The Epidemiology of Epstein-Barr Virus-Associated Malignancies

  • P. H. Levine
Part of the Developments in Medical Virology book series (DIMV, volume 1)


Epidemiologic studies of Epstein-Barr Virus (EBV)-associated malignancies continue to demonstrate the interrelationship of multiple etiologic factors, thereby allowing several opportunities for intervention with the disease process. For the two malignancies most closely linked with EBV, Burkitt’s lymphoma (BL) and nasopharyngeal carcinoma (NPC), the risk factors are more readily identified in high-incidence areas than in low-incidence areas. The report of an apparent decline in BL incidence in Africa is in contrast with a reported increase in incidence among young white males in the United States. The search for etiologic factors in BL, in addition to EBV and malaria, is currently focusing on retroviruses. For NPC, evidence continues to support the major roles of genetics and salted fish in southern Chinese, but other etiologic factors appear to be important in non-Chinese. In areas of low incidence for BL and NPC, less homogeneous patterns are seen suggesting the inclusion of unrelated cases. Precise definition of study groups may be aided by new laboratory assays. The further development and utilization of cancer registry data throughout the world will also increase our knowledge of these diseases.


Nasopharyngeal Carcinoma Multiple Etiologic Factor Young White Male Lymphoma Registry 
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.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. ARMSTRONG, R.W., ARMSTRONG, M.J., YU, M.C., AND HENDERSON, B.E., Salted fish and inhalants as risk factors for nasopharyngeal carcinoma. Cancer, 43, 2967–2970 (1983)Google Scholar
  2. BALE, S., BALE, A.E., AND LEVINE, P.H., The “Family Study” approach to investigating the role of genetic factors in nasopharyngeal carcinoma (this volume).Google Scholar
  3. BERARD, C.W., O’CONOR, G.T., THOMAS, L.B., and TORLONI, H., Histopathological Definition of Burkitt’s Tumor, World Health Organization, , New York (1969).Google Scholar
  4. BIGGAR, R.J., NKRUMAH, F.K., NEEQUAYE, J., and LEVINE, P.H., Changes in presenting tumor site of Burkitt’s lymphoma in Ghana, West Africa, 1975–1978. Br. J. Cancer, 46, 632–636 (1981).CrossRefGoogle Scholar
  5. BURKITT, D., A lymphoma syndrome in African children. Ann. Royal Coll. Surg. Eng., . 30, 211–219 (1962).Google Scholar
  6. FRAUMENI, J.F., JR., AND MASON, T.J., Cancer mortality among Chinese Americans, 1950–1969. JNCI, 52, 659–665 (1974).PubMedGoogle Scholar
  7. HO., J.H.C., Nasopharyngeal carcinoma (NPC). In: G. Klein, S. Weinhouse, and A. Haddow (eds.), Advances in Cancer Research, pp. 57–92, Academic Press, New York (1972).CrossRefGoogle Scholar
  8. HUANG, D.P., SAW, D., TEOH, T.B., AND HO, J.H.C., Carcinoma of the nasal and paranasal regions in rats fed Cantonese salted marine fish. In: G. de-The, and Y. Ito (eds.), Nasopharyngeal Carcinoma: Etiology and Control, pp. 315–3Z8, International Agency for Research in Cancer, Lyon (1978).Google Scholar
  9. ITO, Y., KISHISHITA, M., MORIGAKI, T., YANASE, S., and HIRAYAMA, T., Induction and intervention of Epstein-Barr virus expression in human lymphoblastoid cell lines: a simulation model for study of cause and prevention of nasopharyngeal carcinoma and Burkitt’s lymphoma. In: E. Grundmann, G.R.F. Krueger, and D.V. Ablashi (eds.), Nasopharyngeal Carcinoma, pp. 255–262, Gustav Fischer Verlag, Stuttgart/New York(1981).Google Scholar
  10. JUDSON, S.C., HENLE, W., and HENLE, G., A cluster of Epstein-Barr virus-associated American Burkitt’s lymphomas. N. Engl. J. Med., 297, 464–468 (1977).PubMedCrossRefGoogle Scholar
  11. KLEIN, G., Studies on the Epstein-Barr virus genome and the EBV-determined nuclear antigen in human malignant disease in tumor viruses. Cold Spring Harbor Symp. Quant. Biol., 39, 783–796 (1974).Google Scholar
  12. Lenoir, G., O’conor, G.T., And Olweny, C. (eds.), Burkitt’s Lymphoma: A Human Tumor Model, International Agency for Research on Cancer, Lyon (1985).Google Scholar
  13. Levine, P.H., And Connelly, R.R., Epidemiology of nasopharyngeal cancer. In: R.E. Wittes (ed.), Head and Neck Cancer, pp. 13–34, John Wiley and Sons, Ltd., Sussex, England (1985).Google Scholar
  14. Levine, P.H., Connelly, R.R., And Mckay, W.F., The influence of residence, race, and place of birth on the incidence of nasopharyngeal carcinoma. In: U. Prasad, D.V. Ablashi, P.H., Levine, and G.R. Pearson (eds.), Nasopharyngeal Carcinoma: Current Concepts, pp. 143–156, University of Malaya Press, Kuala Lumpur (1983).Google Scholar
  15. Levine, P.H., Connelly, R.R., And Mckay, W.F., Burkitt’s lymphoma in the United States: cases reported to the American Burkitt Lymphoma Registry compared with population-based incidence and mortality data. In: G.T. O’Conor (ed.), Burkitt’s Lymphoma: A Human Cancer Model, International Agency for Research on Cancer, Lyon (in press).Google Scholar
  16. Levine, P.H., Connelly, R.R., And Mckay, F.W., Recent findings in nasopharyngeal cancer in the United States, (submitted).Google Scholar
  17. Levine, P.H., Kamaraju, L.S., Connelly, R.R., Berard, C.W., Dorfman, R.F., Magrath, I., And Easton, J.M., The American Burkitt’s lymphoma registry: Eight years experience. Cancer, 49, 1016–1022 (1982).Google Scholar
  18. Levine, P.H., O’conor, G.T., And Berard, C.W., Antibodies to Epstein-Barr virus (EBV) in American patients with Burkitt’s lymphoma. Cancer, 30, 610–615 (1972).PubMedCrossRefGoogle Scholar
  19. Levine, P.H., Sandler, S.G., Komp, D.M., O’conor, G.T., And O’connor, D.M., Simultaneous occurrence of “American Burkitt’s Lymphoma” in neighbors. N. Engl. J. Med., 288, 562–563 (1973).PubMedCrossRefGoogle Scholar
  20. Magrath, I., Clinical and pathobiological features of Burkitt’s lymphoma and their relevance to treatment (this volume).Google Scholar
  21. Miller, R.W., Genetic and familial factors. In: P. Calabresi, P.S. Schein, and S.A. Rosenberg (eds.), Basic Principles and Clinical Management of Cancer, Macmillan Publishing Company, New York (in press).Google Scholar
  22. Pike, M.C., Williams, E.H., And Wright, B.H., Burkitt’s tumour in the West Nile District of Uganda, 1961–5. Br. J. Med., 2, 395–399 (1967).CrossRefGoogle Scholar
  23. Pike, M.C., And Morrow, R.H., Some epidemiological problems with “EBV + Malaria gives BL”-A review. In: P.M. Biggs, G. de-The, and L.N. Payne (eds.). Oncogenesis and Herpesviruses, pp. 349–350, International Agency for Research on Cancer, Lyon (1972).Google Scholar
  24. Raab-Traub, N., Huang, D., Yang, C.S., And Pearson, G., Ebv Dna content and expression in nasopharyngeal carcinoma (this volume).Google Scholar
  25. Saxinger, W., Blattner, W.A., Levine, P.H., Clark, J., Biggar, R., Hoh, M.W., Moghissi, J., Mourali, N., Nkrumah, F.K., Wilson, P.J.L., Jacobson, R., Crookes, R., Strong, M., Ansari, A.A., And Gallo, R.C., Human T-cell leukemia virus (HTLV-1) antibodies in Africa. Science, 225, 1473–1476 (1984).PubMedCrossRefGoogle Scholar
  26. Saxinger, W.C., Levine, P.H., Dean, A.G., De-The, G., Sarngadharan, M.G., And Gallo, R.C., Evidence for exposure to the HTLV-III in Uganda prior to 1973 (submitted).Google Scholar
  27. Shanmugaratnam, K., Nasopharynx. In: D. Schottenfeld, and J.F. Fraumeni, Jr. (eds.), Cancer Epidemiology and Prevention, pp. 536–553, W.B. Saunders Co., Philadelphia (1982).Google Scholar
  28. Simons, M.J., Genetic aspects of EBV-associated malignancies (this volume).Google Scholar
  29. Simons, M.J., And Shanmugaratnam, K. (eds.), The Biology of Nasopharyngeal Carcinoma, UICC Technical Report Series, Hans Huber Publishers, Berne (1982).Google Scholar

Copyright information

© Martinus Nijhoff Publishing, Boston 1985

Authors and Affiliations

  • P. H. Levine
    • 1
  1. 1.Clinical Epidemiology BranchNational Cancer InstituteBethesdaUSA

Personalised recommendations