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

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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 (≥ 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.