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"Kissing Disease" Increases Cancer Risk

Viral Cause of Infectious Mononucleosis Linked to Hodgkin's Disease

By Salynn Boyles WebMD Medical News
Reviewed By Brunilda Nazario, MD
Wednesday, October 01, 2003

Oct. 1, 2003 -- New research confirms a long-suspected link between
infectious mononucleosis -- also known as the "kissing disease" -- and a
cancer commonly found in young adults.

Researchers are implicating the Epstein-Barr virus (EBV), the cause of
mononucleosis, in roughly one-third of Hodgkin's disease cases.

Using a comprehensive nationwide medical database, investigators in
Denmark compared 17,000 people with mononucleosis caused by Epstein-Barr
virus to more than 24,000 people who were suspected of having mono, but
did not have evidence of EBV.

The risk of Hodgkin's disease was higher in people with a positive
antibody blood test that confirmed mononucleosis caused by EBV. No
increased risk in Hodgkin's disease was found in those people suspected
of having mono but testing negative for EBV.

An association between EBV and Hodgkin's disease has long been
suspected. Studies have shown that there is a higher rate of the cancer
in people with a history of mononucleosis. Studies also show that the
virus is present in about 50% of these tumors.

In the current study, researchers found that mono caused by EBV
quadrupled the risk of Hodgkin's disease. Mono-like illnesses caused by
other viruses, such as cytomegalovirus, were not associated with
Hodgkin's.

In addition, mono was directly linked to lymphomas that contained EBV
and not to lymphomas with no evidence of the virus.

The findings are reported in the Oct. 2 issue of The New England Journal
of Medicine.

From Mono to Lymphoma

The researchers estimated the average time between mononucleosis
developing into Hodgkin's disease to be four years, with risks peaking
two years after infection.

"But it is important to stress that while mononucleosis does increase
the risk of getting Hodgkin's lymphoma, the risk is still very small --
on the order of one case of the cancer per 1,000 patients," study
co-author Mads Melbye, MD, tells WebMD. "And it appears from this
research that not all cases of Hodgkin's disease are related to this
virus, as some people have suggested."

The Kissing Disease

Infectious mononucleosis, colloquially known as the "kissing disease,"
is caused by Epstein-Barr virus infection. Almost everyone becomes
infected with the virus at some point in his or her lives, and those
infected during childhood rarely become ill. But between one-third and
half of people infected during adolescence and young adulthood develop
the illness, mononucleosis.

Hodgkin's disease is a cancer of the lymph nodes, which are part of the
immune system and help fight infection and cancer. Hodgkin's disease is
one of the most common malignancies among ****s and young adults.

Researchers have suspected that infection with Epstein-Barr virus sets
the stage for Hodgkin's disease by weakening the immune cells that help
fight off cancer.

A Direct Link?

We have shown a direct link between infection with EBV and tumors that
contain EBV, Melbye says.

But in an editorial accompanying the Danish study, Johns Hopkins
oncologist Richard F. Ambinder, MD, PhD, questions whether EBV infection
still may play a role in lymphomas not found to contain the virus.

As evidence of this, he makes note of Hodgkin's disease that runs in
families. He says that both lymphomas with and without EBV have been
found to run in families. "Hence, it is not appropriate to presume that
EBV-positive and EBV-negative lymphomas are distinct entities."

SOURCES: Hjalgrim, H. The New England Journal of Medicine, Oct. 2, 2003;
vol 349: pp 1324-1332. Ambinder, R. The New England Journal of Medicine,
Oct. 2, 2003; vol 349: pp 1309-1310. Mads Melbye, MD, professor, head of
the Department of Epidemiology Research, Danish Epidemiology Science
Center, Statens Serum Institute, Copenhagen, Denmark. Richard Ambinder,
MD, PhD, director, hematological malignancies division, Sidney Kimmel
Comprehensive Cancer Center, Johns Hopkins University School of
Medicine, Baltimore, Md.

http://my.webmd.com/content/article/74/89355.htm