UK Non-Hodgkin lymphoma incidence statistics

In 2006 there were 10,569 people diagnosed with non-Hodgkin lymphoma in the UK ( Table 1.1). 1-4

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While there are roughly equal numbers of cases diagnosed in males and females, because there are more women than men in the population, the male age-standardised incidence rate per 100,000 population (16.3) is higher than the female rate (11.7). 1-4

The incidence of NHL increases with age, rates increase sharply in people over 50 and more than two thirds (70%) of all cases are diagnosed in people over 60 years ( Figure 1.1). 1-4

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The non-Hodgkin lymphoma incidence trend in Great Britain is shown in Figure 1.2. The age-standardised incidence rate for NHL increased by over 40% in the twenty-year period between 1987-2006. 1-3

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The UK non-Hodgkin lymphoma incidence trend is shown in Figure 1.3.

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This pattern of increase has also been seen in the US 11 and Western Europe 12. There have also been increases in India, Japan, Brazil and Singapore. 13-14 In Britain the biggest increases in incidence have been in older people. Rates in those over 75 are three times higher than they were in 1975 ( Figure 1.4). 1-3

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These trends need to be interpreted with caution as at least some of the increase in incidence can be explained by changes in the diagnosis, classification and patient registration rates for NHL. 13, 15 However there is evidence to suggest that increases in incidence are real. 16, 17

American data show the incidence of high-grade NHL tripled among males and doubled among females between the late 1970s and mid 1990s. Immunoblastic NHL was the fastest growing high-grade subtype, followed by small noncleaved and lymphoblastic NHL. 18

Elsewhere extra-nodal B-cell lymphomas, nodal T-cell lymphomas, ‘high grade’ lymphoma and follicular lymphoma, are reported to have increased in incidence more than others. 12, 19 In countries hit worst by HIV, increases in immunoblastic and Burkitt-like NHL have been striking. 20, 21

While there are no significant variations in the incidence of NHL across the UK, there are significant international variations in the incidence and types of NHL, with the highest rates in Northern America, Australia, New Zealand and Western Europe and the lowest rates in Eastern and South Central Asia ( Figure 1.5). 5

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Notable variations exist within the types of lymphoma seen, examples being the endemic Burkitt lymphoma prevalent in Africa, T-cell lymphomas which are much more common in the Far East and the Carribean 6 and Gastric lymphoma in Northern Italy 7. The international variation in the incidence and mortality of NHL in males and females are very similar 5. The UK comes 20th in the world ranking of NHL.

Within the EU the highest incidence rates are in Finland and France and the lowest rates in Latvia and Lithuania ( Figure 1.6). 5 The UK ranks 6th in the EU ranking of NHL.

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A reliable classification system for haematological malignancies has only recently been developed and agreed by oncologists and pathologists: this is the World Health Organisation (WHO) classification ( Table 1.2). 8

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No single marker can be used as the ‘gold standard’ for diagnosis, a combination of techniques is needed, including morphology, immunophenotype, genetic features and clinical features, including symptoms. Confirmation of diagnosis requires a lymph node or other tissue biopsy, ideally with analysis of fresh tissue for patterns of protein expression on the cell surface as well as genetic changes at the molecular level. Retrospective analysis of different lymphoma types is difficult in practice and progress in targeted therapies may mean future developments in tumour classification 9.

The percentage of all NHLs coded as being of extra-nodal origin is between 25% and 35% in most countries, with the stomach, skin and small intestine being the most common extra-nodal sites.

In general, the pattern of incidence rates for extra-nodal lymphomas tends to reflect that of other lymphomas. For example, the age incidence curve of each site-specific extra-nodal lymphoma is similar to that of nodal lymphomas, and in countries where total lymphoma incidence is high the incidence of lymphomas at each extra-nodal site also tends to be relatively high.

Although specific factors are known to increase the risk of lymphomas at certain anatomical sites, these data suggest that the aetiology of extra-nodal lymphomas is not entirely independent from that of nodal lymphomas 10.