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.
N1 - Funding Information:
This research was funded by Canadian Institutes of Health Research/Arthritis Society grant RG06/092 and National Institutes of Health (NIH) grant 1R03CA128052-01 . We also acknowledge the grant that supports the Chicago Lupus Database, NIH/NIAMS P60 2 AR30692 and the grants that support the UCSF Lupus Outcomes Study, NIH/NIAMS P60 AR053308 and NIH/NIAMS R01 5R01AR56476-9 , the grant that support the Hopkins Lupus Cohort NIH R01 AR43727 , and the grant by the Department of Education, Universities and Research of the Basque Government supporting the Lupus-Cruces research project. Support for McGill University Health Centre cohort comes from Singer Family Fund for Lupus Research. Dr. Criswell would like to acknowledge support from the Alliance for Lupus Research and from a Kirkland Scholar Award. Dr. Bae's work is supported by the Korea Healthcare technology R&D Project, Ministry for Health and Welfare , Republic of Korea (A120404).
PY - 2013/5
Y1 - 2013/5
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.
KW - Disease activity
KW - Epidemiology
KW - Systemic lupus erythematosus
KW - Treatment
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U2 - 10.1016/j.jaut.2012.12.009
DO - 10.1016/j.jaut.2012.12.009
M3 - Article
C2 - 23410586
AN - SCOPUS:84877148183
SN - 0896-8411
VL - 42
SP - 130
EP - 135
JO - Journal of Autoimmunity
JF - Journal of Autoimmunity
ER -