Risk of cancer among rheumatoid arthritis patients in California
- 296 Downloads
The objective of this retrospective cohort study was to evaluate cancer risk among rheumatoid arthritis (RA) patients in California.
The study cohort derived from statewide patient discharge records was followed via linkage with cancer registry data over the period 1991–2002. Age and sex adjusted standardized incidence ratios (SIRs) and 95% confidence intervals were calculated to compare observed to expected numbers of cancers based on age, race, and sex specific incidence rates in the California population.
Among the 84,475 RA patients, who were observed for 405,540 person-years, 5,533 incident cancers were diagnosed during the observation interval. The risk of developing lymphohematopoietic cancer was significantly higher in the cohort for both sexes. Males had significantly higher risks of lung, liver, and esophageal cancer, but a lower risk of prostate cancer. Females were at significantly decreased risk for several cancers including breast, ovary, uterus, cervix, and melanoma, with the risk reduction ranging from 15 to 57% lower than the general population. Hispanics had increased risks of leukemia, vagina/vulva, lung, and liver cancers.
Studies investigating the mechanisms that underlie the reported associations between RA and specific cancer types are needed.
KeywordsCancer Rheumatoid arthritis Registries Cohort studies Neoplasms
This work was funded by grant 1R21CA100759-01A2 from the National Cancer Institute. The collection of cancer incidence data used in this study was supported by the California Department of Health Services as part of the statewide cancer reporting program mandated by California Health and Safety Code Section 103885; the National Cancer Institute’s Surveillance, Epidemiology and End Results Program under contract N01-PC-35136 awarded to the Northern California Cancer Center, contract N01-PC-35139 awarded to the University of Southern California, and contract N02-PC-15105 awarded to the Public Health Institute; and the Centers for Disease Control and Prevention’s National Program of Cancer Registries, under agreement #U55/CCR921930-02 awarded to the Public Health Institute.
The ideas and opinions expressed herein are those of the author(s) and endorsement by the State of California, Department of Health Services, the National Cancer Institute, and the Centers for Disease Control and Prevention or their Contractors and Subcontractors is not intended nor should be inferred.
- 2.Harris ED (1997) Clinical features of rheumatoid arthritis. In: Kelly WN, Harris ED, Ruddy S, Sledge CB (eds) Textbook of rheumatology, 5th edn. WB Saunders, Philadelphia, pp 895–922Google Scholar
- 3.Abu-Shakra M, Buskila D, Shoenfeld Y (2000) Rheumatoid arthritis and cancer. In: Gershwin ME, Shoenfeld Y (eds) Cancer and autoimmunity. Elsevier, Amsterdam, pp 19–30Google Scholar
- 12.Shenberger KN, Schned AR, Taylor TH (1984) Rheumatoid disease and bronchogenic carcinoma-case report and review of the literature. J Rheumatol 13:909–911Google Scholar
- 17.Askling J, Baecklund E, Granath F, Geborek P, Fored M, Backlin C, et al. (2008) Anti-TNF therapy in RA and risk of malignant lymphomas relative risks and time-trends in the Swedish Biologics Register. Ann Rheum DisGoogle Scholar
- 22.Tennis P, Andrews E, Bombardier C, Wang Y, Strand L, West R et al (1993) Record linkage to conduct an epidemiologic study on the association of rheumatoid arthritis and lymphoma in the province of Saskatchewan, Canada. J Clin Epidemiol 46(7):685–695. doi: 10.1016/0895-4356(93)90049-7 PubMedCrossRefGoogle Scholar
- 23.Services USDoHaH (ed) (2000) ICD-9-CM: international classification of diseases, 9th revision, clinical modification, 6th edn. Washington, DCGoogle Scholar
- 24.Cancer Reporting in California: Standards for Automated Reporting (1997) California cancer reporting system standards, vol II. California Department of Health Services, Cancer Surveillance Section, Sacramento, CAGoogle Scholar
- 25.Cancer Reporting in California: Data Standards for Regional Registries and California Cancer Registry (1997) California cancer reporting system standards, vol III. California Department of Health Services, Cancer Surveillance Section, Sacramento, CAGoogle Scholar
- 26.Cancer Reporting in California: Reporting Procedures for Physicians (1998) California cancer reporting system standards, vol IV. California Department of Health Services, Cancer Surveillance Section, Sacramento, CAGoogle Scholar
- 27.Cancer Reporting in California: Abstracting and Coding Procedures for Hospitals (1997) California cancer reporting system standards, vol I. California Department of Health Services, Cancer Surveillance Section, Sacramento, CAGoogle Scholar
- 28.Chen VW, Howe HL, Wu XC (2000) Cancer in North America, 1993–1997 vol I. Incidence. North American Association of Central Cancer Registries, Springfield, ILGoogle Scholar
- 30.Vality Technology Inc. (1999) Integrity program: data reengineering environment software, ver 3.3. Vality Technology Inc., Boston, MAGoogle Scholar
- 31.Allen M (2001) Validation of OSHPD and CCR insurance status. In: California association of central cancer registries technical conference, 25 September, 2001, Riverside, CAGoogle Scholar
- 32.Breslow NE, Day NE (1987) Statistical methods in cancer research. Vol II. The design and analysis of cohort studies. International Agency for Research on Cancer, LyonGoogle Scholar
- 36.Baecklund E, Ekbom A, Sparen P, Feltelius N, Klareskog L (1998) Disease activity and risk of lymphoma in patients with rheumatoid arthritis: nested case–control study. Br Med J 317(7152):180–181Google Scholar
- 37.Wolfe F (1998) Inflammatory activity but not prednisone or methotrexate use predicts non-Hodgkin’s lymphoma in rheumatoid arthritis: a 25-year study of 1,767 RA patients [abstract 931]. Arthritis Rheum S188Google Scholar
- 40.Matteson EL, Hickey AR, Maguire L, Tilson HH, Urowitz MB (1991) Occurrence of neoplasia in patients with rheumatoid arthritis enrolled in a DMARD registry. Rheumatoid arthritis azathioprine registry steering committee. J Rheumatol 8(6):809–814Google Scholar
- 41.Radis CD, Kahl LE, Baker GL, Wasko MC, Cash JM, Gallatin A et al (1995) Effects of cyclophosphamide on the development of malignancy and on long-term survival of patients with rheumatoid arthritis. A 20-year followup study. Arthritis Rheum 38(8):1120–1127. doi: 10.1002/art.1780380815 PubMedCrossRefGoogle Scholar
- 42.Bongartz T, Sutton AJ, Sweeting MJ, Buchan I, Matteson EL, Montori V (2006) Anti-TNF antibody therapy in rheumatoid arthritis and the risk of serious infections and malignancies: systematic review and meta-analysis of rare harmful effects in randomized controlled trials. JAMA 295(19):2275–2285. doi: 10.1001/jama.295.19.2275 PubMedCrossRefGoogle Scholar
- 53.Gao J, Niwa K, Sun W, Takemura M, Lian Z, Onogi K et al (2004) Non-steroidal anti-inflammatory drugs inhibit cellular proliferation and upregulate cyclooxygenase-2 protein expression in endometrial cancer cells. Cancer Sci 95(11):901–907. doi: 10.1111/j.1349-7006.2004.tb02200.x PubMedCrossRefGoogle Scholar
- 58.Stock DC, Groome PA, Siemens DR, Rohland SL, Song Z (2008) Effects of non-selective non-steroidal anti-inflammatory drugs on the aggressiveness of prostate cancer. ProstateGoogle Scholar
- 59.Cevik R, Em S, Gur A, Nas K, Sarac AJ, Colpan L (2004) Sex and thyroid hormone status in women with rheumatoid arthritis: are there any effects of menopausal state and disease activity on these hormones? Int J Clin Pract 58(4):327–332. doi: 10.1111/j.1368-5031.2004.00005.x PubMedCrossRefGoogle Scholar