Cancer Research UK : UK Non-Hodgkin lymphoma incidence statistics

UK Non-Hodgkin lymphoma incidence statistics

This section contains the latest cancer incidence statistics on non-Hodgkin lymphoma (NHL) in adults by age and sex, trends over time, geographic variation and sub-types (including WHO classification table for NHL). Statistics on lymphomas in children are presented in the childhood cancer section. The ICD code for non-Hodgkin lymphoma is ICD9 200+202, ICD10 C82-85, and C96.

Non-Hodgkin lymphoma incidence by age and sex

In 2005 there were 10,310 people diagnosed with non-Hodgkin lymphoma in the UK (Table 1.1).1-4

Table showing the number of new cases and rates of non-Hodgkin lymphoma in the UK

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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 (16.2) is higher than the female rate (11.5). 1-4

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

Figure showing the numbers of new cases and age-specific incidence rates for non-Hodgkin lymphoma, by sex, in the UK

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Non-Hodgkin lymphoma incidence trends

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 50% in the twenty-year period between 1986-2005.1-3

Chart showing the age standardised (European) incidence rates for non-Hodgkin lymphoma, by sex, in Great Britain

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

Figure showing the age-standardised incidence rates for non-Hodgkin lymphoma in the UK

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This pattern of increase has also been seen in the US11 and Western Europe12. 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

Figure 1.4: Percentage change in age-specific incidence from 1975, non-Hodgkin lymphoma,

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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

Geographic variation in Non-Hodgkin lymphoma incidence

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

Figure 1.5: Age-standardised incidence and mortality rates, males, non-Hodgkin lymphoma, by region of the world

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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 Carribean6 and Gastric lymphoma in Northern Italy7. The international variation in the incidence and mortality of NHL in males and females are very similar5. 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.

Figure 1.6: Age-standardised incidence rates, non-Hodgkin lymphoma, by sex, EU,

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Sub-types of Non-Hodgkin lymphoma

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 classification9.

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 lymphomas10.

References for non-Hodgkin lymphoma incidence

Office for National Statistics. Cancer Statistics registrations: Registrations of cancer diagnosed in 2005, England. Series MB1 no.36. 2008
Welsh Cancer Intelligence and Surveillance Unit. Cancer registrations in Wales 2005. 2008
ISD Online. Cancer Incidence, Mortality and Survival 2008
Northern Ireland Cancer Registry. Cancer Registrations in Northern Ireland, 2005 2008
IARC. GLOBOCAN 2002. Cancer Incidence, Mortality and Prevalence Worldwide (2002 estimates) 2006
Pallesen, G., S.J. Hamilton-Dutoit, and X. Zhou, The association of Epstein-Barr virus (EBV) with T cell lymphoproliferations and Hodgkin's disease: two new developments in the EBV field. Adv Cancer Res, 1993. 62: p. 179-239
Doglioni, C., et al., High incidence of primary gastric lymphoma in northeastern Italy. Lancet, 1992. 339(8797): p. 834-5.
Jaffe, E.S., et al., Pathology and Genetics of Tumours of Haematopoietic and Lymphoid Tissues. World Health Organisation Classification of Tumours. 2001, Lyon, France: IARC Press.
Ottensmeier, C., The classification of lymphomas and leukemias. Chem Biol Interact, 2001. 135-136: p. 653-64.
Newton, R., et al., The epidemiology of non-Hodgkin's lymphoma: comparison of nodal and extra-nodal sites. Int J Cancer, 1997. 72(6): p. 923-30.
National Cancer Institute. Non-Hodgkin's lymphoma incidence trends. 2004
Cartwright, R., et al., The rise in incidence of lymphomas in Europe 1985-1992. Eur J Cancer, 1999. 35(4): p. 627-33.
Devesa, S.S. and T. Fears, Non-Hodgkin's lymphoma time trends: United States and international data. Cancer Res, 1992. 52(19 Suppl): p. 5432s-5440s.
Naresh, K.N., V. Srinivas, and C.S. Soman, Distribution of various subtypes of non-Hodgkin's lymphoma in India: a study of 2773 lymphomas using R.E.A.L. and WHO Classifications. Ann Oncol, 2000. 11 Suppl 1: p. 63-7.
Cartwright, R.A., Changes in the descriptive epidemiology of non-Hodgkin's lymphoma in Great Britain? Cancer Res, 1992. 52(19 Suppl): p. 5441s-5442s.
Banks, PM Changes in diagnosis of non-Hodgkin's lymphomas over time. Cancer Res 1992:52 (19 Suppl): 5453s-5s.
Hartge, P. and S.S. Devesa, Quantification of the impact of known risk factors on time trends in non-Hodgkin's lymphoma incidence. Cancer Res, 1992. 52(19 Suppl): p. 5566s-5569s.
Groves, F.D., et al., Cancer surveillance series: non-Hodgkin's lymphoma incidence by histologic subtype in the United States from 1978 through 1995. J Natl Cancer Inst, 2000. 92(15): p. 1240-51.
Carli, P.M., et al., Increase in the incidence of non-Hodgkin's lymphomas: evidence for a recent sharp increase in France independent of AIDS. Br J Cancer, 1994. 70(4): p. 713-5.
Chokunonga, E., et al., Aids and cancer in Africa: the evolving epidemic in Zimbabwe. Aids, 1999. 13(18): p. 2583-8.
Parkin, D.M., et al., AIDS-related cancers in Africa: maturation of the epidemic in Uganda. Aids, 1999. 13(18): p. 2563-70.