Epstein-Barr virus-associated malignancies: epidemiologic patterns and etiologic implications

Epstein-Barr virus (EBV), a ubiquitous B-lymphotrophic herpesvirus, has bee n found in the tumor cells of a heterogeneous group of malignancies (Burkit t's lymphoma, lymphomas associated with immunosuppression, other non-Hodgki n's lymphomas, Hodgkin's disease, nasopharyngeal carcinoma, gastric adenoca rcinoma, lymphoepithelioma-like carcinomas, and immuno-deficiency-related l eiomyosarcoma). As the epidemiologic characteristics of these cancers have not been considered together, this review seeks to relate their incidence p atterns and risk factors to EBV biology and virus-host interaction in an at tempt to help elucidate factors involved in EBV-related carcinogenesis. We include a brief review of EBV virology and primary infection to provide a b iologic context for considering the epidemiology, summarize the most salien t epidemiologic features of each malignancy, synthesize epidemiologic data by risk factor to uncover commonalities and informative contrasts across th e diseases, and propose hypotheses regarding etiologic mechanisms, based on the possible effect of the risk factors at various stages in the viral lif e cycle. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.