Burkitt’s lymphoma: incidence among IICC-3 risk-assessed countries emphasizing the Middle East with new data from Iraqi Kurdistan

Background: Burkitt's lymphoma (BL) is rare, with variations in regional incidence related with the age of Epstein-Barr virus (EBV) infection. This study examined the age-specific incidence rate (ASIR) of BL and the age of community EBV infection in Northern Iraq and other countries tabulated in the WHO IICC-3. Materials and Methods The ASIR and 95% confidence interval (95%CI) of BL in Sulaimani Governorate were calculated for the years 2010—2020. Tumor EBV latency was determined by in situ hybridization for EBV-encoded mRNA (EBER). Specimens from 515 outpatients were tested for IgG antibodies to EBV viral capsid antigen (VCA). Results In the Middle East, BL is predominantly a pediatric tumor, with an ASIR in Sulaimani of 6.2 (4.7–7.7) per million children. This ASIR is not significantly different than that of Egypt, Morocco, Israel, Spain, and France. It is slightly higher than the ASIR of the United States, the United Kingdom, and Germany and markedly higher than for Asia and South Africa. In Africa and much of Asia, EBV is acquired in early childhood. In Sulaimani, EBV seropositivity develops in late childhood and early adolescence. In Europe and North America, seropositivity is acquired in adolescents and young adults (AYD). In countries with AYD infections, adult predominates over childhood BL. Conclusions Early childhood EBV infections associate with low rates of childhood BL and few adult BL. In the Middle East, childhood BL is relatively common while adult BL is rare. In our region, half of EBV infections is found in late childhood. This may reflect the Mid East more widely. The high childhood/low adult BL rates may be a regional influence of EBV exposure intermediate between early childhood and AYD infections.