TY - JOUR
T1 - Cancer risk in systemic lupus
T2 - An updated international multi-centre cohort study
AU - Bernatsky, Sasha
AU - Ramsey-Goldman, Rosalind
AU - Labrecque, Jeremy
AU - Joseph, Lawrence
AU - Boivin, Jean-Francois
AU - Petri, Michelle
AU - Zoma, Asad
AU - Manzi, Susan
AU - Urowitz, Murray B
AU - Gladman, Dafna
AU - Fortin, Paul R
AU - Ginzler, Ellen
AU - Yelin, Edward
AU - Bae, Sang-Cheol
AU - Wallace, Daniel J
AU - Edworthy, Steven
AU - Jacobsen, Soren
AU - Gordon, Caroline
AU - Dooley, Mary Anne
AU - Peschken, Christine A
AU - Hanly, John G
AU - Alarcón, Graciela S
AU - Nived, Ola
AU - Ruiz-Irastorza, Guillermo
AU - Isenberg, David
AU - Rahman, Anisur
AU - Witte, Torsten
AU - Aranow, Cynthia
AU - Kamen, Diane L
AU - Steinsson, Kristjan
AU - Askanase, Anca
AU - Barr, Susan
AU - Criswell, Lindsey A
AU - Sturfelt, Gunnar
AU - Patel, Neha M
AU - Senécal, Jean-Luc
AU - Zummer, Michel
AU - Pope, Janet E
AU - Ensworth, Stephanie
AU - El-Gabalawy, Hani
AU - McCarthy, Timothy
AU - Dreyer, Lene
AU - Sibley, John
AU - St Pierre, Yvan
AU - Clarke, Ann E
PY - 2013
Y1 - 2013
N2 - 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% CI 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.
AB - 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% CI 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.
U2 - 10.1016/j.jaut.2012.12.009
DO - 10.1016/j.jaut.2012.12.009
M3 - Journal article
SN - 0896-8411
VL - 42
SP - 130
EP - 135
JO - Journal of Autoimmunity
JF - Journal of Autoimmunity
ER -