title: An epidemiologic study of index and family infectious mononucleosis and adult Hodgkin's disease (HD): evidence for a specific association with EBV+ve HD in young adults.
abstract: Infectious mononucleosis (IM) is an established risk factor for Hodgkin's disease (HD). A substantial minority (33%) of cases of HD have Epstein-Barr virus (EBV) DNA within the malignant cells (are EBV+ve). It is unclear whether risk after IM applies specifically to EBV+ve HD. We report the results of a population-based case-control study of HD in adults (n = 408 cases of classical HD, 513 controls) aged 16-74 years; the case series included 113 EBV+ve and 243 EBV+ve HD. Analyses compared total HD, EBV+ve HD and EBV-ve HD with the controls and EBV+ve HD with EBV-ve HD cases using, mainly, logistic regression. Regression analyses were adjusted for gender, age-group and socioeconomic status, and were performed for the whole age range and separately for young (< 35 years) and old adults (> or = 35 years); formal tests of effect modification by age were included. For the young adults, reported IM in index or relative was strongly and significantly associated with EBV+ve HD when compared to controls (odds ratio [OR] = 2.94, 95% confidence interval [CI]: 1.08-7.98 and OR = 5.22, 95% CI: 2.15-12.68, respectively). These results may be interpreted as indications that late first exposure to EBV increases risk of HD, especially in young adults; this applies primarily to EBV+ve HD.
authors.affiliation: Department of Community Health, Public Health Sciences, University of Edinburgh, Medical School, Teviot Place, Edinburgh, UK. freda.alexander@ed.ac.uk
authors.forename: Freda E
authors.initials: FE
authors.lastname: Alexander
authors.forename: Davia J
authors.initials: DJ
authors.lastname: Lawrence
authors.forename: June
authors.initials: J
authors.lastname: Freeland
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Krajewski
authors.forename: Brian
authors.initials: B
authors.lastname: Angus
authors.forename: G Malcolm
authors.initials: GM
authors.lastname: Taylor
authors.forename: Ruth F
authors.initials: RF
authors.lastname: Jarrett
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D020031:Epstein-Barr Virus Infections / Q000453:epidemiology*; D005190:Family; D005260:Female; D004854:Herpesvirus 4, Human; D006689:Hodgkin Disease / Q000453:epidemiology* / Q000821:virology; D006801:Humans; D007244:Infectious Mononucleosis / Q000453:epidemiology* / Q000821:virology; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014412:Tumor Virus Infections / Q000150:complications*; D006113:United Kingdom / Q000453:epidemiology