Non-Hodgkin lymphoma risk

Preventable cases

Non-Hodgkin lymphoma cases are preventable, UK, 2015

 

H. Pylori

Non-Hodgkin lymphoma cases caused by infections, UK, 2015

 

The estimated lifetime risk of being diagnosed with non-Hodgkin lymphoma is 1 in 39 (3%) for males, and 1 in 51 (2%) for females born after 1960 in the UK.[1]

These figures have been calculated on the assumption that the possibility of having more than one diagnosis of non-Hodgkin lymphoma 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 Office for National Statistics (ONS) 2016-based Life expectancies and population projections. Accessed December 2017, and Smittenaar CR, Petersen KA, Stewart K, Moitt N. Cancer Incidence and Mortality Projections in the UK Until 2035. Brit J Cancer 2016. 
  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. 

About this data

Data is for UK, past and projected cancer incidence and mortality and all-cause mortality rates for those born in 1961, ICD-10 C82-C86.

The calculations used past and projected cancer incidence and mortality and all-cause mortality rates for those born in 1961 to project risk over the lifetime of those born in 1961 (cohort method).[1] Projections are based on observed incidence and mortality rates and therefore implicitly include changes in cancer risk factors, diagnosis and treatment.

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3% of non-Hodgkin lymphoma cases in the UK are preventable.[1]

Non-Hodgkin Lymphoma risk is associated with a number of risk factors.[2,3]

Non-Hodgkin Lymphoma Risk Factors

Increases risk ('sufficient' or 'convincing' evidence) May increase risk ('limited' or 'probable' evidence) Decreases risk ('sufficient' or 'convincing' evidence) May decrease risk ('limited' or 'probable' evidence)
  • Working in rubber production[a]
  • Epstein-Barr virus (EBV), immune suppression related
  • Hepatitis C virus (HCV)
  • Human immunodeficiency virus (HIV) type I
  • Human T-cell lymphotropic virus type 1 (HTLV-1)[b]
  • Kaposi sarcoma herpes virus (KSHV)[c]
  • Helicobacter Pylori (H. Pylori)[d]
  • Azathioprine
  • Cyclosporine
  • Benzene
  • Ethylene oxide
  • 2,3,7,8-Tetrachlorodibenzo-para-dioxin
  • X radiation, gamma radiation
  • Hepatitis B virus (HBV)
  • Polychlorophenols or their sodium salts (combined exposures)
  • Tetrachloroethylene
  • Trichloroethylene

-

-

International Agency for Research on Cancer (IARC) classification. World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) classification does not include non-Hodgkin lymphoma because it is not generally recognised to have a relationship to food, nutrition, and physical activity.

a Classification for ‘lymphoma’ not NHL specifically. b Classification for adult T-cell lymphoma. c Classification for primary effusion lymphoma. d Classification for low-grade B-cell mucosa-associated lymphoid tissue (MALT) gastric lymphoma.

References

  1. Brown KF, Rumgay H, Dunlop C, et al. The fraction of cancer attributable to known risk factors in England, Wales, Scotland, Northern Ireland, and the UK overall in 2015. British Journal of Cancer 2018. 
  2. Cogliano VJ, Baan R, Straif K, et al. Preventable Exposures Associated With Human Cancers. JNCI 2011;103(24):1827-39.
  3. World Cancer Research Fund / American Institute for Cancer Research. Continuous Update Project Findings & Reports. Accessed October 2018.
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International Agency for Research on Cancer (IARC) classifies the role of this risk factor in cancer development.[1] 58% of MALT cases in the UK are caused by H. pylori infection, that's 2% of all NHL cases.[2]

Marginal zone lymphomas (MZL) risk is 1.6 times higher in people with an ulcer (used as a proxy measure for H. pylori infection), a pooled analysis showed.[3]

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International Agency for Research on Cancer (IARC) classifies the role of this risk factor in cancer development.[1] Less than 1% of NHL cases in the UK are caused by hepatitis B virus (HBV) infection.[2]

NHL patients are more than twice as likely to have HBV infection, compared with healthy controls, meta-analyses have shown.[3-5]

Marginal zone lymphomas (MZL) risk is 3 times higher in people with a history of hepatitis C virus (HCV) infection, a pooled analysis showed.[6] Diffuse large B-cell lymphoma (DLBCL) risk is 2 times higher in people with a history of HCV infection versus those without, a pooled analysis showed.[7]

References

  1. Cogliano VJ, Baan R, Straif K, et al. Preventable Exposures Associated With Human Cancers. JNCI 2011;103(24):1827-39.
  2. Calculated by the Statistical Information Team at Cancer Research UK, 2018. Based on Brown KF, Rumgay H, Dunlop C, et al. The fraction of cancer attributable to known risk factors in England, Wales, Scotland, Northern Ireland, and the UK overall in 2015. British Journal of Cancer 2018.
  3. Nath A, Agarwal R, Malhotra P, et al. Prevalence of hepatitis B virus infection in non-Hodgkin lymphoma: a systematic review and meta-analysis. Intern Med J 2010;40:633-41.
  4. Dalia S, Chavez J, Castillo JJ, Sokol L. Hepatitis B infection increases the risk of non-Hodgkin lymphoma: a meta-analysis of observational studies. Leuk Res. 2013;37(9):1107-15.
  5. Yi HZ, Chen JJ, Cen H, et al. Association between infection of hepatitis B virus and onset risk of B-cell non-Hodgkin's lymphoma: a systematic review and a meta-analysis. Med Oncol 2014;31(8):84.
  6. Bracci PM, Benavente Y, Turner JJ, et al. Medical history, lifestyle, family history, and occupational risk factors for marginal zone lymphoma: the InterLymph Non-Hodgkin Lymphoma Subtypes Project. J Natl Cancer Inst Monogr 2014;2014(48):52-65.
  7. Cerhan JR, Kricker A, Paltiel O, et al. Medical history, lifestyle, family history, and occupational risk factors for diffuse large B-cell lymphoma: the InterLymph Non-Hodgkin Lymphoma Subtypes Project. J Natl Cancer Inst Monogr 2014;2014(48):15-25.
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International Agency for Research on Cancer (IARC) classifies the role of this risk factor in cancer development.[1] Less than 1% of NHL cases in the UK are caused by HIV infection.[2]

NHL risk is around 11 times higher in people with HIV, compared with the general population, a cohort study has shown.[3] Risk varies by NHL subtype; the risks of AIDS-defining NHL subtypes (including DLBCL) are 18+ times higher in people with HIV versus the general population, while the risks of non AIDS-defining NHL subtypes are increased to a lesser extent, a cohort study showed.[4] NHL risk in HIV-positive people increases with HIV severity, cohort studies have shown.[5,6]

HIV-associated NHL risk has decreased markedly since highly active antiretroviral therapy (HAART) was introduced to treat HIV in 1996,[7-11] probably because HAART improves immune system functioning.[12]

References

  1. Cogliano VJ, Baan R, Straif K, et al. Preventable Exposures Associated With Human Cancers. JNCI 2011;103(24):1827-39.
  2. Calculated by the Statistical Information Team at Cancer Research UK, 2018. Based on Brown KF, Rumgay H, Dunlop C, et al. The fraction of cancer attributable to known risk factors in England, Wales, Scotland, Northern Ireland, and the UK overall in 2015. British Journal of Cancer 2018. 
  3. Seaberg EC, Wiley D, Martínez-Maza O, et al. Cancer incidence in the multicenter aids cohort study before and during the HAART era: 1984 to 2007. Cancer 2010;116:5507-16.
  4. Gibson TM1, Morton LM, Shiels MS, et al. Risk of non-Hodgkin lymphoma subtypes in HIV-infected people during the HAART era: a population-based study. AIDS 2014 Sep;28(15):2313-8.
  5. Achenbach CJ, Buchanan AL, Cole SR, et al. HIV Viremia and Incidence of Non-Hodgkin Lymphoma in Patients Successfully Treated With Antiretroviral Therapy. Clin Infect Dis. 2014.
  6. Engels EA, Pfeiffer RM, Landgren O, et al. Immunologic and virologic predictors of AIDS-related non-hodgkin lymphoma in the highly active antiretroviral therapy era. J Acquir Immune Defic Syndr. 2010;54(1):78-84.
  7. Roman E, Smith AG. Epidemiology of lymphomas. Histopathology 2011;58:4-14.
  8. Boffetta PI. Epidemiology of adult non-Hodgkin lymphoma. Ann Oncol 2011;22:iv27-iv31.
  9. Grulich AE, van Leeuwen MT, Falster MO, et al. Incidence of cancers in people with HIV/AIDS compared with immunosuppressed transplant recipients: a meta-analysis. Lancet 2007;370:59-67.
  10. Engels EA, Pfeiffer RM, Goedert JJ, et al. Trends in cancer risk among people with AIDS in the United States 1980-2002. AIDS 2006;20:1645-54.
  11. International Collaboration on HIV and Cancer. Highly Active Antiretroviral Therapy and Incidence of Cancer in Human Immunodeficiency Virus-Infected Adults. J Natl Cancer I 2000;92:1823-30.
  12. Palmieri C, Treibel T, Large O, et al. AIDS-related non-Hodgkin's lymphoma in the first decade of highly active antiretroviral therapy. QJM 2006;99:811-26.
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International Agency for Research on Cancer (IARC) classifies the role of this risk factor in cancer development.[1] Less than 1% of NHL cases in the UK are caused by Epstein-Barr virus (EBV) infection.[2]

NHL risk is 26% higher in people with previous infectious mononucleosis (which is caused by EBV), a pooled analysis showed.[3] NHL risk is higher in EBV-positive people, a meta-analysis showed.[4]

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Immune dysregulation underpins both autoimmune disease and lymphoma development. 

The NHL subtypes most often associated with autoimmunity are diffuse large B-cell lymphoma (DLBCL) and marginal zone lymphomas (MZL).[1-4]

Sjögren’s syndrome

NHL risk is 14-19 times higher in people with primary Sjögren’s syndrome, compared with the general population, a meta-analysis showed.[5

Systemic lupus erythematosus

NHL risk is 5-7 times higher in people with systemic lupus erythematosus (SLE), compared with the general population, meta-analyses have shown.[5-7

Rheumatoid arthritis

NHL risk is 2.3 times higher in people with rheumatoid arthritis, compared with the general population, a meta-analysis showed.[8

NHL risk (B-cell NHL subtypes) in inflammatory rheumatic disease patients may be higher in those receiving antitumor necrosis factor alpha (anti-TNFα) treatment.[9,10]

Coeliac disease

NHL risk is 2-6-4.4 times higher in people with coeliac disease (enteropathy-associated T-cell lymphomas – EATCL/EATL) compared with the general population, meta-analyses have shown.[11,12]

Sclerosis

NHL risk is 2.7 times higher in people with systemic sclerosis, compared with the general population, a meta-analysis showed. [13]

Psoriasis

NHL risk is 40% higher in people with psoriasis, compared with the general population, a meta-analysis showed.[14]

References

  1. Dias C, Isenberg DA. Susceptibility of patients with rheumatic diseases to B-cell non-Hodgkin lymphoma. Nat Rev Rheumatol 2011;7:360-8.
  2. Ansell P, Simpson J, Lightfoot T, et al. Non-Hodgkin lymphoma and autoimmunity: Does gender matter? Int J Cancer 2011;129:460-6.
  3. Anderson LA, Gadalla S, Morton LM, et al. Population-based study of autoimmune conditions and the risk of specific lymphoid malignancies. Int J Cancer 2009;125:398-405.
  4. Zintzaras E, Voulgarelis M, Moutsopoulos HM. The risk of lymphoma development in autoimmune diseases: A meta-analysis. Arch Int Med 2005;165:2337-44.
  5. Cao L, Tong H, Xu G, et al. Systemic lupus erythematous and malignancy risk: a meta-analysis. PLoS One. 2015 Apr 17;10(4):e0122964.
  6. Simon TA, Thompson A, Gandhi KK, et al. Incidence of malignancy in adult patients with rheumatoid arthritis: a meta-analysis. Arthritis Res Ther. 2015 Aug 15;17:212.
  7. Kane E, Newton R, Roman E. Non-Hodgkin lymphoma and gluten-sensitive enteropathy: estimate of risk using meta-analyses. Cancer Cause Control 2011;22:1435-44.
  8. Zhang JQ, Wan YN, Peng WJ, et al. The risk of cancer development in systemic sclerosis: a meta-analysis. Cancer Epidemiol. 2013;37(5):523-7.
  9. Pouplard C, Brenaut E, Horreau C, et al. Risk of cancer in psoriasis: a systematic review and meta-analysis of epidemiological studies. J Eur Acad Dermatol Venereol. 2013 Aug;27 Suppl 3:36-46.
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International Agency for Research on Cancer (IARC) classifies the role of this risk factor in cancer development.[1]

Trichloroethylene

NHL risk is higher in people with occupational exposure to trichloroethylenemeta-analyses have shown.[2-5]

Pesticides

NHL risk is higher in people with occupational exposure toor pesticides, meta-analyses have shown.[6-8]

References

  1. Cogliano VJ, Baan R, Straif K, et al. Preventable Exposures Associated With Human Cancers. JNCI 2011;103(24):1827-39.
  2. Scott CS, Jinot J. Trichloroethylene and cancer: systematic and quantitative review of epidemiologic evidence for identifying hazards. Int J Environ Res Public Health 2011;8:4238-72.
  3. Mandel JH, Kelsh MA, Mink PJ, et al. Occupational trichloroethylene exposure and non-Hodgkin’s lymphoma: a meta-analysis and review. Occup Environ Med 2006;63:597-607.
  4. Karami S, Bassig B, Stewart PA, et al. Occupational trichloroethylene exposure and risk of lymphatic and haematopoietic cancers: a meta-analysis. Occup Environ Med. 2013;70(8):591-9.
  5. Merhi M, Raynal H, Cahuzac E, et al. Occupational exposure to pesticides and risk of hematopoietic cancers: meta-analysis of case–control studies. Cancer Cause Control 2007;18:1209-26.
  6. Keller-Byrne JE, Khuder SA, Schaub EA, et al. A meta-analysis of non-Hodgkin's lymphoma among farmers in the central United States. Am J Industrial Med 1997;31:442-4.
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NHL risk is higher in people with a first-degree relative (parent, sibling, child) with NHL, a pooled analysis and cohort study have shown;[1,2] relatives may develop the same NHL subtype.[3]

NHL risk may be higher in people with a first degree relative with other cancer types, particularly haematological cancers, pooled analyses of case-control studies have shown.[4-9]

Self-reported family history information and changes over time in NHL classification may impact on the reliability of this evidence.

References

  1. Wang SS, Slager SL, Brennan P, et al. Family history of hematopoietic malignancies and risk of non-Hodgkin lymphoma (NHL): a pooled analysis of 10 211 cases and 11 905 controls from the International Lymphoma Epidemiology Consortium (InterLymph). Blood 2007;109:3479-88.
  2. Crump C, Sundquist K, Sieh W, et al. Perinatal and Family Risk Factors for Non-Hodgkin Lymphoma in Early Life: A Swedish National Cohort Study. J Natl Cancer I 2012;104:923-30.
  3. Goldin LR, Björkholm M, Kristinsson SY, et al. Highly increased familial risks for specific lymphoma subtypes. Brit J Haematol 2009;146:91-4.29.
  4. Zhang Y, Wang R, Holford T, et al. Family history of hematopoietic and non-hematopoietic malignancies and risk of non-Hodgkin lymphoma. Cancer Cause Control 2007;18:351-9.
  5. Negri E, Talamini R, Montella M, et al. Family History of Hemolymphopoietic and Other Cancers and Risk of Non-Hodgkin's Lymphoma. Cancer Epidem Biomar 2006;15:245-50.
  6. Smedby KE, Sampson JN, Turner JJ, et al. Medical history, lifestyle, family history, and occupational risk factors for mantle cell lymphoma: the InterLymph Non-Hodgkin Lymphoma Subtypes Project. J Natl Cancer Inst Monogr 2014;2014(48):76-86.
  7. Bracci PM, Benavente Y, Turner JJ, et al. Medical history, lifestyle, family history, and occupational risk factors for marginal zone lymphoma: the InterLymph Non-Hodgkin Lymphoma Subtypes Project. J Natl Cancer Inst Monogr 2014;2014(48):52-65.
  8. Linet MS, Vajdic CM, Morton LM, et al. Medical history, lifestyle, family history, and occupational risk factors for follicular lymphoma: the InterLymph Non-Hodgkin Lymphoma Subtypes Project. J Natl Cancer Inst Monogr 2014;2014(48):26-40.
  9. Cerhan JR, Kricker A, Paltiel O, et al. Medical history, lifestyle, family history, and occupational risk factors for diffuse large B-cell lymphoma: the InterLymph Non-Hodgkin Lymphoma Subtypes Project. J Natl Cancer Inst Monogr 2014;2014(48):15-25.
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