Epstein-Barr virus (EBV) DNA presence in plasma samples may predict nasopharyngeal carcinoma in high-risk populations, according to a study published in The New England Journal of Medicine.1

Liquid biopsies are increasingly used in clinical oncology to predict disease recurrence, but less often as a screening tool for early cancers. Nasopharyngeal carcinoma, which occurs in up to 35 persons per 100,000 in high-risk populations, is associated with EBV.

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For this prospective study (ClinicalTrials.gov Identifier: NCT02063399), researchers analyzed plasma specimens from 20,174 participants to determine whether screening for EBV could effectively detect asymptomatic, early nasopharyngeal carcinoma.

Just over 1100 participants were positive for EBV in plasma samples at baseline; 309 of these patients were EBV-positive at the median follow-up testing of 34 days.

Of the 309 patients with persistent EBV, 300 underwent nasal endoscopy; nasopharyngeal carcinoma was diagnosed in 34 of these patients. Seventy-one percent of these patients were diagnosed with stage I or II disease.

Of the 9 patients who refused further testing, 1 was diagnosed with advanced disease 32 months after enrolling in the study. This patient died 2 months post-diagnosis.

The cost of each liquid biopsy for EBV is 30 USD.

RELATED: Uric Acid May Mark Nasopharyngeal Cancer Progression

The authors concluded that these results show “the potential of analysis of circulating DNA to screen for early nasopharyngeal cancer. Even small tumors could release sufficient amounts of DNA into the circulation to allow sensitive detection.”


  1. Allen Chan KC, Woo JK, King A, et al. Analysis of plasma Epstein–Barr virus DNA to screen for nasopharyngeal cancer. N Engl J Med. 2017;377:513-22. doi: 10.1056/NEJMoa1701717