Screening for family members of patients with nasopharyngeal carcinoma

Abstract

Nasopharyngeal carcinoma (NPC) is well known for its peculiarly skewed distribution with highest incidence in Southern Chinese population. Familial aggregation is evident, hence screening for early detection is offered by oncology centers in Hong Kong to first-degree relatives of patients with NPC. During the period 1994 -2001, 929 family members were screened in our center. The screenees were advised to attend an annual examination that includes serological test against Epstein Barr Virus (EBV), physical examination to exclude cervical lymphadenopathy and cranial nerve palsy, and endoscopic examination of the nasopharyngeal region. Two different methods were used for the serology test: indirect immuno-fluorescent (IF) test for IgA against viral capsid antigen; and starting in 1997 enzyme-linked immunosorbent assay (ELIZA) against nuclear antigen and viral capsid antigen. Twelve cases of nasopharyngeal carcinoma were diagnosed, giving a detection rate of 5/1,155 (433/100,000) person-year for male and 7/1,404 (499/100,000) person-year for female participants observed. The corresponding average annual incidence in Hong Kong during this period was 24.1 and 9.6 per 100,000, respectively. Forty-one percent of these detected cases had Stage I disease, whereas only 2% of patients referred to the department for primary treatment presented with such early disease. Six cases were detected at first visit, and all were EBV-positive. Another 78 screenees with positive serology at first visit were followed up for 204 person years, and thus far NPC was detected in 3 after an interval of 6 -32 months. Of the 845 initially EBV-negative screenees followed up for 2,337 person-years, NPC was detected in 3 after an interval of 12-45 months. One showed sero-conversion at the time of diagnosis. We conclude that family members of known patients do show a substantially higher risk of developing NPC, and regular screening by current method improves the chance of early detection. © 2004 Wiley-Liss, Inc.Key words: nasopharyngeal carcinoma; family aggregation; screening Although rare in most parts of the world, nasopharyngeal carcinoma (NPC) is common in Southern China and parts of SouthEast Asia, 1 and the incidence is highest among the Cantonesespeaking residents. According to the Hong Kong Cancer Registry, it ranked 4th for males and 9th for females for new cancers. In 1999, there were 1,118 newly diagnosed cases and 371 deaths registered. The average annual age-standardized incidence rate is 24.1/100,000 for males and 9.6/100,000 for females. 2 Epstein Barr Virus (EBV) has long been implicated in the pathogenesis of NPC. 3 Old et al. 4 first made the association of EBV with NPC using immunodiffusion when patients with undifferentiated NPC showed elevated IgG and IgA antibody titers against EA-D (early antigen-diffuse) and VCA (viral capsid antigen). Using in situ hybridization techniques, EBV DNA has also been confirmed in NPC tumour cells. 5 Patients with nasopharyngeal carcinoma usually exhibit high levels of antibodies directed again...

Plasma Epstein‐Barr virus (EBV) DNA: Role as a screening test for nasopharyngeal carcinoma (NPC)?

“…1 Although several previous studies [2][3][4][5] have reported on the use of EBV serology for screening and early detection of NPC, the role of EBV DNA detection as a screening test for NPC remains to be defined. Circulating cell-free EBV DNA is detectable in the plasma of 96% of NPC patients 6 by quantitative real-time polymerase chain reaction (PCR) and has been shown to be a useful marker in prognostication 7 as well as residual disease detection.…”

Chinese Medicine and Biomodulation in Cancer Patients—Part Two

“…Its highest incidence is in the Southern Chinese population, with familial aggregation. The annual detection rate is 433 per 100,000 for men and 499 per 100,000 for women in high-risk families, as compared with an average overall annual incidence in Hong Kong of 24 per 100,000 for men and 10 per 100,000 for women 171 .…”

Epstein-Barr Virus Serology in the Detection and Screening of Nasopharyngeal Carcinoma

“…Further genetic and epigenetic alterations post-NPC development can occur, which may result in a more metastatic disease. Because of it takes years for premalignant lesion after EBV infection to NPC formation (Choi et al, 2011;Ji et al, 2007;Ng et al, 2010;Ng et al, 2005), the long period of pre-clinical detectable phase (PCDP) offer the opportunity for screening and early diagnosis of NPC.…”

“…Screening in Hong-Kong with positive NPC family history was conducted since 1994 Ng et al, 2010;Ng et al, 2005). Participants in this screening program for NPC were all first degree relatives of patients with NPC and they were all 18 years of age or older.…”