Background: American Indians and Alaska Natives (AI/AN) currently represent approximately 2% of the US population. However, population-based cancer studies are generally limited. Utilizing the Surveillance, Epidemiology and End Results Program (SEER), we investigated the incidence, major subtype distribution, and survival of non-Hodgkin lymphomas (NHL) in the AI/NA population.

Methods: We queried the SEER 2000-2012 database for AI/AN patients with NHL using ICD-O-3 codes 9590-9823. We calculated their incidence rate (case/1,000,000) and trend as well as risk ratios compared to other races, age-adjusted to the US 2000 standard population. Patient level data were extracted to perform summary statistics and calculate overall survival (OS) using STATA/IC 12.1.

Results: We identified 1,135 AI/NA patients with NHL. The average age was 59.6 years (range, 20-85) and 53% were males. The distribution of the major NHL subtypes resembles that seen among the rest of the population and is as follows: diffuse large B-cell (DLBCL; 28%), marginal zone (MZL; 19%), follicular (FL; 13%), small lymphocytic/chronic lymphocytic leukemia (SLL/CLL; 10%), NHL not-otherwise specified (NOS, 4%), mantle cell (MCL; 2%), anaplastic large cell (ALCL; 2%), lymphoplasmacytic (LPL; 1%), and peripheral T-cell (PTCL; 1%). The overall incidence of NHL is 26.4 and did not significantly change over the 12-year study period (Annual Percent Change 0.0, 95% CI [-0.3, 0.3]). Compared to other races, AI/NA have lower incidence of NHL including most of the major subtypes (Table). The median OS for all types of NHL combined is 4.16 years. AI/AN OS is statistically inferior compared to Whites(Figure).

Conclusions: The NHLincidence in AI/NA is lowest among the major race groups and has remained stable in the past 12 years. However their OS is inferior when compared to Whites. The distribution of major NHL subtypes and OS are similar to the rest of the population.


No relevant conflicts of interest to declare.

Author notes


Asterisk with author names denotes non-ASH members.