Epstein-Barr virus-attributable cancers among children and adolescents in Europe and North America: a meta-analysis

Abstract

Background Epstein-Barr virus (EBV), a common childhood infection, is associated with Burkitt lymphoma, Hodgkin lymphoma, and nasopharyngeal cancer. We estimated the proportion and number of cancers attributable to EBV among individuals aged ≤19 years in Europe and North America in 2022. Methods Embase and MEDLINE were searched from inception to August 25th, 2025. Cancer incidence was derived from GLOBOCAN. We included studies where cancer tissue from ≥8 individuals aged ≤19 years residing in Europe or North America were tested for EBV. Pooled EBV prevalence and 95% confidence intervals (CIs) were estimated using random-effects models. To obtain EBV-attributable cases, pooled prevalence was multiplied by cancer incidence. Results After screening 17,388 titles/abstracts and 1,084 full-texts, 53 studies met the inclusion criteria for Burkitt lymphoma (9 studies, 433 cases), Hodgkin lymphoma (40 studies, 3197 cases), and nasopharyngeal cancer (4 studies, 62 cases). The pooled prevalence of EBV was 19.7% (CI: 10.2–34.7%, I2=69.5%) in Burkitt lymphoma, 33.4% (CI: 27.4–40.0%, I2=75.6%) in Hodgkin lymphoma, and 96.8% (CI: 88.0–99.2%, I2=0.0) in nasopharyngeal cancer. An estimated 1,166 (2.8%) of 41,366 cancers diagnosed in 2022, were attributable to EBV. These cases comprised 899 Hodgkin lymphomas, 140 Burkitt lymphomas, and 127 nasopharyngeal cancers. The burden was higher among males (3.2% vs 2.3% for females) and those aged 10–14 years (5.0% vs 1.7% for 0–9-year-olds and 3.1% for 15-19-year-olds). Conclusion In 2022, 2.8% of childhood cancers diagnosed in Europe and North America were attributable to EBV.