Non-Hodgkin lymphoma incidence statistics

Non-Hodgkin lymphoma (NHL) (all subtypes combined) is the sixth most common cancer in the UK (2012), accounting for 4% of all new cases. In males, it is the fifth most common cancer (4% of the male total), whilst it is the seventh in females (4%).[1-4]

In 2012, 12,900 new cases of NHL were registered in the UK: 7,007 (54%) in males and 5,893 (46%) in females, giving a male:female ratio of around 12:10.[1-4] The crude incidence rate Open a glossary item shows that there are 22 new NHL cases for every 100,000 males in the UK, and 18 for every 100,000 females.

Differences in registration methods, diagnosis and classification are likely to have a bearing on comparisons between the countries and regions within the UK.[5] For males, the estimated European age-standardised incidence rate Open a glossary item (AS rate) is significantly higher in England compared Wales, and higher in Northern Ireland compared with Wales and Scotland.[1-4] The rates for females are significantly lower in Wales compared with England and Northern Ireland. Rates do not differ significantly between the constituent countries of the UK.[1-4]

Non-Hodgkin Lymphoma (C82-C85), Number of New Cases, Crude and European Age-Standardised (AS) Incidence Rates per 100,000 Population, UK, 2012

England Wales Scotland Northern Ireland UK
Male Cases 5,934 319 544 210 7,007
Crude Rate 22.5 21.1 21.1 23.5 22.4
AS Rate 26.9 23.1 24.5 31.1 26.6
AS Rate - 95% LCL 26.2 20.6 22.5 26.9 25.9
AS Rate - 95% UCL 27.5 25.7 26.6 35.3 27.2
Female Cases 4,923 271 524 175 5,893
Crude Rate 18.1 17.3 19.1 18.8 18.2
AS Rate 19.1 16.5 19.2 21.8 19.0
AS Rate - 95% LCL 18.5 14.6 17.6 18.6 18.5
AS Rate - 95% UCL 19.6 18.5 20.9 25.0 19.5
Persons Cases 10,857 590 1,068 385 12,900
Crude Rate 20.3 19.2 20.1 21.1 20.2
AS Rate 22.6 19.6 21.5 26.0 22.5
AS Rate - 95% LCL 22.2 18.0 20.2 23.4 22.1
AS Rate - 95% UCL 23.1 21.2 22.8 28.6 22.8

95% LCL and 95% UCL are the 95% lower and upper confidence limits Open a glossary item around the AS Rate Open a glossary item

ASR calculated with ESP2013. Not comparable with ASRs calculated with ESP1976.
 

Though variation in NHL incidence across the UK has been reported[6-8] an analysis comparing reported incidence with the expected incidence based on Haematological Malignancy Research Network (HMRN) rates found that this variation is most likely artefactual.[5]

Using HMRN data for 2004-2011, it is estimated that almost half of all NHL cases diagnosed in the UK are diffuse large B-cell lymphoma (Diffuse large B-cell lymphoma (DLBCL), 48%).[9] Marginal zone lymphomas (MZL) and follicular lymphoma (FL) account for a further one-fifth of cases each (20% and 19%, respectively), with T-cell lymphomas (6%), mantle cell lymphoma (MCL, 5%) and Burkitt lymphoma (2%) making up the remainder. Crude incidence rates range from 0.5 (Burkitt lymphoma) to 9 (DLBCL) cases for every 100,000 men in the UK, and from 0.2 (Burkitt lymphoma) to 8 (DLBCL) cases for every 100,000 women in the UK.

HMRN’s European AS incidence rates are significantly higher in males than females for five of the six main NHL subtypes; the exception is FL, where rates do not differ significantly between the sexes.[9]

Non-Hodgkin Lymphoma Subtypes, Expected Number of New Cases, Crude and European Age-Standardised (AS) Incidence Rates per 100,000 Population, UK (Estimates Based on HMRN data), 2004-2011

  Male Female Persons
Cases AS Rate (95% LCL-95% UCL) Cases AS Rate (95% LCL-95% UCL) Cases AS Rate (95% LCL-95% UCL)
B-cell Diffuse large B-Cell Lymphoma 2,532 7.8 (7.6-8) 2,199 5.6 (5.4-5.7) 4,835 6.6 (6.5-6.7)
Marginal Zone Lymphomas 1,073 3.2 (2.5-2.6) 847 2.0 (1.9-2.1) 1,962 2.5 (2.5-2.6)
Follicular Lymphoma 857 2.7 (2.6-2.8) 998 2.8 (2.7-2.9) 1,884 2.8 (2.7-2.8)
Mantle Cell Lymphoma 331 1 (0.9-1.1) 181 0.4 (0.3-0.4) 513 0.6 (0.6-0.7)
Burkitt Lymphoma 152 0.5 (0.4-0.6) 52 0.2 (0.1-0.2) 204 0.3 (0.3-0.4)
T-cell Lymphomas 350 1.1 (1-1.2) 254 0.7 (0.6-0.7) 604 0.9 (0.8-0.9)
Lymphoproliferative Disorders Not Otherwise Specified 608 1.8 (1.7-1.9) 509 1.0 (0.9-1.1) 1,116 1.3 (1.3-1.4)

95% LCL and 95% UCL are the 95% lower and upper confidence limits Open a glossary item around the AS Rate Open a glossary item

ASR calculated with ESP2013. Not comparable with ASRs calculated with ESP1976.

References

  1. Data were provided by the Office for National Statistics on request, July 2014. Similar data can be found here: http://www.ons.gov.uk/ons/rel/vsob1/cancer-statistics-registrations--england--series-mb1-/index.html.
  2. Data were provided by ISD Scotland on request, April 2014. Similar data can be found here: http://www.isdscotland.org/Health-Topics/Cancer/Publications/index.asp.
  3. Data were provided by the Welsh Cancer Intelligence and Surveillance Unit on request, April 2014. Similar data can be found here:http://www.wales.nhs.uk/sites3/page.cfm?orgid=242&pid=59080.
  4. Data were provided by the Northern Ireland Cancer Registry on request, June 2014. Similar data can be found here: http://www.qub.ac.uk/research-centres/nicr/
  5. Haematological Malignancy Research Network. Haematological malignancies & cancer registration in England (2004-2008). Quality appraisal comparing data from the National Cancer Data Repository (NCDR) with the population-based Haematological Malignancy Research Network (HMRN). Final Report. London: Leukaemia & Lymphoma Research; 2012.
  6. Quinn M, Wood H, Cooper N, et al, eds. Cancer Atlas of the United Kingdom and Ireland 1991-2000. Studies on Medical and Population Subjects No. 68. London: ONS; 2005.
  7. National Cancer Intelligence Network (NCIN). Cancer Incidence and Mortality by Cancer Network, UK, 2005. London: NCIN; 2008.
  8. National Cancer Intelligence Network (NCIN). Cancer e-Atlas. Accessed at: http://www.qub.ac.uk/research-centres/nicr/
  9. Data were provided by Haematological Malignancy Research Network (HMRN) on request.
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Non-Hodgkin lymphoma (NHL) (all subtypes combined) incidence is strongly related to age, with the highest incidence rates being in older men and women. In the UK between 2010 and 2012, an average of 34% of cases were diagnosed in men and women aged 75 and over, almost 3 in 20 (13%) were diagnosed in the under-50s.[1-4] Age-specific incidence rates rise steeply from around age 50-54, reaching an overall peak in the 80-84 age group for both men and women, and subsequently dropping. Incidence rates are higher for males than females for almost all age groups, though the sex ratios vary between age groups.[1-4]

Non-Hodgkin Lymphoma (C82-C85), Average Number of New Cases per Year and Age-Specific Incidence Rates, UK, 2010-2012

ASR calculated with ESP2013. Not comparable with ASRs calculated with ESP1976.
 

Haematological Malignancy Research Network (HMRN) data show that in the UK people aged 65 years and over comprise around 63% of diffuse large B-cell lymphoma (DLBCL) cases, 71% of Marginal zone lymphomas (MZL), 49% of follicular lymphoma (FL), 74% of mantle cell lymphoma (MCL), 24% of Burkitt lymphoma (BL), and 50% of T-cell.[5] Among B-cell NHL subtypes, only a small proportion of cases occur in younger people: around 9% of DLBCL cases, 9% of FL, 3% of MZL, and 1% of MCL are diagnosed in the under-45s; the exception being Burkitt lymphoma where almost half (46%) of cases are diagnosed in people under 45.

Non-Hodgkin Lymphoma Subtypes, Average Number of Expected Cases per Year, UK (Estimates Based on HMRN Data), 2004-2011

Age-specific incidence rates rise from around age 50-54 in the four main subtypes, with steeper rises for DLBCL and MZL, and slower rises for MCL and FL.[5] Rates peak in the 75+ age groups for DLBCL, MZL and MCL, but increase until around age 60-64 and stabilise thereafter for FL. FL rates are higher than MZL rates until age 60-64, but at this point FL rates become stable whilst MZL rates continue to increase, and so MZL becomes the commoner of the two in people aged 65 and over.

Incidence rates are higher for males than females in most age groups for most of the main subtypes (again the exception is FL, where rates are similar in males and females across the age range), though again the sex ratios vary between age groups.

Non-Hodgkin Lymphoma Subtypes, Age-Specific Incidence Rates, UK (Estimates Based on HMRN data), 2004-2011

ASR calculated with ESP2013. Not comparable with ASRs calculated with ESP1976.

References

  1. Data were provided by the Office for National Statistics on request, July 2014. Similar data can be found here: http://www.ons.gov.uk/ons/rel/vsob1/cancer-statistics-registrations--england--series-mb1-/index.html.
  2. Data were provided by ISD Scotland on request, April 2014. Similar data can be found here: http://www.isdscotland.org/Health-Topics/Cancer/Publications/index.asp.
  3. Data were provided by the Welsh Cancer Intelligence and Surveillance Unit on request, April 2014. Similar data can be found here:http://www.wales.nhs.uk/sites3/page.cfm?orgid=242&pid=59080.
  4. Data were provided by the Northern Ireland Cancer Registry on request, June 2014. Similar data can be found here: http://www.qub.ac.uk/research-centres/nicr/.
  5. Data were provided by Haematological Malignancy Research Network (HMRN) on request.
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In line with other developed countries,[1-3] Non-Hodgkin lymphoma (NHL) (all subtypes combined) registrations have more than doubled (153% increase) in Great Britain since the late-1970s, with much of the rise occurring before the mid-1990s.[4-6] Improvements in diagnostic techniques and data registration for NHL have likely contributed to these trends, so interpretation of these trends should be undertaken with caution.[7] With the exception of Human immunodeficiency virus (HIV), no established risk factors are known to have changed over time.

Non-Hodgkin Lymphoma (C82-C85), European Age-Standardised Incidence Rates, Great Britain, 1979-2012

ASR calculated with ESP2013. Not comparable with ASRs calculated with ESP1976.
 

Over the last decade (between 2001-2003 and 2010-2012), the European AS incidence rates have decreased by 16% in both males and females in the UK.[4-6,8]

Non-Hodgkin Lymphoma (C82-C85), European Age-Standardised Incidence Rates, UK, 1993-2012

ASR calculated with ESP2013. Not comparable with ASRs calculated with ESP1976.
 

In line with the overall trends, NHL registration rates have increased for all broad age groups in Great Britain since the late-1970s.[4-6] The largest increases have been in people aged 80+, with European AS incidence rates rising by more than three fold (209% increase) between 1979-1981 and 2010-2012. The smallest change has been in people aged 0-24, with European AS incidence rates rising by 30% between 1979-1981 and 2010-2012.

Non-Hodgkin lymphoma (C82-C85), European Age-Standardised Incidence Rates, By Age, Persons, Great Britain, 1979-2012

ASR calculated with ESP2013. Not comparable with ASRs calculated with ESP1976.
 

Incidence trends for the main NHL subtypes cannot yet be accurately reported, as Haematological Malignancy Research Network (HMRN) data have only been collected since 2004. However, examination of the data over the eight-year period 2004-2012 do not indicate any significant changes over time, either for total NHL or its component subtypes.

References

  1. Devesa SS, Fears T. Non-Hodgkin's Lymphoma Time Trends: United States and International Data. Cancer Res 1992;52:5432s-40s.
  2. Clarke CA, Glaser SL. Changing incidence of non-Hodgkin lymphomas in the United States. Cancer 2002;94:2015-23.
  3. Cartwright R, Brincker H, Carli PM, et al. The rise in incidence of lymphomas in Europe 1985-1992. Eur J Cancer 1999;35:627-33.
  4. Data were provided by the Office for National Statistics on request, July 2014. Similar data can be found here: http://www.ons.gov.uk/ons/rel/vsob1/cancer-statistics-registrations--england--series-mb1-/index.html.
  5. Data were provided by ISD Scotland on request, April 2014. Similar data can be found here: http://www.isdscotland.org/Health-Topics/Cancer/Publications/index.asp.
  6. Data were provided by the Welsh Cancer Intelligence and Surveillance Unit on request, April 2014. Similar data can be found here:http://www.wales.nhs.uk/sites3/page.cfm?orgid=242&pid=59080.
  7. Adamson P, Bray F, Costantini AS, et al. Time trends in the registration of Hodgkin and non-Hodgkin lymphomas in Europe. Eur J Cancer 2007;43:391-401.
  8. Data were provided by the Northern Ireland Cancer Registry on request, June 2014. Similar data can be found here: http://www.qub.ac.uk/research-centres/nicr/
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The lifetime risk of developing non-Hodgkin lymphoma (NHL) (all subtypes combined) is 1 in 48 for men and 1 in 58 for women, in 2012 in the UK.[1]

The lifetime risk for NHL has been calculated on the assumption that the possibility of having more than one diagnosis of NHL over the course of a lifetime is very low (‘Current Probability’ method).[2]

References

  1. Lifetime risk estimates calculated by the Statistical Information Team at Cancer Research UK. Based on data provided by the Office of National Statistics, ISD Scotland, the Welsh Cancer Intelligence and Surveillance Unit and the Northern Ireland Cancer Registry, on request, December 2013 to July 2014.
  2. Esteve J, Benhamou E and Raymond L. Descriptive epidemiology. IARC Scientific Publications No.128, Lyon, International Agency for Research on Cancer, pp 67-68 1994.
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The Ann Arbor staging system is most commonly used for Non-Hodgkin lymphoma (NHL):[1]

Stage I: the cancer is located in a single region, usually one lymph node and the surrounding area.
Stage II: the cancer is located in two separate regions, an affected lymph node or organ and a second affected area, and that both affected areas are confined to one side of the diaphragm - that is, both are above the diaphragm, or both are below the diaphragm.
Stage III: the cancer has spread to both sides of the diaphragm, including one organ or area near the lymph nodes or the spleen.
Stage IV: diffuse or disseminated involvement of one or more extralymphatic organs, including any involvement of the liver, bone marrow, or nodular involvement of the lungs.

Haematological Malignancy Research Network (HMRN) data indicate that around 13% of NHL patients do not have all the investigations required for staging (e.g. bone marrow, CT scan). This is largely reflective of how ill the patient is at presentation. The proportion not staged varies by subtype, from around 6% of MZL cases to 26% of T-cell lymphomas combined.

Stage distributions also vary by subtype, the highest proportion of stage 1 and 2 being seen for Diffuse large B-cell lymphoma (DLBCL) and the lowest for mantle cell lymphoma (MCL).[2]

Non-Hodgkin Lymphoma Subtypes, Stage Distribution at Diagnosis, Persons, HMRN, 2004-2011

References

  1. Leukaemia and Lymphoma Research. Non-Hodgkin Lymphoma (NHL). London: Leukaemia and Lymphoma Research; 2011.
  2. Data were provided by Haematological Malignancy Research Network (HMRN) on request.
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Non-Hodgkin lymphoma (NHL) (C82-C85 and C96) is the 11th most common cancer in Europe, with around 93,500 new cases diagnosed in 2012 (3% of the total). In Europe (2012), the highest World age-standardised Open a glossary item incidence rates for NHL are in Italy for men and the Netherlands for women; the lowest rates are in Albania for both men and women. UK NHL incidence rates are estimated to the ninth highest in males in Europe, and eighth highest in females.[1] These data are broadly in line with Europe-specific data available elsewhere.[2]

NHL (C82-C85 and C96) is the tenth most common cancer worldwide, with nearly 386,000 new cases diagnosed in 2012 (3% of the total). NHL incidence rates are highest in Northern America and lowest in South Central Asia, but this partly reflects varying data quality worldwide.[1]

Variation between countries may reflect different prevalence of risk factors, use of screening, and diagnostic methods.

References

  1. Ferlay J, Soerjomataram I, Ervik M, et al. GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; 2013. Available from:http://globocan.iarc.fr, accessed December 2013.
  2. Ferlay J, Steliarova-Foucher E, Lortet-Tieulent J, et al.Cancer incidence and mortality patterns in Europe: Estimates for 40 countries in 2012. European Journal of Cancer (2013) 49, 1374-1403.
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Non-Hodgkin lymphoma (NHL) (all subtypes combined) incidence does not show an association with measures of social class, such as area-based deprivation.[1-4] These results are perhaps unsurprising since there are no known aetiological links between deprivation and NHL.

References

  1. National Cancer Intelligence Network (NCIN). Cancer Incidence and Mortality by Cancer Network, UK, 2005. London: NCIN; 2008.
  2. Information Services Division Scotland. Cancer Statistics. Non-Hodgkin's Lymphoma. Accessed April 2013.
  3. Welsh Cancer Intelligence and Surveillance Unit. Cancer in Wales, 1995-2009: A Comprehensive Report. Wales; 2011.
  4. Donnelly DW, Gavin AT, Comber H. Cancer in Ireland 1994-2004: A comprehensive report. Ireland: Northern Ireland Cancer Registry/National Cancer Registry; 2009.
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Age-standardised Open a glossary item rates for White males with Non-Hodgkin lymphoma (ICD-10 C82-C85 and C96) range from 15.7 to 16.5 per 100,000. Rates for Asian males are similar, ranging from 10.3 to 16.9 per 100,000 and the rates for Black males are also similar, ranging from 11.4 to 19.6 per 100,000. For females there is a similar pattern - the age-standardised rates for White females range from 11.2 to 11.8 per 100,000 and rates for Asian and Black females are also similar ranging from 7.0 to 11.8 per 100,000 and 8.7 to 15.1 per 100,000 respectively.[1]

There appears to be no significant variation in Non-Hodgkin lymphoma incidence by ethnicity in the UK.[1,2] However, US data shows that since 1992, NHL rates have been significantly higher in non-Hispanic white people than in black people.[3]

Ranges are given because of the analysis methodology used to account for missing and unknown data. For Non-Hodgkin lymphoma, 42,576 cases were identified; 21% had no known ethnicity.

References

  1. National Cancer Intelligence Network (NCIN) and Cancer Research UK. Cancer Incidence and Survival by Major Ethnic Group, England, 2002-2006. London: NCIN; 2009.
  2. Ross JRY, Oliver SE. National Cancer Intelligence Network (NCIN) analyses of haematological malignancy. Incidence and survival by sex, ethnicity, deprivation, year of diagnosis and cancer network in the United Kingdom. Brit J Haematol 2010;149:57.
  3. Surveillance Epidemiology and End Results. Age-Adjusted SEER Incidence Rates and 95% Confidence Intervals; By Race/Ethnicity; Non-Hodgkin Lymphoma, All Ages, Both Sexes; 1992- 2009. Accessed at: http://seer.cancer.gov. Accessed September 2012.
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Prevalence refers to the number of people who have previously received a diagnosis of cancer and who are still alive at a given time point. Some patients will have been cured of their disease and others will not.

In the UK around 46,000 people were still alive at the end of 2006, up to ten years after being diagnosed with Non-Hodgkin lymphoma (all subtypes combined).[1]

Non-Hodgkin Lymphoma (C82-C85 and C96), One, Five and Ten Year Cancer Prevalence, UK, 31st December 2006

1 Year Prevalence 5 Year Prevalence 10 Year Prevalence
Male 4,094 15,378 24,004
Female 3,497 13,674 21,768
Persons 7,591 29,052 45,772

Worldwide, it is estimated that there were around 772,000 men and women still alive in 2008, up to five years after their diagnosis.[2]

References

  1. National Cancer Intelligence Network (NCIN). One, Five and Ten Year Cancer Prevalence by Cancer Network, UK, 2006. London: NCIN; 2010.
  2. Ferlay J Shin HR, Bray F, et al. GLOBOCAN 2008 v1.2, Cancer incidence and mortality worldwide: IARC CancerBase No. 10 [Internet]. Lyon, France: International Agency for Research on Cancer; 2010. Available from http://globocan.iarc.fr.
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