Contents lists available at ScienceDirect Cancer Epidemiology journal homepage: www.elsevier.com/locate/canep Established and suggested exposures on CLL/SLL etiology: Results from the CLL-MCC-Spain study Yolanda Benavente a,b, ⁎ , Delphine Casabonne a,b , Laura Costas a,b , Claudia Robles c , Esther Alonso d , Esmeralda de la Banda d , Eva Gonzalez-Barca e , Rafael Marcos-Gragera f , Javier Llorca b,g , Adonina Tardón b,h , José J. Monleon b,i,j , Marta Aymerich k , Elías Campo k , Eva Gimeno-Vázquez l,m , Gemma Castaño-Vinyals b,n,o,p , Nuria Aragonés b,q , Marina Pollán b,q,r , Manolis Kogevinas b,n,o,p , Sílvia de Sanjosé a,b,s a Unit of Infections and Cancer (UNIC), Cancer Epidemiology Research Programme, IDIBELL, Institut Català d’Oncologia, 08908, L’Hospitalet De Llobregat, Barcelona, Spain b CIBER Epidemiología y Salud Pública (CIBERESP), 28029, Madrid, Spain c Prevention and Implementation Group, Section of Early Detection and Prevention, International Agency for Research on Cancer, Lyon, France d Hematology Laboratory, Pathology Department, Hospital Universitari de Bellvitge, 08908, L’Hospitalet De Llobregat, Barcelona, Spain e Hematology, IDIBELL, Institut Català d’ Oncologia, 08908, L’Hospitalet De Llobregat, Barcelona, Spain f Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health, Autonomous Government of Catalonia, Catalan Institute of Oncology, Girona Biomedical Research Institute (IdiBGi), 17007, Girona, Spain g University of Cantabria – IDIVAL, Santander, Spain h Oncology Institute (IUOPA), University of Oviedo, Asturias, Spain i Department of Preventive Medicine and Public Health, University of Granada, 18071, Granada, Spain j Instituto de Investigación Biosanitaria de Granada, Servicio Andaluz de Salud/Universidad de Granada, 18012, Granada, Spain k Hematopathology Unit, Pathology Department, Hospital Clínic, University of Barcelona, Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), 08036, Barcelona, Spain l Department of Clinical Hematology, Hospital del Mar, Barcelona, 08003, Spain m Grup de Recerca Aplicada en Neoplasies Hematològiques-PSMAR, Barcelona, Spain n ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain o Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain p Universitat Pompeu Fabra (UPF), Barcelona, Spain q Cancer and Environmental Epidemiology Unit, National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain r Cancer Epidemiology Research Group, Oncology and Hematology Area, IIS Puerta de Hierro (IDIPHIM), Madrid, Spain s Department of Medicine, University of Barcelona, Barcelona, Spain ARTICLE INFO Keywords: Etiology Chronic lymphocytic leukemia Waist-to-hip ratio Case-control Lymphoproliferative disorders Agriculture ABSTRACT Introduction: Chronic Lymphocytic Leukemia (CLL/SLL) is the most common adult leukemia in Western coun- tries. Although it is mostly an indolent disease it is still incurable and with limited knowledge in relation to its etiology. We aim to confirm and quantify established risk factors for CLL/SLL using a multi-center epidemio- logical population-based case-control study on CLL/SLL as well as to explore new exposures inconclusively associated with CLL/SLL Methods: Using the framework provided by the large MCC-Spain case-control study, we explored established and suggested risk factors associated with CLL/SLL using data collected through a face-to-face interview. We esti- mated odds ratios (OR) and confidence intervals (CI) adjusted by basic confounders, in 1,845 controls from the general population and 560 CLL/SLL from 5 different Spanish regions. Results: Among the established risk factors, CLL/SLL cases were 3 times more likely to report first degree re- latives with an hematological cancer (OR = 3.11, 95% CI 2.10 to 4.61) and nearly twice likely to have ever worked in agriculture (OR = 1.70, 95% CI = 1.34 to 2.16). New findings suggest that women with CLL/SLL were more likely to have central obesity (OR = 1.67 95% CI = 1.12 to 2.48). An inverse association was found for current alcohol consumption (p-trend < 0.016) and for type II diabetes. https://doi.org/10.1016/j.canep.2017.12.012 Received 26 May 2017; Received in revised form 13 November 2017; Accepted 19 December 2017 ⁎ Corresponding author at: Unit of Infections and Cancer, Cancer Epidemiology Research Programme, Institut Català d’Oncologia, Av. Gran Via 199 - 203, 2°; 08908 L’Hospitalet de Llobregat, Barcelona, Spain. E-mail address: ybenavente@iconcologia.net (Y. Benavente). Abreviation: CLL, Chronic Lymphocytic Leukemia; OR, Odds Ratios; CI, Confidence Intervals; WHR, Waist-to-Hip Ratio Cancer Epidemiology 52 (2018) 106–111 1877-7821/ © 2017 Published by Elsevier Ltd. T