Risks for non-Hodgkin lymphoma

Some things can affect your risk, or chance, of developing cancer. Certain behaviours, substances or conditions can increase or decrease the risk. Most cancers are the result of many risks. But sometimes cancer develops in people who don’t have any risks.

The risk of developing non-Hodgkin lymphoma (NHL) increases with age. It is more common in people 60 years of age and older. Overall, NHL is more common in men than women, but some specific types of NHL are more common in women.

People with certain genetic conditions have a higher than average risk for NHL. If you have a genetic condition that increases your risk for NHL, you may need to visit your doctor more often. Talk to your doctor about your risk and if you need to have certain tests to check for NHL.

Some of these risks canʼt be changed. But in some cases, there are things you can do to lower your risk.

The following can increase your risk for NHL:

Weakened immune system

Autoimmune disorders

Certain infections

Previous cancer treatment

Family history of NHL

Breast implants

Infliximab

Having obesity as a young adult

A weakened immune system means that your immune system isn’t working as well as it should. It can be weakened when you are born (called congenital immune system damage). Or it can be weakened over the course of your life (called acquired immune system damage). No matter when your immune system is weakened, you have a higher risk of developing NHL once it happens.

The following can weaken your immune system.

Immunosuppressant drugs affect the immune system so it doesn’t react as it normally would. These drugs are given after an organ transplant so the person’s immune system doesn’t attack the donated organ.

People who take immunosuppressant drugs after a solid organ transplant (such as a kidney, heart or liver transplant) have a higher risk for NHL. People who take these drugs for other conditions, such as rheumatoid arthritis, lupus, severe eczema or inflammatory bowel disease, also have a higher risk of developing NHL. But their risk is not as high as the risk for people who take immunosuppressant drugs after an organ transplant.

People with HIV (human immunodeficiency virus) or AIDS (acquired immunodeficiency syndrome) have a greater risk of developing some types of NHL. This risk is decreasing as drugs are developed to treat HIV and AIDS.

Immunodeficiency disorders affect the immune system’s natural ability to defend the body against infection. People with immunodeficiency disorders often have frequent infections, which can be severe or unusual. They also have a higher risk of developing certain types of cancer.

You can have an immunodeficiency disorder when you are born. These disorders are usually inherited, which means they are passed from parents to children. Immunodeficiency disorders can also develop over the course of your life. These are called acquired immunodeficiency disorders. They can be caused by another disorder or treatments that suppress the immune system. Inherited immunodeficiency disorders are very rare, but acquired ones are a little more common.

How NHL develops is related to the specific disorder and which part of the immune system it affects. The following immunodeficiency disorders increase the risk of developing NHL:

• ataxia telangiectasia
• Wiskott-Aldrich syndrome
• common variable immunodeficiency (CVID)
• severe combined immunodeficiency (SCID)
• x-linked lymphoproliferative disease (XLP)

An autoimmune disorder causes the immune system to attack the body’s own tissue. Some autoimmune disorders have been linked to a higher risk for NHL. But only a small number of NHL cases are linked with autoimmune disorders.

The following autoimmune disorders have been linked with NHL:

• Sjogren’s syndrome
• rheumatoid arthritis
• systemic lupus erythematosus (SLE) (also called lupus)
• celiac disease
• Hashimoto’s thyroiditis

The following viral and bacterial infections can increase the risk of developing NHL. They may damage lymphocytes or constantly stimulate the immune system so it doesn’t work properly.

Epstein-Barr virus (EBV) is a type of herpes virus that causes infectious mononucleosis (also called mono, or the kissing disease). It is linked to Burkitt lymphoma and to NHL in people with a weakened immune system because of HIV/AIDS or immunosuppressant drugs. EBV and Burkitt lymphoma are most common in Africa.

Human T-cell leukemia/lymphoma virus, type 1 (HTLV-1) increases the risk of developing adult T-cell lymphoma and leukemia. It is most common in southern Japan and the Caribbean.

Helicobacter pylori (H. pylori) is a type of bacteria that causes stomach ulcers and inflammation of the stomach lining (called gastritis). It is linked with a type of lymphoma that occurs in the stomach called mucosa-associated lymphoid-tissue (MALT) lymphoma.

Human herpesvirus 8 (HHV-8) is also called Kaposi sarcoma herpesvirus (KSHV). It is linked with primary effusion lymphoma, body cavity lymphomas and AIDS-related lymphomas.

Hepatitis C virus (HCV) is a virus that can cause inflammation of the liver (called hepatitis). HCV infection increases the risk of diffuse large B-cell lymphoma (DLBCL), splenic marginal zone lymphoma and lymphoplasmacytic lymphoma.

Campylobacter jejuni (C. jejuni) is a type of bacteria that can cause gastrointestinal (GI) infections. It is linked with MALT lymphoma.

People who have received chemotherapy, with or without radiation therapy, for another type of cancer have a higher risk of developing NHL. This is especially true for people who were treated for Hodgkin lymphoma. But the benefit of being treated for cancer usually far outweighs the risk of developing a second cancer.

The risk of developing NHL is greatest in the first 5 years after treatment. But people who have been treated for cancer have a higher risk of developing NHL for the rest of their lives.

People who have a first-degree relative (a parent, brother, sister or child) who has been diagnosed with NHL have a higher risk of developing the disease.

People with breast implants (silicone or saline) can develop a rare type of NHL called breast implant–associated anaplastic large cell lymphoma (BIA-ALCL). It starts in the scar tissue that forms around the implant. The risk is higher for people who have textured implants than it is for those with smooth implants.

Infliximab (Remicade and other biosimilars) is a type of drug called a tumour necrosis factor (TNF) inhibitor. It is used to treat inflammation caused by some autoimmune diseases such as rheumatoid arthritis and ankylosing spondylitis.

Infliximab increases the risk of a rare type of NHL called hepatosplenic T-cell lymphoma.

Having obesity as a young adult (before the age of 30) increases the risk of developing DLBCL.

The following have been linked with an increased risk of NHL but more research is needed to know for sure that they are risks:

• exposure to pesticides, including lindane and glyphosate
• exposure to trichloroethylene
• occupational exposures including farmers (who seem to have the highest risk), firefighters, welders, and people who work certain industries, such as rubber and plastics, meat processing, printing, forestry, and hairdressing and barber services
• hepatitis B virus (HBV) infection
• tall adult height
• exposure to benzene
• taking other types of TNF inhibitor drugs for autoimmune diseases

To make the decisions that are right for you, ask your doctor questions about risks. Learn how cancer can be prevented and what you can do to reduce your risk.