Background and Risk Factors

Lymphomas are cancers that affect the white blood cells of the immune system, mostly in the lymph nodes, spleen, and thymus. Lymphomas are classified as Hodgkin's disease or non-Hodgkin's lymphoma (NHL).

The causes of lymphomas are not well understood. Exposure to certain infectious agents and reduced immune function are associated with high risks of non-Hodgkin's lymphoma. The infectious agents include the human immunodeficiency virus (HIV, which causes AIDS), the human T-lymphotropic virus (HTLV-I), and the Epstein-Barr herpesvirus (EBV). Kidney and other organ transplant patients, whose immune systems are suppressed with medications, are at high risk of non- Hodgkin's lymphoma.

Occupational exposure to certain herbicides and pesticides appears to increase the risk of non-Hodgkin's lymphoma; pesticide applicators, pesticide manufacturing workers, and farmers have higher risks. Increased risks also have been found among rubber workers, petroleum refining workers, vinyl chloride workers, chemists, dry cleaners, and aircraft maintenance workers. The responsible agent has not yet been identified but an exposure common to these workers is organic solvents.

Hair dye use and occupational exposure to hair coloring products were associated with immune and blood system cancers including non-Hodgkin's lymphoma in several recent studies, but these results are controversial.

Prevention and Control

Methods to prevent non-Hodgkin's lymphoma do not exist because the causes are mostly unknown. Very careful use of pesticides and organic solvents with minimal exposure is warranted. No screening tests are available for the early detection of non-Hodgkin's lymphoma.

Incidence and Mortality in the U.S.

About 55,400 new cases of non-Hodgkin's lymphoma are estimated for 1998 in the U.S, making it the fifth most common cancer. The incidence is higher among whites than blacks and higher among white men than white women. The incidence rates for non-Hodgkin's lymphoma have nearly doubled since the early 1970's, the largest increase for any cancer type. Part of the increase in more recent years is related to acquired immunodeficiency syndrome (AIDS); non- Hodgkin's lymphoma occurs about 60 times more frequently in AIDS patients than in the general population. The one-year and five-year survival rates for non-Hodgkin's lymphoma are 71 percent and 51 percent, respectively. An estimated 24,900 deaths are expected to occur due to non-Hodgkin's lymphoma in the U.S. in 1998; it is expected to be the sixth largest cause of cancer deaths.

Incidence in New Jersey - 1986-1996

Tables 33 through 36 provide incidence data on non-Hodgkin's lymphoma by county for the years 1986 through 1996. Figure 12 shows trends statewide. Statewide, white men had the highest rates, black men usually had the second highest rates, white women usually had the third highest rates, and black women had the lowest rates (see Figure 12). The counties followed a similar pattern except that in Cumberland, Hudson, Morris, and Somerset black men had higher rates than white men and in Somerset county black women had higher rates than white women (see Table 36). However, the rates for Morris and Somerset counties should be interpreted cautiously because the numbers are small for black men, and for Somerset county, also for black women. Over the years, non-Hodgkin's lymphoma increased among white males and even more so among black males. The rates also increased among white women and black women, although the rates have declined for these two groups in recent years (See Figure 12).

Conclusion

Continued research into the causes of non-Hodgkin's lymphoma is important, since it is increasing and not much is known about its causes. Minimizing exposure to pesticides and organic solvents at home and at work may reduce the risk of non-Hodgkin's lymphoma.

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COUNTY	1986		1987		1988		1989		1990		1991		1992		1993		1994		1995		1996 (Prelim.)
	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate
Atlantic	17	17.6	20	19.2	15	14.7	22	20.9	19	18.7	23	21.8	19	18.5	20	19.0	25	24.1	19	19.4	16	12.4
Bergen	80	17.9	67	14.6	78	17.0	98	21.5	100	22.2	86	19.7	88	19.2	84	17.9	93	20.8	103	22.3	87	18.7
Burlington	29	19.5	26	16.1	28	16.5	18	11.1	22	12.8	31	19.1	30	19.3	34	20.6	33	20.6	36	20.3	34	19.9
Camden	37	19.1	36	17.9	34	16.4	28	13.9	41	19.6	44	21.3	39	17.7	39	17.8	44	21.3	38	18.4	47	22.8
Cape May	6	11.5	10	16.7	10	13.9	13	20.6	13	19.5	14	20.6	13	27.8	17	27.3	20	33.4	8	10.4	10	19.1
Cumberland	8	15.3	14	23.2	6	10.3	8	12.1	10	14.9	---	----	14	23.0	12	18.8	14	21.3	12	20.4	11	18.7
Essex	46	16.9	41	15.1	38	14.3	53	20.4	59	22.9	50	20.4	54	21.2	56	22.0	42	16.6	45	18.5	52	21.2
Gloucester	11	13.8	14	16.6	14	15.0	14	13.7	19	20.7	7	7.3	29	29.4	14	14.5	22	21.0	20	18.4	21	20.0
Hudson	41	16.5	38	15.6	41	17.0	42	16.8	57	23.6	48	18.9	48	19.9	50	21.3	58	24.8	53	22.4	52	21.7
Hunterdon	---	---	6	11.0	12	25.1	10	20.6	5	10.0	10	17.7	12	22.8	12	18.8	11	19.3	10	19.1	9	14.6
Mercer	22	16.6	22	15.8	25	17.1	23	16.8	25	17.2	29	20.8	32	22.2	31	22.3	27	19.1	34	23.2	23	16.4
Middlesex	42	15.0	55	18.6	47	16.9	66	22.9	47	15.1	63	20.0	50	16.6	49	16.0	56	18.8	62	19.8	46	14.6
Monmouth	49	19.7	47	18.7	52	21.0	42	16.4	50	19.4	52	19.4	53	19.7	43	15.6	57	20.4	45	16.4	53	20.1
Morris	26	13.9	29	16.3	26	13.0	40	21.4	24	12.0	36	17.8	33	16.9	38	17.9	42	19.8	39	18.5	43	21.7
Ocean	44	16.0	41	14.9	40	13.3	48	17.3	56	16.7	54	17.6	48	15.8	55	19.4	52	16.6	67	20.8	68	21.5
Passaic	32	15.9	28	13.9	33	15.6	33	16.4	27	14.2	41	20.3	34	17.9	39	18.8	39	18.8	41	21.2	43	19.9
Salem	---	---	5	16.3	---	---	---	---	9	28.8	6	22.0	---	---	---	---	7	19.9	6	18.0	10	27.9
Somerset	14	12.7	13	12.8	22	21.4	24	22.9	18	15.3	9	7.0	13	11.1	19	15.0	15	12.0	29	23.3	18	15.5
Sussex	8	14.4	6	13.1	5	8.3	9	14.7	6	10.3	8	15.3	17	32.4	11	18.6	10	17.9	8	10.0	15	24.4
Union	34	13.9	34	13.9	48	20.8	46	19.7	45	19.0	45	18.3	38	16.1	51	20.6	54	23.5	57	24.0	51	21.1
Warren	10	23.0	7	14.7	---	---	5	11.4	6	13.6	---	---	11	22.9	7	14.4	13	26.6	14	26.0	13	24.8
STATE	562	16.2	560	15.8	582	16.5	647	18.2	661	18.4	665	18.3	677	18.8	685	18.5	734	20.0	746	20.3	722	19.3

¹Incidence rates - per 100,000 males, age-adjusted to the 1970 U.S. standard population. Cases of unknown county are included in the State numbers and rates. The dashes indicate fewer than five cases. Source: New Jersey State Cancer Registry.

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COUNTY	1986		1987		1988		1989		1990		1991		1992		1993		1994		1995		1996 (Prelim.)
	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate
Atlantic	13	11.4	16	9.9	11	9.3	18	13.2	13	9.5	20	12.3	19	11.2	27	18.0	23	15.2	20	15.8	19	11.4
Bergen	86	15.1	75	12.7	49	8	73	12.8	74	13.0	62	9.8	81	12.7	81	13.0	75	12.3	98	15.9	85	13.6
Burlington	21	10.9	25	12.7	25	12.1	24	11.7	33	15.2	22	11.1	21	10.0	29	13.0	29	14.6	20	8.6	25	10.7
Camden	29	10.5	25	9.3	32	10.9	42	15.1	27	10.1	40	14.0	34	11.3	44	15.5	45	17.9	31	10.4	32	11.6
Cape May	5	12.3	9	8.5	7	7.9	6	5.6	8	8.0	10	11.3	8	7.3	14	18.7	9	9.2	13	15.9	10	10.4
Cumberland	10	13.0	9	10.6	10	11.2	---	---	14	16.9	8	9.3	12	16.4	17	18.3	9	10.2	11	9.7	9	10.3
Essex	48	12.1	52	13.6	48	11.8	57	15.4	50	14.4	42	11.5	41	12.1	47	12.4	66	19.2	49	15.4	51	15.6
Gloucester	9	8.4	6	5.5	13	10.5	12	9.7	11	9.6	18	13.7	16	13.3	20	16.8	20	15.5	14	10.6	15	11.2
Hudson	39	10.4	34	9.9	32	11.1	50	15.3	40	12.3	42	12.5	42	12.3	48	16.0	44	14.3	33	9.5	42	12.8
Hunterdon	6	11.1	---	---	6	11.8	---	---	---	---	---	---	8	13.0	12	19.4	6	8.3	6	9.8	8	12.3
Mercer	17	11.3	19	10.4	21	11.6	26	12.9	20	9.4	27	13.7	28	14.0	29	14.6	31	15.6	30	16.4	24	12.5
Middlesex	50	14.7	49	13.6	51	13.6	56	15.0	47	12.8	52	13.3	48	12.9	50	12.7	67	16.6	62	16.1	49	11.6
Monmouth	42	11.9	35	9.8	45	14.2	34	9.6	41	12.5	46	13.6	53	14.4	60	16.6	46	13.3	55	15.5	55	14.6
Morris	31	12.7	20	8.4	43	18.1	31	12.4	32	12.8	45	16.8	35	15.0	26	9.1	42	15.8	40	16.6	37	14.2
Ocean	36	9.8	38	8.4	51	12.7	51	10.9	40	8.1	53	12.6	55	12.2	51	12.6	59	12.4	65	14.0	62	11.5
Passaic	29	10.0	29	9.4	35	11.8	26	10.1	46	17.7	41	16.0	17	6.2	36	13.0	34	13.0	36	13.5	43	14.4
Somersex	15	11.5	24	19.3	15	12	25	19.3	13	9.1	18	13.8	16	11.2	18	12.3	13	9.0	22	13.5	20	12.5
Sussex	5	8.0	9	15.1	8	11.6	5	9.6	5	7.4	10	15.5	11	16.9	5	8.2	8	10.1	6	9.2	12	17.3
Union	42	13.1	36	10.1	43	12.2	41	13.0	33	10.3	31	9.1	37	11.0	39	12.3	35	10.5	44	13.5	41	14.4
Warren	6	10.5	14	23.6	17	28.4	9	15.9	6	8.7	8	10.6	8	8.8	5	7.5	12	20.9	8	9.8	10	17.1
STATE	545	11.9	529	11.1	565	11.9	599	12.7	561	11.9	603	12.5	596	12.2	659	13.6	677	13.9	671	13.7	658	13.0

¹Incidence rates - per 100,000 females, age-adjusted to the 1970 U.S. standard population. Cases of unknown county are included in the State numbers and rates. Counties with six or more years of fewer than five cases each year were removed from the table - Salem county. The dashes indicate fewer than five cases. Source: New Jersey State Cancer Registry.

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