Sasha Bernatsky1, Rosalind Ramsey-Goldman2, Murray B Urowitz3, John G Hanly4, Caroline Gordon5, Michelle A Petri6, Ellen M Ginzler7, Daniel J Wallace8, Sang-Cheol Bae9, Juanita Romero-Diaz10, Mary Anne Dooley11, Christine A Peschken12, David A Isenberg13, Anisur Rahman13, Susan Manzi14, Søren Jacobsen15, S Sam Lim16, Ronald van Vollenhoven17, Ola Nived18, Diane L Kamen19, Cynthia Aranow20, Guillermo Ruiz-Irastorza21, Jorge Sánchez-Guerrero3, Dafna D Gladman3, Paul R Fortin22, Graciela S Alarcón23, Joan T Merrill24, Kenneth C Kalunian25, Manuel Ramos-Casals26, Kristjan Steinsson27, Asad Zoma28, Anca Askanase29, Munther A Khamashta30, Ian Bruce31, Murat Inanc32, Ann E Clarke33. 1. McGill University, Montreal, Quebec, Canada. 2. Northwestern University and Feinberg School of Medicine, Chicago, Illinois. 3. Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada. 4. Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada. 5. College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK. 6. Johns Hopkins University School of Medicine, Baltimore, Maryland. 7. State University of New York Downstate Medical Centre, Brooklyn. 8. Cedars-Sinai/David Geffen School of Medicine at University of California, Los Angeles. 9. Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea. 10. Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico. 11. University of North Carolina, Chapel Hill. 12. University of Manitoba, Winnipeg, Manitoba, Canada. 13. University College London, London, UK. 14. Allegheny Health Network, Pittsburgh, Pennsylvania. 15. Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. 16. Emory University, Atlanta, Georgia. 17. Amsterdam University Medical Centres, Amsterdam, The Netherlands. 18. Lund University, Lund, Sweden. 19. Medical University of South Carolina, Charleston. 20. Feinstein Institute for Medical Research, Manhasset, New York. 21. Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Spain. 22. CHU de Québec, Université Laval, Quebec City, Quebec, Canada. 23. University of Alabama at Birmingham. 24. Oklahoma Medical Research Foundation, Oklahoma City. 25. University of California, San Diego, School of Medicine, La Jolla, California. 26. Hospital Clínic, Barcelona, Spain. 27. Fossvogur Landspitali University Hospital, Reykjavik, Iceland. 28. Hairmyres Hospital, East Kilbride, Scotland, UK. 29. Columbia University College of Physicians and Surgeons, New York, New York. 30. St. Thomas' Hospital, King's College London School of Medicine, London, UK. 31. University of Manchester and NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, and Manchester Academic Health Science Centre, Manchester, UK. 32. Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey. 33. Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Abstract
OBJECTIVE: To assess cancer risk factors in incident systemic lupus erythematosus (SLE). METHODS: Clinical variables and cancer outcomes were assessed annually among incident SLE patients. Multivariate hazard regression models (overall risk and most common cancers) included demographic characteristics and time-dependent medications (corticosteroids, antimalarial drugs, immunosuppressants), smoking, and the adjusted mean Systemic Lupus Erythematosus Disease Activity Index 2000 score. RESULTS: Among 1,668 patients (average 9 years follow-up), 65 cancers occurred: 15 breast, 10 nonmelanoma skin, 7 lung, 6 hematologic, 6 prostate, 5 melanoma, 3 cervical, 3 renal, 2 each gastric, head and neck, and thyroid, and 1 each rectal, sarcoma, thymoma, and uterine cancers. Half of the cancers (including all lung cancers) occurred in past/current smokers, versus one-third of patients without cancer. Multivariate analyses indicated that overall cancer risk was related primarily to male sex and older age at SLE diagnosis. In addition, smoking was associated with lung cancer. For breast cancer risk, age was positively associated and antimalarial drugs were negatively associated. Antimalarial drugs and higher disease activity were also negatively associated with nonmelanoma skin cancer risk, whereas age and cyclophosphamide were positively associated. Disease activity was associated positively with hematologic and negatively with nonmelanoma skin cancer risk. CONCLUSION: Smoking is a key modifiable risk factor, especially for lung cancer, in SLE. Immunosuppressive medications were not clearly associated with higher risk except for cyclophosphamide and nonmelanoma skin cancer. Antimalarials were negatively associated with breast cancer and nonmelanoma skin cancer risk. SLE activity was associated positively with hematologic cancer and negatively with nonmelanoma skin cancer. Since the absolute number of cancers was small, additional follow-up will help consolidate these findings.
OBJECTIVE: To assess cancer risk factors in incident systemic lupus erythematosus (SLE). METHODS: Clinical variables and cancer outcomes were assessed annually among incident SLE patients. Multivariate hazard regression models (overall risk and most common cancers) included demographic characteristics and time-dependent medications (corticosteroids, antimalarial drugs, immunosuppressants), smoking, and the adjusted mean Systemic Lupus Erythematosus Disease Activity Index 2000 score. RESULTS: Among 1,668 patients (average 9 years follow-up), 65 cancers occurred: 15 breast, 10 nonmelanoma skin, 7 lung, 6 hematologic, 6 prostate, 5 melanoma, 3 cervical, 3 renal, 2 each gastric, head and neck, and thyroid, and 1 each rectal, sarcoma, thymoma, and uterine cancers. Half of the cancers (including all lung cancers) occurred in past/current smokers, versus one-third of patients without cancer. Multivariate analyses indicated that overall cancer risk was related primarily to male sex and older age at SLE diagnosis. In addition, smoking was associated with lung cancer. For breast cancer risk, age was positively associated and antimalarial drugs were negatively associated. Antimalarial drugs and higher disease activity were also negatively associated with nonmelanoma skin cancer risk, whereas age and cyclophosphamide were positively associated. Disease activity was associated positively with hematologic and negatively with nonmelanoma skin cancer risk. CONCLUSION: Smoking is a key modifiable risk factor, especially for lung cancer, in SLE. Immunosuppressive medications were not clearly associated with higher risk except for cyclophosphamide and nonmelanoma skin cancer. Antimalarials were negatively associated with breast cancer and nonmelanoma skin cancer risk. SLE activity was associated positively with hematologic cancer and negatively with nonmelanoma skin cancer. Since the absolute number of cancers was small, additional follow-up will help consolidate these findings.
Authors: S Bernatsky; J F Boivin; L Joseph; S Manzi; E Ginzler; M Urowitz; D Gladman; P Fortin; C Gordon; S Barr; S Edworthy; S C Bae; M Petri; J Sibley; D Isenberg; A Rahman; K Steinsson; C Aranow; M A Dooley; G S Alarcon; J Hanly; G Sturfelt; O Nived; J Pope; S Ensworth; R Rajan; H El-Gabalawy; T McCarthy; Y St Pierre; A Clarke; R Ramsey-Goldman Journal: Arthritis Rheum Date: 2005-10-15
Authors: G Ruiz-Irastorza; A Ugarte; M V Egurbide; M Garmendia; J I Pijoan; A Martinez-Berriotxoa; C Aguirre Journal: Ann Rheum Dis Date: 2007-01-04 Impact factor: 19.103
Authors: Wei Yang; Sarah R Hosford; Nicole A Traphagen; Kevin Shee; Eugene Demidenko; Stephanie Liu; Todd W Miller Journal: FASEB J Date: 2018-01-03 Impact factor: 5.191