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EPIDEMIOLOGY

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  • Approximately 70,000 cases of non-Hodgkin lymphoma (NHL) will be diagnosed in 2010 and approximately 20,000 persons will die of the disease in the United States.

  • NHL represents approximately 4.5 percent of cancers in the United States and 3.0 percent of cancer deaths, annually.

  • The age-adjusted incidence rates for NHL in the United States are: 25.6 for white males, 18.4 for black males, 17.5 for white females, and 13.1 for black females.

  • The risk of NHL in the United States is approximately three fold that of several underdeveloped countries and two fold that of several comparable industrialized country.

  • There is a logarithmic increase in annual incidence in both men and women from late teenagers to octogenarians in the United States: males 15 to 19 years of age, 2.3 cases/100,000 persons; males 80 to 84 years of age, 140 cases/100,000 persons; females 15 to 19 years, 1.4 cases/100,000 persons; females 80 to 84 years, 100 cases per 100,000 persons.

  • Follicular lymphoma represents approximately 25 to 30 percent of NHL cases in the United States but is uncommon in many developing countries and in Asia, especially China and Japan.

  • Diffuse large B-cell lymphoma represents approximately 30 percent of NHL cases in the United States.

  • The annual incidence of NHL, but not Hodgkin lymphoma, increased significantly between 1972 and 1995 in the United States and Western European countries. The increase probably started before 1972 but the United States National Cancer Institute did not track specific-site cancer incidence before that date.

  • The rate is still increasing slightly for women and older men in the United States. Orbital adenexal lymphoma, and mantle cell lymphoma are increasing at a rate of 6 percent per year.

  • There is no aggregate evidence sufficient to reach a level of medical or scientific certainty at this time that benzene, other solvents, pesticides, herbicides, dyes, various occupations, and other industrial exposures increase the relative risk of lymphoma as determined by the U.S. Public Health Service.

  • There are instances of familial clustering and an increase in the relative risk of lymphoma in siblings of patients with lymphoma or related hematologic malignancies (e.g., myeloma). These so-called nonsyndromic examples of increased risk are likely explained by as yet undefined predisposition genes, akin to the Li-Fraumeni syndrome, which is the result of germ-line inheritance of p53.

  • Several syndromic immunodeficiency states increase the relative risk of lymphoma in family members (see Table 60–2).

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HISTOLOGIC HETEROGENEITY

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  • The World Health Organization has categorized over 30 unique histopathologic types of NHL and these are shown in Table 60–1 with their approximate relative frequency. Approximately 88 percent are B-cell lymphomas and approximately 12 percent are T-cell lymphomas. There are striking variations in the incidence of various subtypes of NHL in different geographic areas throughout the world.

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Table Graphic Jump Location
TABLE 60–1HISTOLOGIC SUBTYPES AND RELATIVE FREQUENCY OF THE NON-HODGKIN LYMPHOMAS (NHL)

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