There is a link between non-Hodgkin’s lymphoma (NHL) and smoking. Heavy smoking has an association with NHL, and the link is especially strong with the subtype known as follicular lymphoma.

A 2017 study found that the link became significant in people who smoked more than 15 cigarettes a day. Smoking may also affect the course of NHL following diagnosis, as research on cancer more generally indicates it raises the likelihood of a secondary tumor.

This article examines the relationship between non-Hodgkin’s lymphoma and smoking, including how much smoking increases the risk, whether smoking makes NHL worse, and whether it affects treatment.

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NHL is a cancer that develops in a type of white blood cells known as lymphocytes, which help the immune system fight cancer and microbes.

The American Cancer Society (ACS) does not list smoking among the causes of NHL, nor do they list it among the known risk factors. However, some research has linked smoking with NHL.

An older 2005 study found a link between smoking and a higher risk of the NHL subtype known as follicular lymphoma, but not other subtypes. Follicular lymphoma is the most common type of slow-growing NHL.

A 2017 case-control study also found a dose-dependent link between smoking and NHL, meaning that the more a person smokes, the higher the risk.

The 2005 study compared 6,594 people with NHL to 8,892 individuals without NHL. Data analysis showed that people who currently smoked had a 31% higher risk of follicular lymphoma than people who did not smoke. The risk was 45% higher among those who smoked heavily.

The 2017 study also suggests that the risk increases with the amount of smoking. In comparison to people who had never smoked, those who smoked heavily had a 42% higher risk of NHL and a 143% higher risk of follicular lymphoma. The authors define heavy smoking as smoking at least 15 cigarettes per day.

Secondhand smoking, or passive smoking, also appears to raise the risk of follicular lymphoma, according to a 2022 study. The researchers discovered that exposure to more than two people who smoke during childhood raised the risk by 84%.

There are no studies that have specifically examined the impact of smoking on NHL, but a 2019 study assessed how smoking affects people who continue to smoke after any cancer diagnosis.

The author discovered that smoking links to a reduced quality of life and an increased risk of secondary tumors, tumors that form in another part of the body.

This suggests that smoking could make NHL worse or raise the risk for future cancers.

A 2022 review explored the impact of smoking on cancer treatment’s effectiveness and its toxicity to people with cancer. It found that, regardless of cancer type, smoking has a negative effect on the effectiveness of radiation therapy.

The review did not find that smoking has a negative effect on chemotherapy, but the authors note that due to low-quality evidence, it was not possible to draw conclusions on this.

However, another review suggests that nicotine, which is in tobacco, may decrease the effectiveness of chemotherapy by activating cell growth. Nicotine also increases resistance to apoptosis, which is the typical death of cells in a healthy person.

Yes, some research suggests that quitting smoking may lengthen survival for those with follicular lymphoma, as well as NHL in general.

The authors of a 2022 case-control study note that, although previous studies on the relationship between smoking and follicular lymphoma survival are inconsistent, their investigation found an association between smoking, follicular lymphoma incidence, and an increased risk of dying from any cause after a follicular lymphoma diagnosis.

Additionally, an older 2010 study notes that smoking can negatively affect NHL survival by:

  • suppressing typical cell death
  • having a direct carcinogenic, or cancer-causing, effect
  • causing other conditions that can affect survival

Although research on smoking and NHL is still evolving, what does exist suggests that it is important to try to quit smoking as soon as possible.

For support, people can use the following resources:

While the ACS does not list smoking as a cause of non-Hodkin’s lymphoma, research does suggest that it increases the risk, particularly for follicular lymphoma. Heavy smoking raises the risk further, with one study indicating that it may elevate the chances of developing NHL by 45%.

Smoking may also affect the effectiveness of cancer treatment and could potentially lower survival rates. People can seek help with quitting smoking from a healthcare professional or support organizations.