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Cancer risk in systemic lupus: An updated international multi-centre cohort study

Bernatsky, Sasha; Ramsey-Goldman, Rosalind; Labrecque, Jeremy; Joseph, Lawrence; Boivin, Jean-Francois; Petri, Michelle; Zoma, Asad; Manzi, Susan; Urowitz, Murray B. and Gladman, Dafna, et al. (2013) In Journal of Autoimmunity 42. p.130-135
Abstract
Objective: To update estimates of cancer risk in SLE relative to the general population. Methods: A multisite international SLE cohort was linked with regional tumor registries. Standardized incidence ratios (SIRs) were calculated as the ratio of observed to expected cancers. Results: Across 30 centres, 16,409 patients were observed for 121,283 (average 7.4) person years. In total, 644 cancers occurred. Some cancers, notably hematologic malignancies, were substantially increased (SIR 3.02, 95% confidence interval, CI, 2.48, 3.63), particularly non-Hodgkin's lymphoma, NHL (SIR 4.39, 95% CI 3.46, 5.49) and leukemia. In addition, increased risks of cancer of the vulva (SIR 3.78, 95% CI 1.52, 7.78), lung (SIR 1.30, 95% CI 1.04, 1.60), thyroid... (More)
Objective: To update estimates of cancer risk in SLE relative to the general population. Methods: A multisite international SLE cohort was linked with regional tumor registries. Standardized incidence ratios (SIRs) were calculated as the ratio of observed to expected cancers. Results: Across 30 centres, 16,409 patients were observed for 121,283 (average 7.4) person years. In total, 644 cancers occurred. Some cancers, notably hematologic malignancies, were substantially increased (SIR 3.02, 95% confidence interval, CI, 2.48, 3.63), particularly non-Hodgkin's lymphoma, NHL (SIR 4.39, 95% CI 3.46, 5.49) and leukemia. In addition, increased risks of cancer of the vulva (SIR 3.78, 95% CI 1.52, 7.78), lung (SIR 1.30, 95% CI 1.04, 1.60), thyroid (SIR 1.76, 95% CI 1.13, 2.61) and possibly liver (SIR 1.87, 95% CI 0.97, 3.27) were suggested. However, a decreased risk was estimated for breast (SIR 0.73, 95% CI 0.61-0.88), endometrial (SIR 0.44, 95% CI 0.23-0.77), and possibly ovarian cancers (0.64, 95% Cl 0.34-1.10). The variability of comparative rates across different cancers meant that only a small increased risk was estimated across all cancers (SIR 1.14, 95% CI 1.05, 1.23). Conclusion: These data estimate only a small increased risk in SLE (versus the general population) for cancer over-all. However, there is clearly an increased risk of NHL and cancers of the vulva, lung, thyroid, and possibly liver. It remains unclear to what extent the association with NHL is mediated by innate versus exogenous factors. Similarly, the etiology of the decreased breast, endometrial, and possibly ovarian cancer risk is uncertain, though investigations are ongoing. (C) 2013 Elsevier Ltd. All rights reserved. (Less)
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publication status
published
subject
keywords
Systemic lupus erythematosus, Epidemiology, Treatment, Disease activity
in
Journal of Autoimmunity
volume
42
pages
130 - 135
publisher
Elsevier
external identifiers
  • wos:000319647900013
  • scopus:84877148183
ISSN
0896-8411
DOI
10.1016/j.jaut.2012.12.009
language
English
LU publication?
yes
id
e4f61ce6-068f-4087-a6a7-a35d1c7a04df (old id 3931165)
date added to LUP
2013-08-01 07:38:33
date last changed
2019-08-14 01:23:49
@article{e4f61ce6-068f-4087-a6a7-a35d1c7a04df,
  abstract     = {Objective: To update estimates of cancer risk in SLE relative to the general population. Methods: A multisite international SLE cohort was linked with regional tumor registries. Standardized incidence ratios (SIRs) were calculated as the ratio of observed to expected cancers. Results: Across 30 centres, 16,409 patients were observed for 121,283 (average 7.4) person years. In total, 644 cancers occurred. Some cancers, notably hematologic malignancies, were substantially increased (SIR 3.02, 95% confidence interval, CI, 2.48, 3.63), particularly non-Hodgkin's lymphoma, NHL (SIR 4.39, 95% CI 3.46, 5.49) and leukemia. In addition, increased risks of cancer of the vulva (SIR 3.78, 95% CI 1.52, 7.78), lung (SIR 1.30, 95% CI 1.04, 1.60), thyroid (SIR 1.76, 95% CI 1.13, 2.61) and possibly liver (SIR 1.87, 95% CI 0.97, 3.27) were suggested. However, a decreased risk was estimated for breast (SIR 0.73, 95% CI 0.61-0.88), endometrial (SIR 0.44, 95% CI 0.23-0.77), and possibly ovarian cancers (0.64, 95% Cl 0.34-1.10). The variability of comparative rates across different cancers meant that only a small increased risk was estimated across all cancers (SIR 1.14, 95% CI 1.05, 1.23). Conclusion: These data estimate only a small increased risk in SLE (versus the general population) for cancer over-all. However, there is clearly an increased risk of NHL and cancers of the vulva, lung, thyroid, and possibly liver. It remains unclear to what extent the association with NHL is mediated by innate versus exogenous factors. Similarly, the etiology of the decreased breast, endometrial, and possibly ovarian cancer risk is uncertain, though investigations are ongoing. (C) 2013 Elsevier Ltd. All rights reserved.},
  author       = {Bernatsky, Sasha and Ramsey-Goldman, Rosalind and Labrecque, Jeremy and Joseph, Lawrence and Boivin, Jean-Francois and Petri, Michelle and Zoma, Asad and Manzi, Susan and Urowitz, Murray B. and Gladman, Dafna and Fortin, Paul R. and Ginzler, Ellen and Yelin, Edward and Bae, Sang-Cheol and Wallace, Daniel J. and Edworthy, Steven and Jacobsen, Soren and Gordon, Caroline and Dooley, Mary Anne and Peschken, Christine A. and Hanly, John G. and Alarcon, Graciela S. and Nived, Ola and Ruiz-Irastorza, Guillermo and Isenberg, David and Rahman, Anisur and Witte, Torsten and Aranow, Cynthia and Kamen, Diane L. and Steinsson, Kristjan and Askanase, Anca and Barr, Susan and Criswell, Lindsey A. and Sturfelt, Gunnar and Patel, Neha M. and Senecal, Jean-Luc and Zummer, Michel and Pope, Janet E. and Ensworth, Stephanie and El-Gabalawy, Hani and McCarthy, Timothy and Dreyer, Lene and Sibley, John and St Pierre, Ivan and Clarke, Ann E.},
  issn         = {0896-8411},
  keyword      = {Systemic lupus erythematosus,Epidemiology,Treatment,Disease activity},
  language     = {eng},
  pages        = {130--135},
  publisher    = {Elsevier},
  series       = {Journal of Autoimmunity},
  title        = {Cancer risk in systemic lupus: An updated international multi-centre cohort study},
  url          = {http://dx.doi.org/10.1016/j.jaut.2012.12.009},
  volume       = {42},
  year         = {2013},
}