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A multi-centre hospital-based case-control study was conducted in three regions of France between 2000 and 2003 in order to establish the risk factors of lymphoid neoplasms. We report here results concerning alcohol and tobacco consumption. A total of 298 cases and 276 controls, case-matched by inclusion centre, age and sex were included. Cases were classified according to the World Health Organization classification and validated by an expert panel of eight pathologists. Overall alcohol intake did not incur any risk increase for non-Hodgkin's lymphoma. Wine consumption marginally increased the risk of follicular lymphoma [odds ratio=2.19 (0.83-5.80)], with a higher risk for drinkers who started before the age of 20 years [odds ratio=4.04 (1.19-13.76)] and for drinkers who consumed more than 19 g of alcohol per day [odds ratio=4.37 (1.04-18.45)]. Beer and spirit consumption was not linked to non-Hodgkin's lymphoma risk. Tobacco consumption did not show a risk increase. The risk increase of follicular lymphoma due to wine consumption was new. We discuss this risk based on the French context, France being the European country with the highest alcohol consumption, particularly of wine.

Background: Monitoring cancer incidence and mortality time trends is essential for cancer research and health-care planning. French cancer registries do not cover the entire population and do not provide a representative sample of the national population. Our study aimed at estimating national cancer incidence and mortality trends over the longest period available., Methods: Incidence and mortality data were collected over the period 1978-1997. Twenty-seven cancer sites were selected and age, sex and site specific incidence and mortality rates were estimated for each year from 1978 up to 2000. Observed incidence and mortality data in the population covered by cancer registries were modelled using age-cohort methods. An estimation of the incidence/mortality ratio was obtained from these models and applied to the mortality rates predicted from an age-cohort model for the entire French population. The person-years of observation were calculated cohort-wise from census data provided by the national institute of statistics, Results: Cancer incidence increased by 63% throughout the study period, from 170,000 new cases in 1980 to 278,000 in 2000. This evolution was due to demographic changes but also to an increase in the risk of cancer which was estimated to more than 35% during the same period. In men, this change is largely explain by the increase of prostate cancer incidence. Among women, the increase was dominated by the continuing increase in breast cancer incidence. Large increases were also seen for non-Hodgkin lymphoma, melanoma, and thyroid cancer in both genders and for lung cancer in women. Cancer mortality increased by 20% from 125,000 deaths in 1980 to 150,000 in 2000. This increase is less than that predicted from changes in demographic factors and corresponds in fact to a decrease in the risk of death estimated to about 8%, slightly greater for women than for men. This decrease is associated with a decreasing incidence for stomach cancers for both sexes, alcohol-related cancer for men and cervical cancer for women. Colo-rectal cancer decreasing mortality contributes to this improvement despite an incidence increase., Conclusion: Between 1980 and 2000, the study showed a large change in the cancer burden both quantitatively and qualitatively. Decrease in exposure, earlier diagnosis and therapeutic improvement explained part of this change, but overall the distribution of cancer cases shifted toward a distribution including less aggressive cancers. A striking divergence between incidence and mortality trends is observed for a great number of cancers. Prostate cancer shares with breast cancer the same pattern of a severe increasing incidence and a stable mortality. This points to important changes in medical practice and needs further analysis. The trend of lung cancer mortality among women should be emphasised since the situation will inevitably worsen in the coming years. It is already the third cause of cancer death among women.