STEP 1: Prevention and early detection

This step outlines recommendations for the prevention and early detection of low-grade lymphomas.

Evidence shows that not smoking, avoiding or limiting alcohol intake, eating a healthy diet, maintaining a healthy body weight, being physically active, being sun smart and avoiding exposure to oncoviruses or carcinogens may help reduce cancer risk (Cancer Council Australia 2018).

The causes of most low-grade lymphomas are not fully understood, and there are currently no clear prevention strategies. Some low-grade lymphomas such as gastric MALT are, however, preventable through identification and eradication of Helicobacter pylori infection.

The risk factors in common across all low-grade indolent lymphomas include the following:

  • Age – incidence of low-grade lymphomas increases with age
  • Obesity – high BMI in adulthood and early adulthood may increase the risk of low-grade lymphomas (Abar et al. 2019)
  • Family history – individuals with a first-degree relative (parent, child, sibling) with a low-grade lymphoma have a small increased risk of developing NHL
  • Race/ethnicity – there is a higher incidence of indolent NHL in white Caucasian populations compared with non-Caucasian ethnicities
  • Radiation exposure – patients treated with radiation for other cancers have slightly increased risk of developing a low-grade This risk is greater for patients treated with both radiation therapy and chemotherapy
  • Weakened immune system – people with weakened immune systems as a result of immunosuppressive drugs, chronic infection or some genetically inherited syndromes are at a higher risk of developing a low-grade lymphoma
  • Autoimmune diseases – people with autoimmune diseases such as rheumatoid arthritis, systemic lupus erythematosus, Sjogren’s disease and coeliac disease may have an increased risk of developing a low-grade lymphoma
  • There is a possible association between exposure to glyphosate-based agricultural pesticides and risk of developing a low-grade lymphoma, but a lack of prospective studies limits definitive

Follicular lymphoma

  • Gender – women have a slightly higher risk of developing FL than men
  • Race/ethnicity – FL occurs more commonly in Caucasian populations
  • Viral infections – viruses that have been implicated in developing FL include Epstein-Barr virus, human T-cell lymphotropic virus type I and Kaposi sarcoma-associated herpesvirus

MALT lymphomas

MALT lymphomas, in particular, are associated with a variety of infectious/autoimmune disorders:

  • 90 per cent of gastric MALT lymphoma are associated with Helicobacter pylori gastritis
  • Ocular adnexal MALT lymphoma may be associated with Chlamydia psittaci
  • Cutaneous MALT lymphoma may be associated with Borrelia burgdorferi
  • MALT lymphoma of the small intestine and immunoproliferative small intestine disease may be associated with Campylobacter jejuni
  • Thyroid MALT may be associated with Hashimoto’s thyroiditis
  • Salivary gland MALT may be associated with Sjogren’s syndrome
  • SMZL may be more common in those with chronic hepatitis C infection and associated with autoimmune conditions such as haemolytic anaemia and immune

Mantle cell lymphoma

  • Gender – men have a greater risk of developing MCL than

Everyone should be encouraged to reduce their modifiable risk factors for cancer, including preventing and/or reducing obesity, alcohol consumption, tobacco smoking and exposure to pesticides, which may be associated with slight increased risk.

A thorough family history for NHL is recommended but no specific genetic tests are recommended.

Based on current evidence, screening is not appropriate for low-grade lymphomas.

Routine screening for lgl is not currently recommended in either the general population or in relatives of people with lgl.