an Environmental Protection Agency database of dioxin-emitting facilities for 969 cases and 749 controls. We evaluated proximity (3 and 5 km) to 10 facility types that accounted for >85% of U.S. emissions and a distance-weighted average emission index (AEI [ng toxic equivalency quotient (TEQ)/year]).


Proximity to any dioxin-emitting facility was not associated with NHL risk (3 km OR = 1.0, 95% CI 0.8-1.3). Risk was elevated for residence near cement kilns (5 km OR = 1.7, 95% CI 0.8-3.3; 3 km OR = 3.8, 95% CI 1.1-14.0) and reduced for residence near municipal solid waste incinerators (5 km OR = 0.5, 95% CI 0.3-0.9; 3 km OR = 0.3, 95% CI 0.1-1.4). The AEI was not associated with risk of NHL overall. Risk for marginal zone lymphoma was increased for the highest versus lowest quartile (5 km OR = 2.6, 95% CI 1.0-6.8; 3 km OR = 3.0, 95% CI 1.1-8.3).


Overall, we found no association with residential exposure to dioxins and NHL risk. However, findings for high emissions and marginal zone lymphoma and for specific facility types and all NHL provide some evidence of an association and deserve future study.

Non-Hodgkin lymphoma; Lymphomas; Dioxins; Air pollution; Geographic information systems; Case–control study