Epidemiology and population screening

Nasopharyngeal carcinoma (NPC) is uncommon with a unique geographical distribution. The age-standardized incidence ranges from below 1 in nonendemic areas to 25+/100,000 person-years in endemic regions, and has decreased without specific primary prevention in the past four decades. We have found that smoking is likely a causal factor, family history of NPC a strong risk factor, while vitamin D and milk consumption, and better socioeconomic status, could be protective. The interaction between genetic factors, Epstein-Barr virus (EBV) infection, and environmental and lifestyle risk factors (classical and novel) warrants further investigation using more vigorous methods. Screening by EBV serological markers and circulating EBV DNA in asymptomatic Chinese men has identified NPC cases at earlier stages and with better survival than a historical cohort in Southern China. Further trials and assessment are needed. International or multicenter collaborations on individual data meta-analysis of case-control and cohort studies are warranted.