Cancer By County
Non-Hodgkin's Lymphoma3-5

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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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Table 33.
Non-Hodgkin's Lymphoma Incidence
By County, White Males, New Jersey - 1986-19961

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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Table 34.
Non-Hodgkin's Lymphoma
By County1, White Females, New Jersey - 1986-1996

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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Table 35.
Non-Hodgkin's Lymphoma Incidence
By County, Blacks By Gender, New Jersey - 1986-1990 And 1991-19961

COUNTY

1986-1990

1991-1996

Male

Female

Male

Female

Number

Rate2

Number

Rate2

Number

Rate2

Number

Rate2

Atlantic

9

11.8

11

8.9

21

19.4

13

8.5

Bergen

9

9.6

12

10.5

13

11.1

14

9.0

Burlington

14

15.1

13

12.9

25

18.9

15

11.0

Camden

15

9.4

8

3.9

29

14.0

16

6.6

Cumberland

6

11.5

---

---

17

31.9

9

11.5

Essex

68

10.6

55

6.9

139

16.4

109

10.0

Gloucester

7

15.5

5

9.4

---

---

9

10.6

Hudson

23

14.9

19

10.9

45

23.7

23

9.6

Mercer

17

13.1

12

7.5

36

19.2

20

9.7

Middlesex

10

8.3

7

7.1

21

16.3

12

7.2

Monmouth

14

14.3

13

9.7

24

16.2

16

8.9

Morris

6

26.1

---

---

7

27.2

---

---

Passaic

13

9.1

15

10.0

26

14.9

27

12.1

Somerset

---

---

---

---

11

18.6

9

18.9

Union

18

9.3

20

8.3

29

12.3

26

8.1

STATE

239

11.5

199

7.9

456

16.3

329

9.3


1Incidence rates - per 100,000 population, age-adjusted to the 1970 U.S. standard population. Cases of unknown county are included in the State numbers and rates. Counties with fewer than five cases for each gender in each time period were removed from the table - Cape May, Hunterdon, Ocean, Salem, Sussex, and Warren counties. The dashes indicate fewer than five cases. Source: New Jersey State Cancer Registry.
2Average annual rate.

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Table 36.
Non-Hodgkin's Lymphoma Incidence
By County, Race And Gender, New Jersey - 1986-1996 Combined1

COUNTY

MALE

FEMALE

WHITE

BLACK

WHITE

BLACK

Number

Rate2

Number

Rate2

Number

Rate2

Number

Rate2

Atlantic

215

18.8

30

16.2

199

12.4

24

8.7

Bergen

964

19.3

22

10.5

839

12.6

26

9.6

Burlington

321

18.0

39

17.4

274

11.9

28

11.8

Camden

427

18.8

44

12.1

381

12.4

24

5.4

Cape May

134

20.1

---

---

99

10.4

---

---

Cumberland

113

16.7

23

23.5

112

11.9

11

8.0

Essex

536

19.0

207

13.8

551

13.9

164

8.6

Gloucester

185

17.6

11

10.1

154

11.5

14

10.2

Hudson

528

19.8

68

20.0

446

12.4

42

10.2

Hunterdon

101

17.5

---

---

63

9.7

---

---

Mercer

293

18.9

53

16.7

272

12.9

32

8.8

Middlesex

583

17.7

31

13.1

581

13.9

19

7.2

Monmouth

543

18.8

38

15.5

512

13.3

29

9.1

Morris

376

17.2

13

26.5

382

13.7

---

---

Ocean

573

17.3

5

11.0

561

11.5

---

---

Passaic

390

17.5

39

12.5

372

12.3

42

11.2

Salem

59

16.8

---

---

52

11.2

---

---

Somerset

194

15.4

15

20.9

199

13.0

12

15.7

Sussex

103

16.4

---

---

84

11.6

---

---

Union

503

19.2

47

11.1

422

11.7

46

8.2

Warren

93

17.8

---

---

103

14.6

---

---

STATE

7241

18.3

695

14.3

6663

12.6

528

8.7


1Incidence rates - per 100,000 population, 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.
2Average annual rate.

Figure 12.

Figure 12
*1996 data are preliminary. Source: New Jersey State Cancer Registry.