Cancer risk in systemic lupus: An updated international multi-centre cohort study

Sasha Bernatsky; Rosalind Ramsey-Goldman; Jeremy Labrecque; Lawrence Joseph; Jean-Francois Boivin; Michelle Petri; Asad Zoma; Susan Manzi; Murray B Urowitz; Dafna Gladman; Paul R Fortin; Ellen Ginzler; Edward Yelin; Sang-Cheol Bae; Daniel J Wallace; Steven Edworthy; Soren Jacobsen; Caroline Gordon; Mary Anne Dooley; Christine A Peschken; John G Hanly; Graciela S Alarcón; Ola Nived; Guillermo Ruiz-Irastorza; David Isenberg; Anisur Rahman; Torsten Witte; Cynthia Aranow; Diane L Kamen; Kristjan Steinsson; Anca Askanase; Susan Barr; Lindsey A Criswell; Gunnar Sturfelt; Neha M Patel; Jean-Luc Senécal; Michel Zummer; Janet E Pope; Stephanie Ensworth; Hani El-Gabalawy; Timothy McCarthy; Lene Dreyer; John Sibley; Yvan St Pierre; Ann E Clarke

doi:10.1016/j.jaut.2012.12.009

Cancer risk in systemic lupus: An updated international multi-centre cohort study

Sasha Bernatsky, Rosalind Ramsey-Goldman, Jeremy Labrecque, Lawrence Joseph, Jean-Francois Boivin, Michelle Petri, Asad Zoma, Susan Manzi, Murray B Urowitz, Dafna Gladman, Paul R Fortin, Ellen Ginzler, Edward Yelin, Sang-Cheol Bae, Daniel J Wallace, Steven Edworthy, Soren Jacobsen, Caroline Gordon, Mary Anne Dooley, Christine A PeschkenJohn G Hanly, Graciela S Alarcón, Ola Nived, Guillermo Ruiz-Irastorza, David Isenberg, Anisur Rahman, Torsten Witte, Cynthia Aranow, Diane L Kamen, Kristjan Steinsson, Anca Askanase, Susan Barr, Lindsey A Criswell, Gunnar Sturfelt, Neha M Patel, Jean-Luc Senécal, Michel Zummer, Janet E Pope, Stephanie Ensworth, Hani El-Gabalawy, Timothy McCarthy, Lene Dreyer, John Sibley, Yvan St Pierre, Ann E Clarke

165 Citationer (Scopus)

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.

Originalsprog	Engelsk
Tidsskrift	Journal of Autoimmunity
ISSN	0896-8411
DOI	https://doi.org/10.1016/j.jaut.2012.12.009
Status	Udgivet - maj 2013

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Bernatsky, S., Ramsey-Goldman, R., Labrecque, J., Joseph, L., Boivin, J-F., Petri, M., Zoma, A., Manzi, S., Urowitz, M. B., Gladman, D., Fortin, P. R., Ginzler, E., Yelin, E., Bae, S-C., Wallace, D. J., Edworthy, S., Jacobsen, S., Gordon, C., Dooley, M. A., ... Clarke, A. E. (2013). Cancer risk in systemic lupus: An updated international multi-centre cohort study. Journal of Autoimmunity. https://doi.org/10.1016/j.jaut.2012.12.009

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 2013, 'Cancer risk in systemic lupus: An updated international multi-centre cohort study', Journal of Autoimmunity. https://doi.org/10.1016/j.jaut.2012.12.009

@article{a6170285bc7e410aa203408cb9bea50a,

title = "Cancer risk in systemic lupus: An updated international multi-centre cohort study",

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.",

author = "Sasha Bernatsky and Rosalind Ramsey-Goldman and Jeremy Labrecque and Lawrence Joseph and Jean-Francois Boivin and Michelle Petri and Asad Zoma and Susan Manzi and Urowitz, {Murray B} and Dafna Gladman and Fortin, {Paul R} and Ellen Ginzler and Edward Yelin and Sang-Cheol Bae and Wallace, {Daniel J} and Steven Edworthy and Soren Jacobsen and Caroline Gordon and Dooley, {Mary Anne} and Peschken, {Christine A} and Hanly, {John G} and Alarc{\'o}n, {Graciela S} and Ola Nived and Guillermo Ruiz-Irastorza and David Isenberg and Anisur Rahman and Torsten Witte and Cynthia Aranow and Kamen, {Diane L} and Kristjan Steinsson and Anca Askanase and Susan Barr and Criswell, {Lindsey A} and Gunnar Sturfelt and Patel, {Neha M} and Jean-Luc Sen{\'e}cal and Michel Zummer and Pope, {Janet E} and Stephanie Ensworth and Hani El-Gabalawy and Timothy McCarthy and Lene Dreyer and John Sibley and {St Pierre}, Yvan and Clarke, {Ann E}",

year = "2013",

month = may,

doi = "10.1016/j.jaut.2012.12.009",

language = "English",

journal = "Journal of Autoimmunity",

issn = "0896-8411",

publisher = "Academic Press",

}

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 - 2013/5

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.

U2 - 10.1016/j.jaut.2012.12.009

DO - 10.1016/j.jaut.2012.12.009

M3 - Journal article

C2 - 23410586

SN - 0896-8411

JO - Journal of Autoimmunity

JF - Journal of Autoimmunity

ER -

Cancer risk in systemic lupus: An updated international multi-centre cohort study

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