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A risk factor is anything that increases your chance of getting a disease like cancer. Different cancers have different risk factors. Some risk factors, like smoking, can be changed. Others, like a person’s age or family history, can’t.
But having a risk factor, or even many risk factors, does not mean that you will get the disease. And many people who get the disease may have few or no known risk factors.
Researchers have found several factors that can affect a person’s chance of getting non-Hodgkin lymphoma (NHL). There are many types of lymphoma, and some of these factors have been linked only to certain types.
Getting older is a strong risk factor for lymphoma overall, with most cases occurring in people in their 60s or older. But some types of lymphoma are more common in younger people.
Overall, the risk of NHL is higher in men than in women, but there are certain types of NHL that are more common in women. The reasons for this are not known.
In the United States, White people are more likely than African Americans and Asian Americans to develop NHL.
Worldwide, NHL is more common in developed countries, with the United States and Europe having some of the highest rates. Some types of lymphoma are linked to certain infections (described further on) that are more common in some parts of the world.
Having a first degree relative (parent, child, sibling) with NHL increases your risk of developing NHL.
Some studies have suggested that chemicals such as benzene and certain herbicides and insecticides (weed- and insect-killing substances) may be linked to an increased risk of NHL. Research to clarify these possible links is still in progress.
Some chemotherapy drugs used to treat other cancers may increase the risk of developing NHL many years later. For example, patients who have been treated for Hodgkin lymphoma have an increased risk of later developing NHL. But it’s not totally clear if this is related to the disease itself or if it is an effect of the treatment.
Some studies have suggested that certain drugs used to treat rheumatoid arthritis (RA), such as methotrexate and the tumor necrosis factor (TNF) inhibitors, might increase the risk of NHL. But other studies have not found an increased risk. Determining if these drugs increase risk is complicated by the fact that people with RA, which is an autoimmune disease, already have a higher risk of NHL (see below).
Patients treated with radiation therapy for some other cancers, such as Hodgkin lymphoma, have a slightly increased risk of developing NHL later in life. This risk is greater for patients treated with both radiation therapy and chemotherapy.
People with weakened immune systems have an increased risk for NHL. For example:
Some autoimmune diseases such as rheumatoid arthritis, systemic lupus erythematosus (SLE or lupus), Sjogren (Sjögren) disease, celiac disease (gluten-sensitive enteropathy), and others have been linked with an increased risk of NHL.
In autoimmune diseases, the immune system mistakenly sees the body’s own tissues as foreign and attacks them, as it would a germ. Lymphocytes (the cells from which lymphomas start) are part of the body’s immune system. The overactive immune system in autoimmune diseases may make lymphocytes grow and divide more often than normal. This might increase the risk of them developing into lymphoma cells.
Some types of infections may raise the risk of NHL in different ways.
Some viruses can directly affect the DNA of lymphocytes, helping to transform them into cancer cells:
Infection with human immunodeficiency virus (HIV), also known as the AIDS virus, can weaken the immune system. HIV infection is a risk factor for developing certain types of NHL, such as primary CNS lymphoma, Burkitt lymphoma, and diffuse large B-cell lymphoma.
Some long-term infections may increase a person’s risk of lymphoma by forcing their immune system to be constantly active. As more lymphocytes are made to fight the infection, there is a greater chance for mutations in key genes to occur, which might eventually lead to lymphoma. Some of the lymphomas linked with these infections actually get better when the infection is treated.
Some studies have suggested that being overweight or obese might increase your risk of NHL. More research is needed to confirm these findings. In any event, staying at a healthy weight, keeping physically active, and following a healthy eating pattern that includes plenty of fruits, vegetables, and whole grains, and that limits or avoids red and processed meats, sugary drinks, and highly processed foods has many known health benefits outside of the possible effect on lymphoma risk.
Although it is rare, some women with breast implants might develop lymphoma in the scar tissue (capsule) that forms around the implant. Most of these are a rare type of T-cell lymphoma known as breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), but other types of NHL have been reported as well.
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Cerhan JR, Kricker A, Paltiel O, et al. Medical History, Lifestyle, Family History, and Occupational Risk Factors for Diffuse Large B-Cell Lymphoma: The InterLymph Non-Hodgkin Lymphoma Subtypes Project. Journal of the National Cancer Institute Monographs. 2014;2014(48):15-25. doi:10.1093/jncimonographs/lgu010.
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Roschewski MJ, Wilson WH. Chapter 106: Non-Hodgkin Lymphoma. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 5th ed. Philadelphia, Pa: Elsevier; 2014.
Slager SL, Benavente Y, Blair A, et al. Medical History, Lifestyle, Family History, and Occupational Risk Factors for Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma: The InterLymph Non-Hodgkin Lymphoma Subtypes Project. Journal of the National Cancer Institute Monographs. 2014;2014(48):41-51. doi:10.1093/jncimonographs/lgu001.
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Smedby KE, Sampson JN, Turner JJ, et al. Medical History, Lifestyle, Family History, and Occupational Risk Factors for Mantle Cell Lymphoma: The InterLymph Non-Hodgkin Lymphoma Subtypes Project. Journal of the National Cancer Institute Monographs. 2014;2014(48):76-86. doi:10.1093/jncimonographs/lgu007.
US Food and Drug Administration. Breast Implants: Update - Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL). 2017. Accessed at www.fda.gov/safety/medwatch/safetyinformation/safetyalertsforhumanmedicalproducts/ucm547622.html on April 30, 2018.
Last Revised: September 19, 2022