Introduction

Lymphoma is a type of cancer that affects the lymphatic system, an essential part of the immune system responsible for fluid regulation and immune defence. Based on the presence of abnormal cells known as Reed-Sternberg cells, lymphoma is classified into two types: Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL). Reed-Sternberg cells are characteristic of  HL but absent in NHL. NHL is more prevalent and includes multiple subtypes, while HL is rare. Both types include uncontrolled growth of lymphocytes ( a type of white blood cell) and present symptoms like fever, night sweats, fatigue and swollen lymph nodes.¹ Advances in diagnosis and treatment have improved survival outcomes, yet the global burden of lymphoma remains high, partly due to modifiable lifestyle and environmental factors such as smoking, poor diet, and exposure to toxins.

Global burden of lymphoma cancer

Lymphoma is one of the significant causes of cancer-related morbidity and mortality worldwide. The global mortality rate for NHL is approximately 2.6 per 100,000 population.²  

Given this burden, understanding preventable risk factors is vital. Lifestyle modification, awareness programs, and early screening can contribute significantly to reducing disease incidence and improving outcomes.

General role of lifestyle and environmental factors in cancer risk

Lifestyle and environmental factors play a major role in increasing the risk of cancer. It induces genetic changes in cells with the use of tobacco, poor diet, lack of exercise, lack of proper sleep, stress and excessive alcohol consumption. Environmental factors like exposure to radiation, chemicals, and infectious agents also contribute to cancer development.³

Given this burden, understanding preventable risk factors is vital. Lifestyle modification, awareness programs, and early screening can contribute significantly to reducing disease incidence and improving outcomes.

Smoking is a major preventable risk factor for various cancers

Smoking is one of the most persistent causes of cancer worldwide. Tobacco smoke contains thousands of chemicals, including benzene, formaldehyde, and polycyclic aromatic hydrocarbons 4. These substances damage DNA, impair repair mechanisms, and promote mutations. 

While smoking can also cause haematological malignancies such as leukaemia and lymphoma. The chemicals from tobacco circulate in the body through the bloodstream, damaging nearly every organ and system. Eliminating smoking not only reduces the risk of solid tumours but also helps prevent blood-related cancers.⁵

Understanding lymphoma

Definition and classification (Hodgkin vs. non-Hodgkin)

Lymphoma arises from malignant transformation of B-cells, T-cells and natural killer (NK) cells, also known as lymphocytes. Lymphomas are classified into two major categories: Hodgkin lymphoma (HL) and Non-Hodgkin lymphoma (NHL).⁶ NHL is more common than HL, and NHL is more common in men than in women.⁷ Patients with lymphoma usually present with fever, night sweats, weight loss, fatigue, and loss of appetite.⁶ Risk factors for lymphoma include a weakened immune system from illness like HIV or from taking immunosuppressant drugs, certain chronic infections such as Epstein-Barr virus (EBV) and Helicobacter pylori, a family history of lymphoma, advanced age, exposure to certain pesticides and radiation, and a personal history of autoimmune diseases.⁸

Smoking and lymphoma

Smoking cigarettes is the cause of lymphoma and increases the risk of both HL and NHL. The risk of lymphoma increases with more intense and prolonged smoking habits. Analysis has shown that heavy smokers have a higher risk of having NHL, such as follicular lymphoma and T-cell NHL.^9,10

The carcinogens present in tobacco smoke can damage lymphoid tissue directly or alter immune regulation, increasing susceptibility to malignant transformation. Although the magnitude of risk is generally lower compared to solid organ cancers, smoking remains a significant modifiable factor in the development and prognosis of lymphoma.

Relative risk increase in smokers vs. non-smokers

Smokers have a higher risk of certain types of lymphoma compared to non-smokers. Some studies have shown a higher risk of HL and specific subtypes of NHL in smokers.¹¹

Possible mechanisms

Cigarette smoking can alter the B-cells and T-cells' immune responses. Direct carcinogenic effects of tobacco-related chemicals can damage the DNA.  Smoking alters cytokine pathways that promote an environment conducive to malignant transformation. Tobacco exposure can lead to DNA methylation that changes affecting oncogenes and tumour suppressor genes.¹²

Prevention and public health perspective

Prevention and public health approaches focus on managing and identifying risk factors like HIV infection. Reducing exposure to environmental toxins, managing a healthy lifestyle by focusing on diet and exercise.¹³ Early detection through awareness towards the symptoms and seeking medical advice for appropriate and effective treatment. Eliminating tobacco and alcohol.

Future directions and research gaps

Advancements in the molecular diagnostic technologies in lymphoma enable more sensitive monitoring of minimal residual disease (MRD) using circulating tumour DNA (ctDNA) for MRD-guided therapy. Furthermore, Artificial Intelligence (AI) should be explored for the diagnosis of lymphoma.¹⁴

Conclusion

Smoking is a well-known carcinogen which not only causes lung and solid organ cancers but also contributes to the risk and poor prognosis of lymphoma. Smoking exposure can significantly affect patients. Public health efforts must expand beyond the classic smoking-related cancers to highlight their role in haematological malignancies. Integration of smoking cessation strategies by clinicians can improve the survival and quality of life of diseased patients. Research on the molecular links between tobacco exposure and lymphoma development will strengthen preventive and therapeutic approaches in the future.