• Sally L. GlaserEmail author
  • Ellen T. Chang
  • Christina A. Clarke
  • Theresa H. Keegan
Part of the Hematologic Malignancies book series (HEMATOLOGIC)


Hodgkin lymphoma (HL) is a relatively rare malignancy with a complex epidemiology. In addition to clinical and histological complexity, it shows substantial variation in incidence and risk factors across demographic factors and tumor characteristics. This chapter provides an overview of the epidemiology of HL with particular attention to this etiologic heterogeneity in incidence patterns, timing of exposure to common infections, the role of Epstein-Barr virus (EBV), altered immune function, genetic susceptibility, and selected lifestyle practices. Altogether, evidence to date points to HL as an uncommon outcome in genetically susceptible individuals of immune dysfunction provoked by early (i.e., childhood) and subsequent environmental exposures. However, given the variations in incidence rates and risk associations with age and tumor EBV status, among other factors, HL has been proposed to comprise four etiologically distinct entities—EBV-associated childhood HL, EBV-associated young-adult HL, EBV-associated HL in older adults (and in the immunosuppressed), and non-EBV-associated HL (occurring primarily in young adults). With this complexity, and the fact that associations with potential etiologic factors have not been strong and/or have low population prevalence, our understanding of risk factors for HL needs to advance considerably to meet the ultimate goal of disease prevention. Furthermore, to account for the considerable epidemiologic heterogeneity of HL, informative future work must be undertaken in diverse study populations of substantial size.


Human Leukocyte Antigen Hodgkin Lymphoma Human Leukocyte Antigen Class Infectious Mononucleosis Classical Hodgkin Lymphoma 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Adjusted hazard ratio


Confidence interval




Epstein-Barr nuclear antigen


Epstein-Barr virus


Genome-wide association study


Hodgkin lymphoma


Human leukocyte antigen


Hodgkin Reed-Sternberg




Infectious mononucleosis


Odds ratio


Relative risk


Surveillance, Epidemiology, and End Results


Socioeconomic status


Standardized incidence ratio


Systemic lupus erythematosus


United Kingdom


United States of America


Ultraviolet radiation


Viral capsid antigen



The authors thank Juan Yang for help with this chapter. The collection of cancer incidence data used in this study was supported by the California Department of Public Health as part of the statewide cancer reporting program mandated by California Health and Safety Code Section 103885; the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program under contract HHSN261201000140C awarded to the Cancer Prevention Institute of California, contract HHSN261201000035C awarded to the University of Southern California, and contract HHSN261201000034C awarded to the Public Health Institute; and the Centers for Disease Control and Prevention’s National Program of Cancer Registries, under agreement U58DP003862-01 awarded to the California Department of Public Health. The ideas and opinions expressed herein are those of the author(s), and endorsement by the State of California, Department of Public Health the National Cancer Institute, and the Centers for Disease Control and Prevention or their contractors and subcontractors is not intended nor should be inferred.


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Copyright information

© Springer International Publishing 2015

Authors and Affiliations

  • Sally L. Glaser
    • 1
    • 2
    Email author
  • Ellen T. Chang
    • 3
    • 2
  • Christina A. Clarke
    • 1
    • 2
  • Theresa H. Keegan
    • 1
    • 2
  1. 1.Department of ResearchCancer Prevention Institute of CaliforniaFremontUSA
  2. 2.Department of Health Research and PolicyStanford University School of MedicineStanfordUSA
  3. 3.Health Sciences PracticeExponent, Inc.Menlo ParkUSA

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