Cancer risk in systemic lupus: an updated international multi-centre cohort study.
Bernatsky S., Ramsey-Goldman R., Labrecque J., Joseph L., Boivin J-F., Petri M., Zoma A., Manzi S., Urowitz MB., Gladman D., Fortin PR., Ginzler E., Yelin E., Bae S-C., Wallace DJ., Edworthy S., Jacobsen S., Gordon C., Dooley MA., Peschken CA., Hanly JG., Alarcón GS., Nived O., Ruiz-Irastorza G., Isenberg D., Rahman A., Witte T., Aranow C., Kamen DL., Steinsson K., Askanase A., Barr S., Criswell LA., Sturfelt G., Patel NM., Senécal J-L., Zummer M., Pope JE., Ensworth S., El-Gabalawy H., McCarthy T., Dreyer L., Sibley J., St Pierre Y., Clarke AE.
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.