abstract
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.
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