In the JournalsPerspective

SLE linked to increased risk for 16 cancers, decreased risk for melanoma

Systemic lupus erythematosus is associated with an increased risk for 16 cancers, including Hodgkin’s and non-Hodgkin’s lymphoma, leukemia and multiple myeloma, but a decreased risk for prostate cancer and cutaneous melanoma, according to data published in Arthritis Research & Therapy.

“Due to early meticulous diagnosis and the progress of treatment, survival rates for SLE patients have increased remarkably in recent decades,” Lebin Song, of the First Affiliated Hospital of Nanjing Medical University, in China, and colleagues wrote. “Despite their increased life expectancy, these patients still have two- to five-times the risk of death compared with the general population, not only for all-cause mortality but also for mortality from cancer. As a result, more attention should be paid to the risks of cancer development in patients with SLE.”

To analyze the association between SLE and the risk for 24 types of cancer, Song and colleagues conducted a search of the PubMed, EMBASE and Web of Science online databases for relevant articles published through May 15, 2018. For their analysis, the researchers limited their search to English-language articles that included patients diagnosed with SLE, focused on the incidence of cancers, and provided sufficient data by means of standardized incident rates and 95% confidence intervals.

Photo of cancer cell 
SLE is associated with an increased risk for 16 cancers, including Hodgkin’s and non-Hodgkin’s lymphoma, leukemia and multiple myeloma, according to data.
Source: Shutterstock

Song and colleagues identified 2,019 relevant articles in their primary literature review. After removing duplicates, review articles, letters, case reports, comments and editorials, and those that failed to meet the inclusion criteria, 24 studies were approved for the final analysis. The associations between SLE and the various cancer types were calculated using pooled standardized incidence rates and 95% confidence intervals.

According to the researchers, SLE was associated with increased risk of overall cancers and cancer risk in both genders. Specifically, patients with SLE were at an increased risk for non-Hodgkin’s lymphoma, Hodgkin’s lymphoma, leukemia and multiple myeloma, as well as cervix, vaginal, renal, bladder, esophagus, gastric, hepatobiliary, lung, oropharynx, larynx, non-melanoma skin and thyroid cancers. SLE was also associated with a decreased risk for prostate cancer and cutaneous melanoma. No association was found between SLE and breast, uterus, ovarian, pancreatic, colorectal or brain cancers.

“To the best of our knowledge, this is the first and largest systematic evaluation to reveal the relationship between SLE and the development of cancer risk,” Song and colleagues wrote. “These outcomes provide a fairly valid and generalizable description of the occurrence of cancers in SLE. Future high-quality research is required to verify our findings, and this should pay more attention to the underlying mechanisms between SLE and cancers risks.” – by Jason Laday

Disclosure: Song reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

Systemic lupus erythematosus is associated with an increased risk for 16 cancers, including Hodgkin’s and non-Hodgkin’s lymphoma, leukemia and multiple myeloma, but a decreased risk for prostate cancer and cutaneous melanoma, according to data published in Arthritis Research & Therapy.

“Due to early meticulous diagnosis and the progress of treatment, survival rates for SLE patients have increased remarkably in recent decades,” Lebin Song, of the First Affiliated Hospital of Nanjing Medical University, in China, and colleagues wrote. “Despite their increased life expectancy, these patients still have two- to five-times the risk of death compared with the general population, not only for all-cause mortality but also for mortality from cancer. As a result, more attention should be paid to the risks of cancer development in patients with SLE.”

To analyze the association between SLE and the risk for 24 types of cancer, Song and colleagues conducted a search of the PubMed, EMBASE and Web of Science online databases for relevant articles published through May 15, 2018. For their analysis, the researchers limited their search to English-language articles that included patients diagnosed with SLE, focused on the incidence of cancers, and provided sufficient data by means of standardized incident rates and 95% confidence intervals.

Photo of cancer cell 
SLE is associated with an increased risk for 16 cancers, including Hodgkin’s and non-Hodgkin’s lymphoma, leukemia and multiple myeloma, according to data.
Source: Shutterstock

Song and colleagues identified 2,019 relevant articles in their primary literature review. After removing duplicates, review articles, letters, case reports, comments and editorials, and those that failed to meet the inclusion criteria, 24 studies were approved for the final analysis. The associations between SLE and the various cancer types were calculated using pooled standardized incidence rates and 95% confidence intervals.

According to the researchers, SLE was associated with increased risk of overall cancers and cancer risk in both genders. Specifically, patients with SLE were at an increased risk for non-Hodgkin’s lymphoma, Hodgkin’s lymphoma, leukemia and multiple myeloma, as well as cervix, vaginal, renal, bladder, esophagus, gastric, hepatobiliary, lung, oropharynx, larynx, non-melanoma skin and thyroid cancers. SLE was also associated with a decreased risk for prostate cancer and cutaneous melanoma. No association was found between SLE and breast, uterus, ovarian, pancreatic, colorectal or brain cancers.

“To the best of our knowledge, this is the first and largest systematic evaluation to reveal the relationship between SLE and the development of cancer risk,” Song and colleagues wrote. “These outcomes provide a fairly valid and generalizable description of the occurrence of cancers in SLE. Future high-quality research is required to verify our findings, and this should pay more attention to the underlying mechanisms between SLE and cancers risks.” – by Jason Laday

Disclosure: Song reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

    Perspective
    Carolyn Zic

    Carolyn Zic

    In this systemic review and meta-analysis, the conclusions by Song and colleagues indicate an association between patients who are diagnosed with SLE and an increased risk in 16 of the 24 types of cancers that were reviewed. Additional findings include a decrease in the risk of prostate and cutaneous melanoma cancers.

    In their discussion, potential causes identified by the authors include — but were not limited to — include flaws in the functioning of the immune system from either SLE or from the use of immunosuppressive therapy, as both lead to an alteration in the functioning of the immune system.

    This analysis, as pointed out by the authors, does not take in account other factors associated with cancer such as environmental factors, race, age and/or ethnicity. For example, childhood cancers are not usually associated with environmental factors unlike that of adult patients, as demonstrated by a large, multi-centered research study conducted by Bernatsky and colleagues in the Journal of Rheumatology, which identified an increased risk for children with SLE.

    As health care providers, we have an opportunity to assist patients in making choices that optimize their health and wellness, despite their underlying diagnosis. The conclusions in the systemic review and meta-analysis by Song and colleagues are impactful to the care of patients with SLE.

    These findings afford rheumatology providers with evidence that can be used to inform patients regarding their cancer risks. Additionally, it emphasizes the importance of ensuring that SLE patients are receiving the necessary cancer screening as indicated by organizations such as the American Cancer Society and the U.S. Preventive Services Task Force.

    • Carolyn Zic, RN, BSN, CPN
    • Pediatric rheumatology nurse
      Comer Children’s Hospital
      University of Chicago Medicine
      Board member, Rheumatology Nurses Society

    Disclosures: Zic reports no relevant financial disclosures.