Increasing Incidence of Non-Hodgkin Lymphoma in England, 1985-2019

Background In the UK, non-Hodgkin lymphoma (NHL) is the most common hematological malignancy and 6th most common cancer overall - accounting for about 14,200 new cases and 4,900 deaths each year. After rising rapidly from the 1980s onwards, the incidence rates of NHL have broadly stabilised in several European and North American countries since the late 1990s. We conducted a retrospective population-based cohort study to examine whether similar changes in the incidence of NHL have also occurred in England from 1985-2019. Methods Individual-level data for patients diagnosed with NHL, and the corresponding national population (denominator) data were obtained from ONS/PHE. Average annual incidence rates (AAIR) were calculated by sex, three age categories (0-34, 35-64 and 65+ years) and seven five-year time periods (1985-89 to 2015-19). Results During the 35-year study period, a total of 304,994 new cases of NHL were registered in England (54% males, 46% females). In young people aged 0-34 years, the AAIRs increased by 33% in males and 60% in females (from 1.8/100,000 in 1985-89 to 2.4/100,000 in 2015-19 in males, and from 1.0/100,000 in 1985-89 to 1.6/100,000 in 2015-19 in females). In middle age (35-64 years), the AAIRs increased by 54% in males and 57% in females (from 13.3 to 20.5 in males, and from 9.6 to 15.1 in females). At older ages (65+ years), the AAIRs increased by 108% in males and 102% in females (from 47.6 to 99.1 in males, and from 34.1 to 68.7 in females). In both sexes and all age categories, the disease was most frequently diagnosed at the advanced Stage 4. With regards to the socioeconomic status, the disease was relatively more commonly diagnosed in the most deprived groups. Conclusions In contrast with many European and North American countries, there has been a steady and substantial increase in the incidence of NHL in England over the past four decades. Overall, the highest increase was observed in males (115%) and those aged 65+ years (109%). Key messages • The reasons behind this continued increase in incidence in England, which is in contrast with most European/North American populations, remain elusive and need further etiological investigation. • Considering that the large majority of cases were diagnosed at the advanced Stage 4, there is an urgent need for clinical guidance to facilitate early diagnosis of NHL.