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EPIDEMIOLOGY

  • Approximately 77,240 cases of non-Hodgkin lymphoma (NHL) will be diagnosed in 2020, and approximately 20,000 persons will die of the disease in the United States.

  • NHL represents approximately 4.3% of cancers in the United States and 3.3% of cancer deaths annually.

  • The age-adjusted incidence rates per 100,000 persons for NHL in the United States are 25 for white males, 18 for black males, 17 for white females, and 12.5 for black females (last assessed in 2017).

  • The lifetime risk for men and women combined for NHL in the United States is approximately 2.2%.

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

  • 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, 2.8 cases/100,000 persons; males 80 to 84 years of age, 152.5 cases/100,000 persons; females 15 to 19 years, 1.5 cases/100,000 persons; and females 80 to 84 years, 95.3 cases/100,000 persons (last assessed in 2017).

  • Follicular lymphoma represents approximately 25% 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 (DLBCL) represents at least 30% of NHL cases in the United States and western Europe.

  • 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 based on European data, although the US National Cancer Institute did not track specific-site cancer incidence before that date.

  • In the late 1990s, the incidence rates stabilized and the death rate fell. In the United States in 1997, the incidence rate of lymphoma was 19.5 cases per 100,000 persons; the death rate from lymphoma was 8.9 deaths per 100,000. Twenty years later in 2017, the incidence rate was 18.6 cases per 100,000, and the death rate was 5.3 per 100,000 persons.

  • The InterLymph Consortium, an international group of investigators working on the epidemiology of NHL, found an association between crop farming (not animal farming), women’s hairdressers, cleaners, spray painters, carpenters, and textile workers and lymphoma. The observed risk (OR) was highest in spray painters (OR, 2.07; 95% confidence interval [CI], 1.3–3.29), but in other occupations, the risk was much lower.

  • Different occupations appeared to be at risk of different subtypes of NHL.

  • The precise chemicals that may contribute to any occupational risk have not been defined, but exposures to aniline dyes, trichloroethylene, organochlorines, organophosphates, or phenoxyacid herbicides are possible causes.

  • A dose–response relationship of NHL with cigarette smoking is restricted to follicular lymphoma. In current heavy smokers, the OR was 1.45 (95% CI, 1.15–1.82).

  • Increased body mass index (BMI) has been associated with an increased risk of lymphoma, and a BMI above 30 kg/m2 was associated with DLBCL risk (OR, 1.33; 95% CI, 1.02–1.73) ...

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