© 1999 by Oxford University Press
Journal of the National Cancer Institute, Vol. 91, No. 24, 2127,
December 15, 1999
© 1999 Oxford University Press
CORRESPONDENCE |
RESPONSE: Re: Detection of Epstein-Barr Virus in Invasive Breast Cancers
Correspondence to: Irene Joab, Ph.D., Institut de Génétique Moleculaire, Pharmacologie Expérimentale et Clinique, IFR Saint Louis, 27 Rue Juliette Dodu, 75010, Paris, France (e-mail: i.joab{at}chu-stlouis.fr).
Epstein-Barr virus (EBV) infects more than 95% of the adult human population, with no serious consequences in the vast majority of the cases. In a few infected people, EBV-associated tumors develop. To the best of my knowledge, there is no record of the number of cases in which patients harbor two different EBV-associated diseases, such as Burkitt's lymphoma and nasopharyngeal carcinoma or nasopharyngeal carcinoma and Hodgkin's disease. Similarly, Drs. Hemminki and Dong did not observe an epidemiologic association between breast cancer and Hodgkin's disease. They also did not find an increased standardized incidence ratio of breast cancer or Hodgkin's disease in the families of women with either disease. Spouses are likely to be infected by EBV before they meet. Moreover, if a specific pattern of EBV-related tumors occurred within a couple, it would imply that both partners harbored a more aggressive EBV variant. Although attempts have been made to associate a specific variant with the development of tumors, no definitive proof has been obtained to support this hypothesis. Because the development of EBV-associated tumors is a multistep process that includes viral as well as genetic and environmental factors, it is likely that, even if EBV is a common cofactor, it may not, by itself, be enough to provoke the initiation or the development of several EBV-associated tumors. Moreover, as suggested by Drs. Hemminki and Dong, the virus-host relationship, which is influenced by the immune status of the patient, is likely to influence the development of the disease.
Dr. Altschuler observed that, while breast cancer as a disease has been described since antiquity, infectious mononucleosis, which is caused by the Epstein-Barr virus, was first reported in 1885. Mononucleosis is a disease that largely occurs in countries with a high standard of living, where primary EBV infection can occur in teenagers or in young adults. In developing countries, clinically silent EBV infection occurs in early childhood. It is likely that, even if mononucleosis is a new disease, whose incidence rate increases with standard of living, EBV might have infected humans for a longer period of time. As suggested by Dr. Altschuler, demographic differences between the past and the present in Europe might have resulted in higher rates of infection in the past.
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