Epstein–Barr virus (EBV) was discovered 40 years ago from examining electron micrographs of cells cultured from Burkitt's lymphoma, a childhood tumour that is common in sub-Saharan Africa, where its unusual geographical distribution — which matches that of holoendemic malaria —indicated a viral aetiology. However, far from showing a restricted distribution, EBV — a γ-herpesvirus — was found to be widespread in all human populations and to persist in the vast majority of individuals as a lifelong, asymptomatic infection of the B-lymphocyte pool. Despite such ubiquity, the link between EBV and 'endemic' Burkitt's lymphoma proved consistent and became the first of an unexpectedly wide range of associations discovered between this virus and tumours.

Epstein–Barr virus: 40 years on

Nasopharyngeal carcinoma (NPC) has a unique and complex etiology that is not completely understood. Although NPC is rare in most populations, it is a leading form of cancer in a few well-defined populations, including natives of southern China, Southeast Asia, the Arctic, and the Middle East/North Africa. The distinctive racial/ethnic and geographic distribution of NPC worldwide suggests that both environmental factors and genetic traits contribute to its development. This review aims to summarize the current knowledge regarding the epidemiology of NPC and to propose new avenues of research that could help illuminate the causes and ultimately the prevention of this remarkable disease. Well-established risk factors for NPC include elevated antibody titers against the Epstein-Barr virus, consumption of salt-preserved fish, a family history of NPC, and certain human leukocyte antigen class I genotypes. Consumption of other preserved foods, tobacco smoking, and a history of chronic respiratory tract conditions may be associated with elevated NPC risk, whereas consumption of fresh fruits and vegetables and other human leukocyte antigen genotypes may be associated with decreased risk. Evidence for a causal role of various inhalants, herbal medicines, and occupational exposures is inconsistent. Other than dietary modification, no concrete preventive measures for NPC exist. Given the unresolved gaps in understanding of NPC, there is a clear need for large-scale, population-based molecular epidemiologic studies to elucidate how environmental, viral, and genetic factors interact in both the development and the prevention of this disease.

https://cebp.aacrjournals.org/content/cebp/15/10/1765.full.pdf

The enigmatic epidemiology of nasopharyngeal carcinoma.

Epidemiology of nasopharyngeal carcinoma.

"Surgical Pathology of the Head and Neck, Third Edition " is a complete stand-alone reference dealing with head and neck pathology. Providing an interdisciplinary approach to the diagnosis, treatment, and management of head and neck diseases, and covering all aspects of general pathology - this is the reference of choice for head and neck pathologists, head and neck surgeons and pathologists promoting clear communication between pathologists and surgeons. With over 1200 photographs, micrographs, drawings, and tables - over 200 more illustrations than the second edition - head and neck pathologists, head and neck surgeons, otolaryngologists and pathologists will find this updated bestseller a valid reference for any practice. Unparalleled in scope and content than any other book available on the subject, "Surgical Pathology of the Head and Neck, Third Edition" is a must-have resource for oral, surgical, and general pathologists; otolaryngologists; oral, maxillofacial, plastic, reconstructive, general, head, neck, and orthopedic surgeons; and neurosurgeons, oncologists, hematologists, ophthalmologists, radiologists, endocrinologists, dermatologists, dentists, and residents and fellows in these disciplines.

Surgical Pathology of the Head and Neck

Nasopharyngeal carcinoma (NPC) has remarkable epidemiological features, including regional, racial, and familial aggregations. The aim of this review is to describe the epidemiological characteristics of NPC and to propose possible causes for the high incidence patterns in southern China. Since the etiology of NPC is not completely understood, approaches to primary prevention of NPC remain under consideration. This situation highlights the need to conduct secondary prevention, including improving rates of early detection, early diagnosis, and early treatment in NPC patients. Since the 1970's, high-risk populations in southern China have been screened extensively for early detection of NPC using anti-Epstein-Barr virus (EBV) serum biomarkers. This review summarizes several large screening studies that have been conducted in the high-incidence areas of China. Screening markers, high-risk age range for screening, time intervals for blood re-examination, and the effectiveness of these screening studies will be discussed. Conduction of prospective randomized controlled screening trials in southern China can be expected to maximize the cost-effectiveness of early NPC detection screening.

The prevalence and prevention of nasopharyngeal carcinoma in China

Two hundred fifty incident cases of nasopharyngeal carcinoma under age 35 years in Hong Kong Chinese and an equal number of age- and sex-matched friend controls were interviewed. Mothers of cases and controls were interviewed also, if available, to obtain information on childhood events concerning the study subjects. Consumption of Cantonese-style salted fish during all time periods was significantly associated with nasopharyngeal carcinoma; the association was especially strong during childhood. The relative risk for having Cantonese-style salted fish as one of the first solid foods during weaning was 7.5 (95% confidence limits, 3.9, 14.8), and the relative risk for consuming the food at least once a week compared to less than once a month at age 10 years was 37.7 (95% confidence limits, 14.1, 100.4). It is estimated that over 90% of young nasopharyngeal carcinoma cases in Hong Kong Chinese can be attributed to consumption of this food during childhood.

https://cancerres.aacrjournals.org/content/canres/46/2/956.full.pdf

Shiu-Hung Lai

Papers

Cantonese-style Salted Fish as a Cause of Nasopharyngeal Carcinoma: Report of a Case-Control Study in Hong Kong