Hodgkin's lymphoma risk factors

This page presents the risk factors for Hodgkin's lymphoma including genetics, infectious agents, the immune system,social and environmental factors and other factors.

The possible causes of Hodgkin’s lymphoma, and the predisposing factors are not understood well and the disease remains poorly characterised at a cellular and molecular level.

Hodgkin's lymphoma risk factors

 
 

Genetics and risk of Hodgkin's lymphoma

Racial differences in the incidence of Hodgkin’s lymphoma have been documented in several countries, particularly in the USA, where the incidence is lower in blacks than in whites 1, 2. A 99-fold increased risk has been reported in the identical twins of people who have had Hodgkin’s lymphoma. 3 Studies also show up to a seven-fold increased risk in people with a parent or sibling diagnosed with Hodgkin's lymphoma or with any blood or lymphatic cancer. 22-24

Risks for nodular sclerosis Hodgkin’s lymphoma have been associated with certain HLA class II loci although the data are inconsistent 4.

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Infectious agents and risk of Hodgkin's lymphoma

Early serological and subsequent molecular studies have demonstrated an association between Hodgkin’s lymphoma and infection with Epstein Barr Virus (EBV). The DNA of the virus can be found in 26% to 50% of cases that are positive for EBV, this being much more common in the paediatric and older adult patients, and lower in young adults ( Figure 4.113, 14).

Figure 4.1: Proportion of EBV-associated Hodgkin's lymphoma cases by age group

Download this chart (27.5KB)13

Consistent with this observation, evidence of EBV is more often found with mixed cellularity than with nodular sclerosis Hodgkin’s lymphoma.

The risk is increased three-fold after a diagnosis of infectious mononucleosis (glandular fever). 17

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The immune system and risk of Hodgkin's lymphoma

People with HIV infection or AIDS have an 11-fold increased risk of Hodgkin’s lymphoma 15. Other groups with reduced immunity, for example after organ transplantation, also show an excess risk 15.

Individuals with a diagnosis of certain autoimmune conditions, including rheumatoid arthritis, systemic lupus erythematosus and sarcoidosis, have an increased risk of Hodgkin's lymphoma. 18-21

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Social and environmental factors and risk of Hodgkin's lymphoma

An increased risk of Hodgkin’s lymphoma is associated with indicators of affluence in childhood such as small family size, standard of maternal education and single family housing 7-11.

While it has been proposed that late exposure to a common infectious agent may be responsible for this association, no agent has been identified.

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Other factors and risk of Hodgkin's lymphoma

People with a previous non-Hodgkin's lymphoma have a four to 16-fold increased risk of Hodgkin's lymphoma. 25-27

Case-control studies show that alcohol consumption protects against Hodgkin's lymphoma, but more evidence is needed before this can be considered an established risk factor. 28-30

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References for Hodgkin's lymphoma risk factors

  1.  Glaser, S.L., Black-white differences in Hodgkin's disease incidence in the United States by age, sex, histology subtype and time. Int J Epidemiol, 1991. 20(1): p. 68-75.
  2.  Zaki, A., N. Natarajan, and C.J. Mettlin, Early and late survival in Hodgkin disease among whites and blacks living in the United States. Cancer, 1993. 72(2): p. 602-6.
  3.  Mack, T.M., et al., Concordance for Hodgkin's disease in identical twins suggesting genetic susceptibility to the young-adult form of the disease. N Engl J Med, 1995. 332(7): p. 413-8.
  4.  Taylor, G.M.G., Crowther, D., et. al. Evidence of an increased frequency of HLA-DPBI*0301 in Hodgkin's disease supports an infectious aetiology. In R, F, J, ed. 1995: London:Plenum
  5.  Kravdal, O. and Hansen, S., Hodgkin's disease: the protective effect of childbearing. Int J Cancer, 1993. 55(6): p. 909-14.
  6.  Glaser, S.L., et al., Reproductive Factors in Hodgkin's Disease in Women. Am. J. Epidemiol., 2003. 158(6): p. 553-563.
  7.  Altieri, A., et al., Number of siblings and the risk of lymphoma, leukemia, and myeloma by histopathology. Cancer Epidemiol Biomarkers Prev, 2006. 15(7): p. 1281-6.
  8.  Petridou, E., et al., Incidence and characteristics of childhood Hodgkin's lymphoma in Greece: a nationwide study (Greece) Cancer Causes Control. 2006. 17(2): p. 209-15.
  9.  Gutensohn, N.M., Shapiro, D.S., Social class risk factors among children with Hodgkin's Disease International Journal of Cancer. 1982. p. 433-435.
  10.  Chang, E.T., et al., Childhood social environment and Hodgkin's lymphoma: new findings from a population-based case-control study Cancer Epidemiol Biomarkers Prev. 2004.13(8): p. 1361-70.
  11.  Chatenoud, L., et al., Number of siblings and risk of hodgkin's and other lymphoid neoplasms Cancer Epidemiol Biomarkers Prev. 2005. 14(2): p. 552.
  12.  Baris, D. and Zahm, S.H. Epidemiology of lymphomas. Curr Opin Oncol, 2000. 12(5): p. 383-94.
  13.  Jarrett, A.F., Armstrong A.A., Alexander E., Epidemiology of EBV and Hodgkin's lymphoma Annals of Oncology. 1996. p. S5-S10.
  14.  Baris, D. and Zahm, S.H., Epidemiology of lymphomas. Curr Opin Oncol, 2000. 12(5): p. 383-94.
  15.  Grulich, A.E., et al., Incidence of cancers in people with HIV/AIDS compared with immunosuppressed transplant recipients: a meta-analysis. Lancet, 2007. 370(9581): p. 59-67.
  16.  Bierman, P.J., et al., Hodgkin's disease following solid organ transplantation. Ann Oncol, 1996. 7(3): p. 265-70.
  17.  Hjalgrim, H., et al., Risk of Hodgkin's disease and other cancers after infectious mononucleosis. J Natl Cancer Inst, 2000. 92(18): p. 1522-8.
  18.  Landgren, O., et al., Autoimmunity and susceptibility to Hodgkin lymphoma: a population-based case-control study in Scandinavia. J Natl Cancer Inst, 2006. 98(18): p. 1321-30.
  19.  Mellemkjaer, L., et al., Rheumatoid arthritis and cancer risk. Eur J Cancer, 1996. 32A(10): p. 1753-7.
  20.  Thomas, E., et al., Risk of malignancy among patients with rheumatic conditions. Int J Cancer, 2000. 88(3): p. 497-502.
  21.  Hakulinen, T., et al., Rheumatoid arthritis and cancer studies based on linking nationwide registries in Finland. Am J Med, 1985. 78(1A): p. 29-32.
  22.  Goldin, L.R., et al., Familial aggregation of Hodgkin lymphoma and related tumors. Cancer, 2004. 100(9): p. 1902-8.
  23.  Hemminki, K., and Czene, K., Attributable risks of familial cancer from the Family-Cancer Database. Cancer Epidemiol Biomarkers Prev, 2002. 11(12): p. 1638-44.
  24.  Chang, E.T., et al., Family history of hematopoietic malignancy and risk of lymphoma. J Natl Cancer Inst, 2005. 97(19): p. 1466-74.
  25.  Travis, L.B., et al., Second cancers among long-term survivors of non-Hodgkin's lymphoma. J Natl Cancer Inst, 1993. 85(23): p. 1932-7.
  26.  Travis, L.B., et al., Second cancers following non-Hodgkin's lymphoma. Cancer, 1991. 67(7): p. 2002-9.
  27.  Dong, C., and Hemminki, K., Second primary neoplasms among 53 159 haematolymphoproliferative malignancy patients in Sweden, 1958-1996: a search for common mechanisms. Br J Cancer, 2001. 85(7): p. 997-1005.
  28.  Besson, H., et al., Tobacco smoking, alcohol drinking and Hodgkin's lymphoma: a European multi-centre case-control study (EPILYMPH). Br J Cancer, 2006. 95(3): p. 378-84.
  29.  Nieters, A., et al., Tobacco and alcohol consumption and risk of lymphoma: results of a population-based case-control study in Germany. Int J Cancer, 2006. 118(2): p. 422-30.
  30.  Gorini, G.S.E., et al., Alcohol consumption and risk of Hodgkin's lymphoma and multiple myeloma: a multicentre case-control study. Ann Oncol, 2007. 18(1): p. 143-8.