Beyond the Usual Suspects: Emerging Associations Between Epstein-Barr Virus Infection/Infectious Mononucleosis and Cancers.
Level 3 - non-randomized controlled study
Systematic review of observational (non-randomized) studies
PubMed 42033165 · doi:10.1002/rmv.70153
What was done
Authors searched MEDLINE, Embase, and Web of Science through July 30, 2024, for observational studies evaluating links between Epstein-Barr virus (EBV) infection or EBV-infectious mononucleosis (IM) and cancers beyond established EBV-driven malignancies (Burkitt lymphoma, Hodgkin lymphoma, gastric carcinoma, and nasopharyngeal carcinoma). Evidence certainty was evaluated using the GRADE framework. For qualifying associations, they assessed etiologic fractions (EFs), biological plausibility, epidemiological burden, latency post-IM, and predictive biomarkers.
What was found
Across 33 included studies, 13 specific hypotheses were advanced for GRADE assessment. Eight cancers across six broad categories showed evidence of EBV involvement: breast, cervical, leukaemia/other haematologic, non-Hodgkin lymphoma (NHL), prostate, and testicular. Biological plausibility was strongest for breast cancer and NHL, and weakest for cervical and prostate cancers; testicular cancer evidence was limited. Reported etiologic fractions spanned from 12.3% (IM and breast cancer) to 85.1% (EBV infection and NHL). Only one study reported latency data from IM to cancer onset (for NHL), and prostate-specific antigen was the sole predictive biomarker identified.
Why it matters
Broadens the recognized scope of EBV-associated malignancies to several high-incidence cancers, reinforcing the rationale and potential public health value of developing prophylactic EBV vaccines.
Limits
The underlying evidence base is entirely observational and limited to 33 studies across multiple disparate cancer types. Latency data was almost entirely absent (available for only one cancer type), viral detection methods across original studies varied, and causality cannot be definitively established from the reviewed data.
Cited by
- supports Epstein-Barr virus (EBV) infection is etiologically linked to cancers including nasopharyngeal carcinoma.