Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Risk factors for Hodgkin’s disease by Epstein-Barr virus (EBV) status: prior infection by EBV and other agents

This article has been updated


A UK population-based case–control study of Hodgkin’s disease (HD) in young adults (16–24 years) included 118 cases and 237 controls matched on year of birth, gender and county of residence. The majority (103) of the cases were classified by Epstein–Barr virus (EBV) status (EBV present in Reed–Stenberg cells), with 19 being EBV-positive. Analyses using conditional logistic regression are presented of subject reports of prior infectious disease (infectious mononucleosis (IM), chicken pox, measles, mumps, pertussis and rubella). In these analyses HD cases are compared with matched controls, EBV-positive cases and EBV-negative cases are compared separately with their controls and formal tests of differences of association by EBV status are applied. A prior history of IM was positively associated with HD (odds ratio (OR) = 2.43, 95% confidence interval (CI) = 1.10–5.33) and with EBV-positive HD (OR = 9.16, 95% CI = 1.07–78.31) and the difference between EBV-positive and EBV-negative HD was statistically significant (P = 0.013). The remaining infectious illnesses (combined) were negatively associated with HD, EBV-positive HD and EBV-negative HD (in the total series, for ≥2 episodes compared with ≤1, OR = 0.45, 95% CI = 0.25–0.83). These results support previous evidence that early exposure to infection protects against HD and that IM increases subsequent risk; the comparisons of EBV-positive and EBV-negative HD are new and generate hypotheses for further study.

Change history

  • 16 November 2011

    This paper was modified 12 months after initial publication to switch to Creative Commons licence terms, as noted at publication


  1. Armstrong AA, Weiss LM, Gallagher A, Jones DB, Krajewski AS, Angus B, Brown G, Jack AS, Wilkins BS and Onions DE (1992) Criteria for the definition of Epstein–Barr virus association in Hodgkin’s disease. Leukemia 6: 869–874

    CAS  PubMed  Google Scholar 

  2. Carter CD, Brown TMJn, Herbert JT and Heath CW (1977) Cancer incidence following infectious mononucleosis. Am J Epidemiol 105: 30

    CAS  Article  Google Scholar 

  3. Cartwright RA, Alexander FE, McKinney PA, Ricketts TJ, Hayhoe FGJ and Clayton DGC (1990). Leukaemia and Lymphoma: An Atlas of Distribution Within Areas of England and Wales, 1984–88, Leukaemia Research Fund: London

    Google Scholar 

  4. Clayton D and Hills M (eds) (1993). Statistical Methods in Epidemiology, Oxford University Press: New York

    Google Scholar 

  5. Connelly RR and Christine BW (1974) A cohort study of cancer following infectious mononucleosis. Cancer Res 34: 1172

    CAS  PubMed  Google Scholar 

  6. Glaser SL, Lin RJ, Stewart SL, Ambinder RF, Jarrett RF, Brousset P, Pallesen G, Gulley ML, Khan G, OGrady J, Hummel M, Preciado MV, Knecht H, Chan JKC and Claviez A (1997) Epstein–Barr virus-associated Hodgkin’s disease: epidemiologic characteristics in international data. Int J Cancer 70: 375–382

    CAS  Article  Google Scholar 

  7. Gutensohn N and Cole P (1980) Epidemiology of Hodgkin’s disease. Semin Oncol 7: 92

    CAS  PubMed  Google Scholar 

  8. Jarman B, Townsend P and Carstairs V (1991) Deprivation indices. Br J Med 303: 523

    CAS  Article  Google Scholar 

  9. Jarrett RF, Armstrong AA and Alexander FE (1996) Epidemiology of EBV and Hodgkin’s lymphoma. Ann Oncol 7: S5–S10

    Article  Google Scholar 

  10. Kvale G, Hoiby EA and Pedersen E (1979) Hodgkin’s disease in patients with previous infectious mononucleosis. Int J Cancer 23: 593

    CAS  Article  Google Scholar 

  11. Levine R, Zhu KM, Gu Y, Brann E, Hall I, Caplan L and Baum M (1998) Self-reported infectious mononucleosis and 6 cancers. A population based case–control study. Scand J Inf Dis 30: 211–214

    CAS  Article  Google Scholar 

  12. Mack TM, Cozen W, Shibata DK, Weiss LM, Nathwani BN, Hernandez AM, Taylor CR, Hamilton AS, Deapen DM and Rappaport EB (1995) Concordance for Hodgkin’s disease in identical twins suggesting genetic susceptibility to the young adult form of the disease. N Engl J Med 332: 413–418

    CAS  Article  Google Scholar 

  13. MacMahon M (1966) Epidemiology of Hodgkin’s disease. Cancer Res 26: 1189

    CAS  PubMed  Google Scholar 

  14. Miller RW and Beebe GW (1973) Infectious mononucleosis and the empirical risk of cancer. J Natl Cancer Inst 50: 315

    CAS  Article  Google Scholar 

  15. Michels KB (1995) The origins of Hodgkin’s disease. Eur J Cancer Prev 4: 379–388

    CAS  Article  Google Scholar 

  16. Mueller NE (1996) Hodgkin’s disease. In: Cancer Epidemiology and Prevention, Schottenfield D, Fraumeni JF Jr (eds) Oxford University Press: New York

    Google Scholar 

  17. Mueller NE and Grufferman S (1999) Epidemiology. In: Hodgkin’s Disease, Mauch P, Armitage J, Diehl V, Hoppe R, Weiss L (eds) Raven Press: New York

    Google Scholar 

  18. Munoz N, Davidson RJL, Witthoff B, Ericsson JE and De-The G (1978) Infectious mononucleosis and Hodgkin’s disease. Int J Cancer 22: 10

    CAS  Article  Google Scholar 

  19. Paffenbarger RS R. S. Jn, Wing AL and Hyde RT (1977) Characteristics in youth indicative of adult-onset Hodgkin’s disease. J Natl Cancer Inst 58: 1489

    Article  Google Scholar 

  20. Pallesen G, Hamilton-Dutoit SJ, Rowe M and Young LS (1991) Expression of Epstein–Barr virus latent gene products in tumour cells of Hodgkin’s disease. Lancet 337: 320–322

    CAS  Article  Google Scholar 

  21. Rosdahl N, Larsen SO and Clemmenson J (1974) Hodgkin’s disease in patients with infectious mononucleosis: 30 years experience. Br Med J 2: 253

    CAS  Article  Google Scholar 

  22. Sleckman BG, Mauch PM, Ambinder RF, Mann R, Pinkus GS, Kadin ME, Sherburne B, PerezAtayde A, Thior I and Mueller N (1998) Correlation between EBV-status and risk factor profile in Hodgkin’s disease. Cancer Epidemiol Biomark Prev 7: 1117–1121

    CAS  Google Scholar 

  23. Weiss LM, Strickler JG, Warnke RA, Purtilo DT and Sklar J (1987) Epstein–Barr viral DNA in tissues of Hodgkin’s disease. Am J Pathol 129: 86–91

    CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information



Rights and permissions

From twelve months after its original publication, this work is licensed under the Creative Commons Attribution-NonCommercial-Share Alike 3.0 Unported License. To view a copy of this license, visit

Reprints and Permissions

About this article

Cite this article

Alexander, F., Jarrett, R., Lawrence, D. et al. Risk factors for Hodgkin’s disease by Epstein-Barr virus (EBV) status: prior infection by EBV and other agents. Br J Cancer 82, 1117–1121 (2000).

Download citation


  • Hodgkin's disease
  • Epstein–Barr virus
  • aetiology
  • late host exposure model
  • infectious agents

Further reading


Quick links