Recommendations for Epstein-Barr virus-based screening for nasopharyngeal cancer in high- and intermediate-risk regions

W K Jacky Lam^{1

2

3

4

5}, Ann D King⁶, Jacob A Miller⁷, Zhiwei Liu⁸, Kelly J Yu⁸, Melvin L K Chua^{9

10

11}, Brigette B Y Ma^{4

12}, Ming Yuan Chen^{13

14}, Benjamin A Pinsky¹⁵, Pei-Jen Lou¹⁶, John K S Woo⁵, Wan-Lun Hsu^{17

18}, Julia Simon¹⁹, Denise L Doolan²⁰, Tim Waterboer¹⁹, Edwin P Hui^{4

12}, Hui Li²¹, Raymond K Tsang²², Kenneth C W Wong^{4

12}, Julian P Goh²³, Alexander C Vlantis⁵, Qi Yong Ai^{6

24}, Lun M Wong⁶, Victor Abdullah^{25

26}, Jin Ching Lin²⁷, Chien-Jen Chen²⁸, Ruth M Pfeiffer⁸, Quynh-Thu Le⁷, Anne W M Lee^{29

30}, Mingfang Ji³¹, Sumei Cao^{14

32}, Jun Ma^{14

33}, Anthony T C Chan^{4

12}, K C Allen Chan^{1

2

3

4}, Allan Hildesheim³⁴

Affiliations

¹ Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China.
² Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China.
³ Centre for Novostics, Hong Kong Science Park, Hong Kong SAR, China.
⁴ State Key Laboratory of Translational Oncology, Sir YK Pao Centre for Cancer, Hong Kong Cancer Institute, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China.
⁵ Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China.
⁶ Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China.
⁷ Department of Radiation Oncology, Stanford University, Stanford, CA, USA.
⁸ Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA.
⁹ Department of Head and Neck and Thoracic Cancers, Division of Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore.
¹⁰ Division of Medical Sciences, National Cancer Centre Singapore, Singapore, Singapore.
¹¹ Oncology Academic Programme, Duke-NUS Medical School, Singapore, Singapore.
¹² Department of Clinical Oncology, State Key Laboratory of Translational Oncology, Sir YK Pao Centre for Cancer, Hong Kong Cancer Institute, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China.
¹³ Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China.
¹⁴ State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Center for Precision Medicine of Sun Yat-sen University, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China.
¹⁵ Department of Pathology, Stanford University, Stanford, CA, USA.
¹⁶ Department of Otolaryngology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
¹⁷ Master Program of Big Data in Biomedicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.
¹⁸ Data Science Center, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.
¹⁹ Infections and Cancer Epidemiology, Infection, Inflammation and Cancer Program, German Cancer Research Center (DKFZ), Heidelberg, Germany.
²⁰ Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Australia.
²¹ Department of Radiology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, China.
²² Department of Otolaryngology-Head and Neck Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
²³ Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore, Singapore.
²⁴ Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong SAR, China.
²⁵ Department of Otorhinolaryngology, Hong Kong Children's Hospital, Hong Kong SAR, China.
²⁶ The Hong Kong College of Otorhinolaryngologists, Hong Kong SAR, China.
²⁷ Department of Radiation Oncology, Changhua Christian Hospital, Changhua, Taiwan.
²⁸ Genomics Research Center, Academia Sinica, Taipei, Taiwan.
²⁹ Clinical Oncology Center, Shenzhen Key Laboratory for Cancer Metastasis and Personalized Therapy, The University of Hong Kong-Shenzhen Hospital, Guangdong, China.
³⁰ Department of Clinical Oncology, The University of Hong Kong, Hong Kong SAR, China.
³¹ Cancer Research Institute of Zhongshan City, Zhongshan City People's Hospital, Zhongshan, China.
³² Department of Cancer Prevention, Sun Yat-sen University Cancer Center, Guangzhou, China.
³³ Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China.
³⁴ Agencia Costarricense de Investigaciones Biológicas (ACIB) - Fundacion del Instituto Costarricense de Investigación y Enseñanza en Nutrición y Salud (INCIENSA), San José, Costa Rica.

PMID: 36723440
PMCID: PMC10086631
DOI: 10.1093/jnci/djad012

Recommendations for Epstein-Barr virus-based screening for nasopharyngeal cancer in high- and intermediate-risk regions

W K Jacky Lam et al. J Natl Cancer Inst. 2023.

. 2023 Apr 11;115(4):355-364.

doi: 10.1093/jnci/djad012.

Authors

Affiliations

¹ Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China.
² Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China.
³ Centre for Novostics, Hong Kong Science Park, Hong Kong SAR, China.
⁴ State Key Laboratory of Translational Oncology, Sir YK Pao Centre for Cancer, Hong Kong Cancer Institute, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China.
⁵ Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China.
⁶ Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China.
⁷ Department of Radiation Oncology, Stanford University, Stanford, CA, USA.
⁸ Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA.
⁹ Department of Head and Neck and Thoracic Cancers, Division of Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore.
¹⁰ Division of Medical Sciences, National Cancer Centre Singapore, Singapore, Singapore.
¹¹ Oncology Academic Programme, Duke-NUS Medical School, Singapore, Singapore.
¹² Department of Clinical Oncology, State Key Laboratory of Translational Oncology, Sir YK Pao Centre for Cancer, Hong Kong Cancer Institute, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China.
¹³ Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China.
¹⁴ State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Center for Precision Medicine of Sun Yat-sen University, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China.
¹⁵ Department of Pathology, Stanford University, Stanford, CA, USA.
¹⁶ Department of Otolaryngology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
¹⁷ Master Program of Big Data in Biomedicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.
¹⁸ Data Science Center, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.
¹⁹ Infections and Cancer Epidemiology, Infection, Inflammation and Cancer Program, German Cancer Research Center (DKFZ), Heidelberg, Germany.
²⁰ Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Australia.
²¹ Department of Radiology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, China.
²² Department of Otolaryngology-Head and Neck Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
²³ Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore, Singapore.
²⁴ Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong SAR, China.
²⁵ Department of Otorhinolaryngology, Hong Kong Children's Hospital, Hong Kong SAR, China.
²⁶ The Hong Kong College of Otorhinolaryngologists, Hong Kong SAR, China.
²⁷ Department of Radiation Oncology, Changhua Christian Hospital, Changhua, Taiwan.
²⁸ Genomics Research Center, Academia Sinica, Taipei, Taiwan.
²⁹ Clinical Oncology Center, Shenzhen Key Laboratory for Cancer Metastasis and Personalized Therapy, The University of Hong Kong-Shenzhen Hospital, Guangdong, China.
³⁰ Department of Clinical Oncology, The University of Hong Kong, Hong Kong SAR, China.
³¹ Cancer Research Institute of Zhongshan City, Zhongshan City People's Hospital, Zhongshan, China.
³² Department of Cancer Prevention, Sun Yat-sen University Cancer Center, Guangzhou, China.
³³ Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China.
³⁴ Agencia Costarricense de Investigaciones Biológicas (ACIB) - Fundacion del Instituto Costarricense de Investigación y Enseñanza en Nutrición y Salud (INCIENSA), San José, Costa Rica.

PMID: 36723440
PMCID: PMC10086631
DOI: 10.1093/jnci/djad012

Abstract

A meeting of experts was held in November 2021 to review and discuss available data on performance of Epstein-Barr virus (EBV)-based approaches to screen for early stage nasopharyngeal carcinoma (NPC) and methods for the investigation and management of screen-positive individuals. Serum EBV antibody and plasma EBV DNA testing methods were considered. Both approaches were found to have favorable performance characteristics and to be cost-effective in high-risk populations. In addition to endoscopy, use of magnetic resonance imaging (MRI) to investigate screen-positive individuals was found to increase the sensitivity of NPC detection with minimal impact on cost-effectiveness of the screening program.

PubMed Disclaimer

Figures

**Figure 1.**
Incidences of nasopharyngeal carcinoma among males from representative high- and intermediate-risk regions in southern parts of China and Southeast Asia. ASR(W) = age-standardized (world) incidence rates.

**Figure 2.**
Summary of screening recommendations. IgA = immunoglobulin A; MRI = magnetic resonance imaging; NGS = next-generation sequencing; NPC = nasopharyngeal carcinoma; rtPCR = real-time polymerase chain reaction; VCA/EBNA1 = viral capsid antigen and Epstein-Barr nuclear antigen1.

See this image and copyright information in PMC

References

1. IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Biological agents. Volume 100 B. A review of human carcinogens. IARC Monogr Eval Carcinog Risks Hum. 2012;100(Pt B):1-441. - PMC - PubMed
1. Chang ET, Adami HO.. The enigmatic epidemiology of nasopharyngeal carcinoma. Cancer Epidemiol Biomarkers Prev. 2006;15(10):1765-1777. - PubMed
1. Zhang LF, Li YH, Xie SH, et al.Incidence trend of nasopharyngeal carcinoma from 1987 to 2011 in Sihui County, Guangdong Province, South China: an age-period-cohort analysis. Chin J Cancer. 2015;34(8):350-357. - PMC - PubMed
1. Hong Kong Cancer Registry. Nasopharyngeal cancer in 2019. https://www3.ha.org.hk/cancereg/. Accessed December 15, 2022.
1. Taiwan Cancer Registry. Cancer incidence rates of Taiwan based on cancer incidence in five continents (CI5) series. https://twcr.tw/. Accessed December 15, 2022.

Publication types

Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Substances

Actions

LinkOut - more resources

Full Text Sources

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Recommendations for Epstein-Barr virus-based screening for nasopharyngeal cancer in high- and intermediate-risk regions

Affiliations

Recommendations for Epstein-Barr virus-based screening for nasopharyngeal cancer in high- and intermediate-risk regions

Authors

Affiliations

Abstract

Figures

References

Publication types

MeSH terms

Substances

LinkOut - more resources

Full Text Sources