Epstein–Barr Virus and Nasopharyngeal Cancer

To the Editor: The thought-provoking results of Pathmanathan et al. (Sept. 14 issue) 1 concerning the role of Epstein–Barr virus (EBV) in nasopharyngeal cancer are of great interest and may have therapeutic implications, especially in areas of the world where the disease is endemic. There is, however, one point I would like clarified. Do the investigators hold that the only evolutionary path for nasopharyngeal cancer is through infection of an epithelial stem cell followed by transformation, clonal expansion, and development into metastatic cancer? From their study, this would seem to be the case, since the episomal EBV DNA in each case . . .