Sasha Bernatsky1,2, Ann E Clarke3,4, Omid Zahedi Niaki3,4, Jeremy Labrecque3,4, Laura E Schanberg3,4, Earl D Silverman3,4, Kristen Hayward3,4, Lisa Imundo3,4, Hermine I Brunner3,4, Kathleen A Haines3,4, Randy Q Cron3,4, Kiem Oen3,4, Linda Wagner-Weiner3,4, Alan M Rosenberg3,4, Kathleen M O'Neil3,4, Ciarán M Duffy3,4, Emily von Scheven3,4, Lawrence Joseph3,4, Jennifer L Lee3,4, Rosalind Ramsey-Goldman3,4. 1. From the Research Institute of the McGill University Health Centre, Montreal, Quebec; University of Calgary, Calgary, Alberta; The Hospital for Sick Children, Hospital for Sick Children Research Institute, University of Toronto, Toronto; Children's Hospital of Eastern Ontario, Ottawa, Ontario; University of Manitoba, Winnipeg, Manitoba; University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Duke University Medical Center, Durham, North Carolina; Seattle Children's Hospital, Seattle, Washington; Columbia University Medical Center, New York, New York; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Hackensack University Medical Center, Hackensack, New Jersey; University of Alabama at Birmingham, Birmingham, Alabama; University of Chicago; Northwestern University Feinberg School of Medicine, Chicago, Illinois; Riley Hospital for Children, Indianapolis, Indiana; University of California, San Francisco, San Francisco, California, USA. sasha.bernatsky@mcgill.ca. 2. S. Bernatsky, MD, PhD, Research Institute of the McGill University Health Centre; A.E. Clarke, MD, MSc, University of Calgary; O. Zahedi Niaki, MD, Research Institute of the McGill University Health Centre; J. Labrecque, MSc, Research Institute of the McGill University Health Centre; L.E. Schanberg, MD, Duke University Medical Center; E.D. Silverman, MD, The Hospital for Sick Children, Hospital for Sick Children Research Institute, University of Toronto; K. Hayward, MD, Seattle Children's Hospital; L. Imundo, MD, Columbia University Medical Center; H.I. Brunner, MD, MSc, MBA, Cincinnati Children's Hospital Medical Center; K.A. Haines, MD, Hackensack University Medical Center; R.Q. Cron, MD, PhD, University of Alabama at Birmingham; K. Oen, MD, University of Manitoba; L. Wagner-Weiner, MD, MS, University of Chicago; A.M. Rosenberg, BA, MD, University of Saskatchewan; K.M. O'Neil, MD, Riley Hospital for Children; C.M. Duffy, MB, BCh, MSc, Children's Hospital of Eastern Ontario; E. von Scheven, MD, University of California; L. Joseph, PhD, Research Institute of the McGill University Health Centre; J.L. Lee, BSc, Research Institute of the McGill University Health Centre; R. Ramsey-Goldman, MD, DrPH, Northwestern University Feinberg School of Medicine. sasha.bernatsky@mcgill.ca. 3. From the Research Institute of the McGill University Health Centre, Montreal, Quebec; University of Calgary, Calgary, Alberta; The Hospital for Sick Children, Hospital for Sick Children Research Institute, University of Toronto, Toronto; Children's Hospital of Eastern Ontario, Ottawa, Ontario; University of Manitoba, Winnipeg, Manitoba; University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Duke University Medical Center, Durham, North Carolina; Seattle Children's Hospital, Seattle, Washington; Columbia University Medical Center, New York, New York; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Hackensack University Medical Center, Hackensack, New Jersey; University of Alabama at Birmingham, Birmingham, Alabama; University of Chicago; Northwestern University Feinberg School of Medicine, Chicago, Illinois; Riley Hospital for Children, Indianapolis, Indiana; University of California, San Francisco, San Francisco, California, USA. 4. S. Bernatsky, MD, PhD, Research Institute of the McGill University Health Centre; A.E. Clarke, MD, MSc, University of Calgary; O. Zahedi Niaki, MD, Research Institute of the McGill University Health Centre; J. Labrecque, MSc, Research Institute of the McGill University Health Centre; L.E. Schanberg, MD, Duke University Medical Center; E.D. Silverman, MD, The Hospital for Sick Children, Hospital for Sick Children Research Institute, University of Toronto; K. Hayward, MD, Seattle Children's Hospital; L. Imundo, MD, Columbia University Medical Center; H.I. Brunner, MD, MSc, MBA, Cincinnati Children's Hospital Medical Center; K.A. Haines, MD, Hackensack University Medical Center; R.Q. Cron, MD, PhD, University of Alabama at Birmingham; K. Oen, MD, University of Manitoba; L. Wagner-Weiner, MD, MS, University of Chicago; A.M. Rosenberg, BA, MD, University of Saskatchewan; K.M. O'Neil, MD, Riley Hospital for Children; C.M. Duffy, MB, BCh, MSc, Children's Hospital of Eastern Ontario; E. von Scheven, MD, University of California; L. Joseph, PhD, Research Institute of the McGill University Health Centre; J.L. Lee, BSc, Research Institute of the McGill University Health Centre; R. Ramsey-Goldman, MD, DrPH, Northwestern University Feinberg School of Medicine.
Abstract
OBJECTIVE: To determine cancer incidence in a large pediatric-onset systemic lupus erythematosus (SLE) population. METHODS: Data were examined from 12 pediatric SLE registries in North America. Patients were linked to their regional cancer registries to detect cancers observed after cohort entry, defined as date first seen in the clinic. The expected number of malignancies was obtained by multiplying the person-years in the cohort (defined from cohort entry to end of followup) by the geographically matched age-, sex-, and calendar year-specific cancer rates. The standardized incidence ratio (SIR; ratio of cancers observed to expected) was generated, with 95% CI. RESULTS: A total of 1168 patients were identified from the registries. The mean age at cohort entry was 13 years (SD 3.3), and 83.7% of the subjects were female. The mean duration of followup was 7.6 years, resulting in a total observation period of 8839 years spanning the calendar period 1974-2009. During followup, fourteen invasive cancers occurred (1.6 cancers per 1000 person-yrs, SIR 4.13, 95% CI 2.26-6.93). Three of these were hematologic (all lymphomas), resulting in an SIR for hematologic cancers of 4.68 (95% CI 0.96-13.67). SIR were increased for both male and female patients, and across age groups. CONCLUSION: Although cancer remains a relatively rare outcome in pediatric-onset SLE, our data do suggest an increase in cancer for patients followed an average of 7.6 years. About one-fifth of the cancers were hematologic. Longer followup, and study of drug effects and disease activity, is warranted.
OBJECTIVE: To determine cancer incidence in a large pediatric-onset systemic lupus erythematosus (SLE) population. METHODS: Data were examined from 12 pediatric SLE registries in North America. Patients were linked to their regional cancer registries to detect cancers observed after cohort entry, defined as date first seen in the clinic. The expected number of malignancies was obtained by multiplying the person-years in the cohort (defined from cohort entry to end of followup) by the geographically matched age-, sex-, and calendar year-specific cancer rates. The standardized incidence ratio (SIR; ratio of cancers observed to expected) was generated, with 95% CI. RESULTS: A total of 1168 patients were identified from the registries. The mean age at cohort entry was 13 years (SD 3.3), and 83.7% of the subjects were female. The mean duration of followup was 7.6 years, resulting in a total observation period of 8839 years spanning the calendar period 1974-2009. During followup, fourteen invasive cancers occurred (1.6 cancers per 1000 person-yrs, SIR 4.13, 95% CI 2.26-6.93). Three of these were hematologic (all lymphomas), resulting in an SIR for hematologic cancers of 4.68 (95% CI 0.96-13.67). SIR were increased for both male and female patients, and across age groups. CONCLUSION: Although cancer remains a relatively rare outcome in pediatric-onset SLE, our data do suggest an increase in cancer for patients followed an average of 7.6 years. About one-fifth of the cancers were hematologic. Longer followup, and study of drug effects and disease activity, is warranted.
Authors: Sasha Bernatsky; Rosalind Ramsey-Goldman; Jeremy Labrecque; Lawrence Joseph; Jean-Francois Boivin; Michelle Petri; Asad Zoma; Susan Manzi; Murray B Urowitz; Dafna Gladman; Paul R Fortin; Ellen Ginzler; Edward Yelin; Sang-Cheol Bae; Daniel J Wallace; Steven Edworthy; Soren Jacobsen; Caroline Gordon; Mary Anne Dooley; Christine A Peschken; John G Hanly; Graciela S Alarcón; Ola Nived; Guillermo Ruiz-Irastorza; David Isenberg; Anisur Rahman; Torsten Witte; Cynthia Aranow; Diane L Kamen; Kristjan Steinsson; Anca Askanase; Susan Barr; Lindsey A Criswell; Gunnar Sturfelt; Neha M Patel; Jean-Luc Senécal; Michel Zummer; Janet E Pope; Stephanie Ensworth; Hani El-Gabalawy; Timothy McCarthy; Lene Dreyer; John Sibley; Yvan St Pierre; Ann E Clarke Journal: J Autoimmun Date: 2013-02-12 Impact factor: 7.094
Authors: Sasha Bernatsky; Rosalind Ramsey-Goldman; Lawrence Joseph; Jean-Francois Boivin; Karen H Costenbader; Murray B Urowitz; Dafna D Gladman; Paul R Fortin; Ola Nived; Michelle A Petri; Soren Jacobsen; Susan Manzi; Ellen M Ginzler; David Isenberg; Anisur Rahman; Caroline Gordon; Guillermo Ruiz-Irastorza; Edward Yelin; Sang-Cheol Bae; Daniel J Wallace; Christine A Peschken; Mary Anne Dooley; Steven M Edworthy; Cynthia Aranow; Diane L Kamen; Juanita Romero-Diaz; Anca Askanase; Torsten Witte; Susan G Barr; Lindsey A Criswell; Gunnar K Sturfelt; Irene Blanco; Candace H Feldman; Lene Dreyer; Neha M Patel; Yvan St Pierre; Ann E Clarke Journal: Ann Rheum Dis Date: 2013-01-08 Impact factor: 19.103
Authors: Sasha Bernatsky; Ann E Clarke; Jeremy Labrecque; Emily von Scheven; Laura E Schanberg; Earl D Silverman; Hermine I Brunner; Kathleen A Haines; Randy Q Cron; Kathleen M O'Neil; Kiem Oen; Alan M Rosenberg; Ciarán M Duffy; Lawrence Joseph; Jennifer L Lee; Mruganka Kale; Elizabeth M Turnbull; Rosalind Ramsey-Goldman Journal: Arthritis Res Ther Date: 2013 Impact factor: 5.156
Authors: May Y Choi; Kelsey Flood; Sasha Bernatsky; Rosalind Ramsey-Goldman; Ann E Clarke Journal: Best Pract Res Clin Rheumatol Date: 2017-11-10 Impact factor: 4.098