What is Epstein-Barr Virus and How Can It Impact Cancer Risk?

Most people around the world have had the Epstein-Barr virus (EBV) at some point in their lives. It usually causes mild or no symptoms, so people might not even know they have it. But it can sometimes cause a more serious illness called mononucleosis. Infectious mononucleosis is also called “mono” or “the kissing disease.”

Having a history of EBV and mono can be a risk factor for developing other illnesses, including some types of cancer. If you have had mono, here’s what to know about how it might affect your cancer risk.

What is Epstein-Barr virus?

Epstein-Barr virus is a common human virus. According to the Centers for Disease Control and Prevention (CDC), about 9 out of 10 people have been infected with EBV. It is a type of herpes virus that spreads easily through saliva (spit) and other bodily fluids. Most people get EBV as children.

Even when it causes no symptoms or mild symptoms, EBV stays in the body forever. Usually, the virus stays dormant or inactive and doesn’t cause problems. But EBV can become active and make you sick again. This is called “reactivation.” Certain medications, menopause, and other hormonal changes can make EBV reactivate. So can stress or a weakened immune system.

There is no vaccine to prevent people from getting EBV. And there aren’t any medicines to get rid of an EBV infection. But medicines can be used to help relieve symptoms of mononucleosis that can develop when EBV is active or reactivated.

What is mononucleosis?

Mononucleosis, or mono, is an illness that is most often caused by Epstein-Barr virus. Anyone can get mono. However, it most commonly affects teenagers and young adults between the ages of 14 and 30. Symptoms of mono can range from mild to severe. They typically start 4 to 6 weeks after being exposed to EBV and can last a long time.

How do I know if I have mono or had it in the past?

The symptoms of mono are similar to other contagious illnesses, such as the common cold and the flu. They include:

• Feeling very tired (fatigue)
• Fever
• Sore throat
• Headache
• Lump in the neck, armpit, or groin from swollen lymph nodes
• Muscle pain
• Enlarged liver or spleen
• Rash

Because symptoms of mono are similar to other diseases, it can be hard to know if you have mono or something else. But as with other infections, your immune system responds to an Epstein-Barr virus.

Antibodies are special proteins that help the body fight an infection and recover from it. They are stored in the blood and organs of the immune system. Sometimes antibodies are called “markers.”

If needed, a simple blood test can be done to confirm if you have Epstein-Barr virus antibodies or not. Some health care providers may refer to this as screening. If the blood test shows you do have antibodies specific to Epstein-Barr virus, this means you have had Epstein-Barr virus at some point in the past. Sometimes knowing this information can be helpful when talking with your doctor about the health-related screenings that are recommended for you.   

What impact does Epstein-Barr virus have on cancer? 

Viruses that can cause cancer are called oncogenic viruses or oncoviruses. Epstein-Barr virus, which causes mono, is an oncovirus. This means that having mono or another infection caused by EBV may put you at a higher risk of some types of cancer. EBV infection increases a person’s risk of getting  nasopharyngeal cancer, a type of cancer that affects the nasopharynx, or upper part of the throat. Certain types of lymphoma and stomach cancer have also been linked to EBV.

It is important to remember that most people who have had mono will not develop a cancer related to Epstein-Barr virus. But knowing your risk can help you watch for signs of cancer, especially if you have more than one risk factor.

Watching for signs of nasopharyngeal cancer if you have had mono

New research has shown that screening or testing for past Epstein-Barr virus infections can help find people at a higher risk of developing nasopharyngeal cancer. Along with having a history of EBV, a person’s genes and lifestyle behaviors can increase a person’s risk of nasopharyngeal cancer. 

Some of these risk factors for nasopharyngeal cancer include:

• Tobacco use and exposure to secondhand smoke
• Alcohol use, especially heavy drinking
• Diets with a lot of salt-cured fish and meat
• Infection with the human papillomavirus (HPV)
• Having a family member with nasopharyngeal cancer
• Living in or being from some parts of Asia, North Africa, or the Arctic

“Though EBV-related nasopharyngeal cancer is less common in the United States, people who have had mono or another illness caused by EBV should know they have a higher risk. Watch for symptoms of nasopharyngeal cancer and schedule an appointment with your primary care doctor if you have any concerns,” said Kedar Kirtane, MD, an American Society of Clinical Oncology (ASCO) expert and an oncologist specializing in head and neck cancer at Moffitt Cancer Center.

Dr. Kirtane said to watch for these symptoms:

• Lump in the neck
• Ear pain, ear infections, or hearing problems
• Congestion (stuffy nose)
• Nose bleeds
• Blurred or double vision
• Trouble opening your mouth or talking

Most often, these symptoms are caused by something other than cancer. But if they do not go away, or if they keep coming back, talk to your doctor.

Dr. Kirtane is an Associate Editor on ASCO’s Patient Information Editorial Board.