There are several risk factors for Hodgkin’s lymphoma (HL) spanning both biological and sociological categories. Nurses are in the unique position to treat and educate patients. Understanding the risk factors of a condition can assist the nurse in identifying patients who may benefit from health education.
Age
HL is more commonly diagnosed in patients age 55 and older or 20 and younger, though it is more likely to be diagnosed in young adults.
Family Links
A family history is related to an increased risk of diagnosis with HL. There is a ten times greater risk for being diagnosed with HL for same sex siblings and up to one hundred times greater risk for identical twins. Research also shows up to a five times greater risk for first degree relatives. This may be due to similar exposure to environmental factors, but could also be related to unknown genetic links.
Immunodeficiency
While immunosuppression does not always precede HL, there is a clear link between several conditions of immunosuppression and its development. Notably, patients with human immunodeficiency virus (HIV) or Epstein Barr virus (EBV) are at a much greater risk of diagnosis with HL. Specifically, patients with HIV faced up to a twenty five times greater risk of diagnosis. It is important to note that most patients with HIV who are diagnosed with HL also test positive for EBV, further strengthening the connection between immunodeficiency, susceptibility to infection, and diagnosis with HL. Infectious mononucleosis, a disease caused by EBV, is linked to a greater risk for diagnosis with HL. Additionally, twenty to fifty percent of patients with classical HL demonstrate signs of EBV in their malignant tumor cells. Despite evidence linking EBV to HL, there is only a small percentage of EBV patients who will be diagnosed with HL.
Other types of immunosuppression also apply and include patients utilizing an immunosuppressant for treatment of an autoimmune disease or patients who have undergone a cell or organ transplant. Patients who are immunosuppressed often present with HL in uncommon locations and at a later stage when diagnosed. Their prognosis is typically worse than that of other patients, even after receiving treatment.
Socioeconomic status
Interestingly, HL has been linked to patients of high socioeconomic status. The rationale may be based in delayed exposure to certain environmental factors or viruses associated with the disease. The connection was even more evident among patients diagnosed with a specific subtype of HL (nodular sclerosis), and among younger patients.
Autoimmune disorders
Patients with the following autoimmune disorders were found to be at greater risk for HL:
Systemic lupus erythematosus
Sarcoidosis
Rheumatoid arthritis
In these cases, the patient must have had a personal history of the disorder. Patients with a family history of ulcerative colitis were also at increased risk.
Conclusion
An understanding of the risk factors for HL is helpful both for patient education and treatment. The known risk factors span from the surprising, such as socioeconomic status, to more familiar, such as familial links. By recognizing risk factors, nurses are in a better position to advocate for and empower their patients.
References:
Aster, Jon C. and Pozdnyakova, Olga. (2016). Epidemiology, pathologic features, and diagnosis of classical Hodgkin lymphoma. UpToDate. Retrieved from https://www.uptodate.com/contents/epidemiology-pathologic-features-and-d…
Ambinder, Richard F. The role of Epstein-Barr virus in Hodgkin lymphoma. UpToDate. Retrieved from https://www.uptodate.com/contents/the-role-of-epstein-barr-virus-in-hodg….
Ansell, Stephen M. (2016). Hodgkin lymphoma: 2016 update on diagnosis, risk-stratification, and management. American Journal of Hemotology, 91 (4), 434-442. Retrieved from http://onlinelibrary.wiley.com/doi/10.1002/ajh.24272/full
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