Skip to main content
PMC home page
British Journal of Cancer logoLink to British Journal of Cancer
. 1999 May 1;80(3-4):604–608. doi: 10.1038/sj.bjc.6690398

Effect of material deprivation on Epstein–Barr virus infection in Hodgkin's disease in the West Midlands

K Flavell 1, C Constandinou 1, D Lowe 1, K Scott 2, C Newey 3, D Evans 3, A Dutton 1, S Simmons 1, R Smith 4, J Crocker 5, L S Young 6, P Murray 1,6
PMCID: PMC2362323  PMID: 10408873

Abstract

We have used Townsend scores from postcode data to compare levels of material deprivation and Epstein–Barr virus (EBV)-positivity for 223 patients diagnosed with Hodgkin's disease (HD) in the period 1981–1997. The presence of EBV in HD tumours was determined using in situ hybridization to target the abundantly expressed EBV early RNAs. EBV was detected in the malignant Hodgkin and Reed–Sternberg cells in 47/223 HD cases (21%). There was found to be a tendency for higher Townsend scores (indicative of higher levels of material deprivation) in EBV-positive HD patients, but this association was not statistically significant. When various subgroups of patients from the study were examined separately the indication of higher Townsend scores in EBV-positive patients was found to be more marked for patients with mixed cellularity disease (P= 0.09) and for females (P= 0.03). The results of this study suggest that differences in the level of material deprivation are important in determining the likelihood of EBV-positive HD in the UK, particularly for certain subgroups of patients. It is not known what specific socioeconomic factors are responsible for these differences, although alterations in the timing or rate of primary EBV infection, or decline in the level of EBV-specific immunity, may be important. © 1999 Cancer Research Campaign

Keywords: Epstein–Barr virus, Hodgkin's disease, Townsend score, material deprivation

Full Text

The Full Text of this article is available as a PDF (91.5 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alexander F. E., Daniel C. P., Armstrong A. A., Clark D. A., Onions D. E., Cartwright R. A., Jarrett R. F. Case clustering, Epstein-Barr virus Reed-Sternberg cell status and herpes virus serology in Hodgkin's disease: results of a case-control study. Eur J Cancer. 1995;31A(9):1479–1486. doi: 10.1016/0959-8049(95)00117-2. [DOI] [PubMed] [Google Scholar]
  2. Ambinder R. F., Browning P. J., Lorenzana I., Leventhal B. G., Cosenza H., Mann R. B., MacMahon E. M., Medina R., Cardona V., Grufferman S. Epstein-Barr virus and childhood Hodgkin's disease in Honduras and the United States. Blood. 1993 Jan 15;81(2):462–467. [PubMed] [Google Scholar]
  3. Anagnostopoulos I., Herbst H., Niedobitek G., Stein H. Demonstration of monoclonal EBV genomes in Hodgkin's disease and Ki-1-positive anaplastic large cell lymphoma by combined Southern blot and in situ hybridization. Blood. 1989 Aug 1;74(2):810–816. [PubMed] [Google Scholar]
  4. Armstrong A. A., Alexander F. E., Cartwright R., Angus B., Krajewski A. S., Wright D. H., Brown I., Lee F., Kane E., Jarrett R. F. Epstein-Barr virus and Hodgkin's disease: further evidence for the three disease hypothesis. Leukemia. 1998 Aug;12(8):1272–1276. doi: 10.1038/sj.leu.2401097. [DOI] [PubMed] [Google Scholar]
  5. Armstrong A. A., Shield L., Gallagher A., Jarrett R. F. Lack of involvement of known oncogenic DNA viruses in Epstein-Barr virus-negative Hodgkin's disease. Br J Cancer. 1998 Apr;77(7):1045–1047. doi: 10.1038/bjc.1998.174. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Barletta J. M., Kingma D. W., Ling Y., Charache P., Mann R. B., Ambinder R. F. Rapid in situ hybridization for the diagnosis of latent Epstein-Barr virus infection. Mol Cell Probes. 1993 Apr;7(2):105–109. doi: 10.1006/mcpr.1993.1014. [DOI] [PubMed] [Google Scholar]
  7. Bernard S. M., Cartwright R. A., Darwin C. M., Richards I. D., Roberts B., O'Brien C., Bird C. C. Hodgkin's disease: case control epidemiological study in Yorkshire. Br J Cancer. 1987 Jan;55(1):85–90. doi: 10.1038/bjc.1987.18. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Bithell J. F., Dutton S. J., Neary N. M., Vincent T. J. Controlling for socioeconomic confounding using regression methods. J Epidemiol Community Health. 1995 Dec;49 (Suppl 2):S15–S19. doi: 10.1136/jech.49.suppl_2.s15. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Carr-Hill R. A., Sheldon T. Designing a deprivation payment for general practitioners: the UPA(8) wonderland. BMJ. 1991 Feb 16;302(6773):393–396. doi: 10.1136/bmj.302.6773.393. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Carstairs V. Multiple deprivation and health state. Community Med. 1981 Feb;3(1):4–13. [PubMed] [Google Scholar]
  11. Carstairs V. Small area analysis and health service research. Community Med. 1981 May;3(2):131–139. [PubMed] [Google Scholar]
  12. Chang K. L., Albújar P. F., Chen Y. Y., Johnson R. M., Weiss L. M. High prevalence of Epstein-Barr virus in the Reed-Sternberg cells of Hodgkin's disease occurring in Peru. Blood. 1993 Jan 15;81(2):496–501. [PubMed] [Google Scholar]
  13. Correa P., O'Conor G. T. Epidemiologic patterns of Hodgkin's disease. Int J Cancer. 1971 Sep 15;8(2):192–201. doi: 10.1002/ijc.2910080203. [DOI] [PubMed] [Google Scholar]
  14. Frizzera G. The distinction of Hodgkin's disease from anaplastic large cell lymphoma. Semin Diagn Pathol. 1992 Nov;9(4):291–296. [PubMed] [Google Scholar]
  15. Glaser S. L., Lin R. J., Stewart S. L., Ambinder R. F., Jarrett R. F., Brousset P., Pallesen G., Gulley M. L., Khan G., O'Grady J. Epstein-Barr virus-associated Hodgkin's disease: epidemiologic characteristics in international data. Int J Cancer. 1997 Feb 7;70(4):375–382. doi: 10.1002/(sici)1097-0215(19970207)70:4<375::aid-ijc1>3.0.co;2-t. [DOI] [PubMed] [Google Scholar]
  16. Gulley M. L., Eagan P. A., Quintanilla-Martinez L., Picado A. L., Smir B. N., Childs C., Dunn C. D., Craig F. E., Williams J. W., Jr, Banks P. M. Epstein-Barr virus DNA is abundant and monoclonal in the Reed-Sternberg cells of Hodgkin's disease: association with mixed cellularity subtype and Hispanic American ethnicity. Blood. 1994 Mar 15;83(6):1595–1602. [PubMed] [Google Scholar]
  17. Gutensohn N., Cole P. Childhood social environment and Hodgkin's disease. N Engl J Med. 1981 Jan 15;304(3):135–140. doi: 10.1056/NEJM198101153040302. [DOI] [PubMed] [Google Scholar]
  18. Gutensohn N., Cole P. Epidemiology of Hodgkin's disease. Semin Oncol. 1980 Jun;7(2):92–102. [PubMed] [Google Scholar]
  19. Hansmann M. L., Küppers R. Pathology and "molecular histology' of Hodgkin's disease and the border to non-Hodgkin's lymphomas. Baillieres Clin Haematol. 1996 Sep;9(3):459–477. doi: 10.1016/s0950-3536(96)80021-7. [DOI] [PubMed] [Google Scholar]
  20. Harris N. L., Jaffe E. S., Stein H., Banks P. M., Chan J. K., Cleary M. L., Delsol G., De Wolf-Peeters C., Falini B., Gatter K. C. A revised European-American classification of lymphoid neoplasms: a proposal from the International Lymphoma Study Group. Blood. 1994 Sep 1;84(5):1361–1392. [PubMed] [Google Scholar]
  21. Herbst H., Dallenbach F., Hummel M., Niedobitek G., Finn T., Young L. S., Rowe M., Müller-Lantzsch N., Stein H. Epstein-Barr virus DNA and latent gene products in Ki-1 (CD30)-positive anaplastic large cell lymphomas. Blood. 1991 Nov 15;78(10):2666–2673. [PubMed] [Google Scholar]
  22. Herbst H., Steinbrecher E., Niedobitek G., Young L. S., Brooks L., Müller-Lantzsch N., Stein H. Distribution and phenotype of Epstein-Barr virus-harboring cells in Hodgkin's disease. Blood. 1992 Jul 15;80(2):484–491. [PubMed] [Google Scholar]
  23. Hummel M., Anagnostopoulos I., Dallenbach F., Korbjuhn P., Dimmler C., Stein H. EBV infection patterns in Hodgkin's disease and normal lymphoid tissue: expression and cellular localization of EBV gene products. Br J Haematol. 1992 Dec;82(4):689–694. doi: 10.1111/j.1365-2141.1992.tb06945.x. [DOI] [PubMed] [Google Scholar]
  24. Jarrett R. F., Gallagher A., Jones D. B., Alexander F. E., Krajewski A. S., Kelsey A., Adams J., Angus B., Gledhill S., Wright D. H. Detection of Epstein-Barr virus genomes in Hodgkin's disease: relation to age. J Clin Pathol. 1991 Oct;44(10):844–848. doi: 10.1136/jcp.44.10.844. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Leoncini L., Spina D., Nyong'o A., Abinya O., Minacci C., Disanto A., De Luca F., De Vivo A., Sabattini E., Poggi S. Neoplastic cells of Hodgkin's disease show differences in EBV expression between Kenya and Italy. Int J Cancer. 1996 Mar 15;65(6):781–784. doi: 10.1002/(SICI)1097-0215(19960315)65:6<781::AID-IJC13>3.0.CO;2-7. [DOI] [PubMed] [Google Scholar]
  26. Levine P. H., Pallesen G., Ebbesen P., Harris N., Evans A. S., Müeller N. Evaluation of Epstein-Barr virus antibody patterns and detection of viral markers in the biopsies of patients with Hodgkin's disease. Int J Cancer. 1994 Oct 1;59(1):48–50. doi: 10.1002/ijc.2910590111. [DOI] [PubMed] [Google Scholar]
  27. Linden M. D., Fishleder A. J., Katzin W. E., Tubbs R. R. Absence of B-cell or T-cell clonal expansion in nodular, lymphocyte predominant Hodgkin's disease. Hum Pathol. 1988 May;19(5):591–594. doi: 10.1016/s0046-8177(88)80210-7. [DOI] [PubMed] [Google Scholar]
  28. MacMahon B. Epidemiology of Hodgkin's disease. Cancer Res. 1966 Jun;26(6):1189–1201. [PubMed] [Google Scholar]
  29. Morris R., Carstairs V. Which deprivation? A comparison of selected deprivation indexes. J Public Health Med. 1991 Nov;13(4):318–326. [PubMed] [Google Scholar]
  30. Mueller N., Evans A., Harris N. L., Comstock G. W., Jellum E., Magnus K., Orentreich N., Polk B. F., Vogelman J. Hodgkin's disease and Epstein-Barr virus. Altered antibody pattern before diagnosis. N Engl J Med. 1989 Mar 16;320(11):689–695. doi: 10.1056/NEJM198903163201103. [DOI] [PubMed] [Google Scholar]
  31. Muir K. R., Parkes S. E., Mann J. R., Stevens M. C., Cameron A. H. Childhood cancer in the West Midlands: incidence and survival, 1980-1984, in a multi-ethnic population. Clin Oncol (R Coll Radiol) 1992 May;4(3):177–182. doi: 10.1016/s0936-6555(05)81083-0. [DOI] [PubMed] [Google Scholar]
  32. Murray P. G., Swinnen L. J., Constandinou C. M., Pyle J. M., Carr T. J., Hardwick J. M., Ambinder R. F. BCL-2 but not its Epstein-Barr virus-encoded homologue, BHRF1, is commonly expressed in posttransplantation lymphoproliferative disorders. Blood. 1996 Jan 15;87(2):706–711. [PubMed] [Google Scholar]
  33. Murray P. G., Young L. S., Rowe M., Crocker J. Immunohistochemical demonstration of the Epstein-Barr virus-encoded latent membrane protein in paraffin sections of Hodgkin's disease. J Pathol. 1992 Jan;166(1):1–5. doi: 10.1002/path.1711660102. [DOI] [PubMed] [Google Scholar]
  34. Pallesen G., Hamilton-Dutoit S. J., Rowe M., Young L. S. Expression of Epstein-Barr virus latent gene products in tumour cells of Hodgkin's disease. Lancet. 1991 Feb 9;337(8737):320–322. doi: 10.1016/0140-6736(91)90943-j. [DOI] [PubMed] [Google Scholar]
  35. Reading R., Openshaw S. Do inaccuracies in small area deprivation analyses matter? J Epidemiol Community Health. 1993 Jun;47(3):238–241. doi: 10.1136/jech.47.3.238. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. SHIMKIN M. B. Hodgkin's disease; mortality in the United States, 1921-1951; race, sex and age distribution; comparison with leukemia. Blood. 1955 Dec;10(12):1214–1227. [PubMed] [Google Scholar]
  37. Stein H., Herbst H., Anagnostopoulos I., Niedobitek G., Dallenbach F., Kratzsch H. C. The nature of Hodgkin and Reed-Sternberg cells, their association with EBV, and their relationship to anaplastic large-cell lymphoma. Ann Oncol. 1991 Feb;2 (Suppl 2):33–38. doi: 10.1007/978-1-4899-7305-4_5. [DOI] [PubMed] [Google Scholar]
  38. Stiller C. A., McKinney P. A., Bunch K. J., Bailey C. C., Lewis I. J. Childhood cancer and ethnic group in Britain: a United Kingdom children's Cancer Study Group (UKCCSG) study. Br J Cancer. 1991 Sep;64(3):543–548. doi: 10.1038/bjc.1991.347. [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Stoler M. H., Nichols G. E., Symbula M., Weiss L. M. Lymphocyte predominance Hodgkin's disease. Evidence for a kappa light chain-restricted monotypic B-cell neoplasm. Am J Pathol. 1995 Apr;146(4):812–818. [PMC free article] [PubMed] [Google Scholar]
  40. Weinreb M., Day P. J., Niggli F., Green E. K., Nyong'o A. O., Othieno-Abinya N. A., Riyat M. S., Raafat F., Mann J. R. The consistent association between Epstein-Barr virus and Hodgkin's disease in children in Kenya. Blood. 1996 May 1;87(9):3828–3836. [PubMed] [Google Scholar]
  41. Weinreb M., Day P. J., Niggli F., Powell J. E., Raafat F., Hesseling P. B., Schneider J. W., Hartley P. S., Tzortzatou-Stathopoulou F., Khalek E. R. The role of Epstein-Barr virus in Hodgkin's disease from different geographical areas. Arch Dis Child. 1996 Jan;74(1):27–31. doi: 10.1136/adc.74.1.27. [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Weiss L. M., Chen Y. Y., Liu X. F., Shibata D. Epstein-Barr virus and Hodgkin's disease. A correlative in situ hybridization and polymerase chain reaction study. Am J Pathol. 1991 Dec;139(6):1259–1265. [PMC free article] [PubMed] [Google Scholar]
  43. Weiss L. M., Strickler J. G., Warnke R. A., Purtilo D. T., Sklar J. Epstein-Barr viral DNA in tissues of Hodgkin's disease. Am J Pathol. 1987 Oct;129(1):86–91. [PMC free article] [PubMed] [Google Scholar]
  44. Wu T. C., Mann R. B., Charache P., Hayward S. D., Staal S., Lambe B. C., Ambinder R. F. Detection of EBV gene expression in Reed-Sternberg cells of Hodgkin's disease. Int J Cancer. 1990 Nov 15;46(5):801–804. doi: 10.1002/ijc.2910460509. [DOI] [PubMed] [Google Scholar]
  45. Zhou X. G., Hamilton-Dutoit S. J., Yan Q. H., Pallesen G. The association between Epstein-Barr virus and Chinese Hodgkin's disease. Int J Cancer. 1993 Sep 30;55(3):359–363. doi: 10.1002/ijc.2910550303. [DOI] [PubMed] [Google Scholar]

Articles from British Journal of Cancer are provided here courtesy of Cancer Research UK

RESOURCES