Cluster-randomized trial of impact of Epstein-Barr virus serology-based screening on nasopharyngeal carcinoma mortality

Screening for nasopharyngeal carcinoma (NPC) has resulted in an improvement of early detection in endemic regions. It is critical to evaluate whether NPC screening can reduce NPC-specific mortality in the population. In a cluster-randomized trial in China, eight towns were randomly allocated to a screening group and eight towns to a control group. Residents (aged 30-69 years) of the screening towns were invited to undergo serum Epstein-Barr virus (EBV) antibody tests. A significant 30% reduction in NPC-mortality was observed in the screening group compared with the control group (8.2 versus 12.5 NPC deaths per 1,000 person-years; aRR 0.70; p=0.048). This benefit was most evident among individuals aged 50 years and older (aRR 0.56; p=0.007) and was not significant among those younger than 50 years (aRR 0.96; p=0.856). The authors conclude that in this 12-year trial, EBV antibody testing resulted in a significant reduction in NPC mortality.