Cancer risk in a cohort of patients with systemic lupus erythematosus (SLE) in California
We conducted a retrospective cohort study to examine cancer risk in a large cohort of systemic lupus erythematosus (SLE) patients in California.
The cohort consisted of individuals with SLE derived from statewide patient discharge data during the period 1991–2002. SLE patients were followed using cancer registry data to examine patterns of cancer development. Standardized incidence ratios (SIRs) and 95% CI were calculated to compare the observed to expected numbers of cancers based on age-, race-, and sex-specific incidence rates in the California population.
The 30,478 SLE patients were observed for 157,969 person-years. A total of 1,273 cancers occurred within the observation interval. Overall cancer risk was significantly elevated (SIR = 1.14, 95% CI = 1.07–1.20). SLE patients had higher risks of vagina/vulva (SIR = 3.27, 95% CI = 2.41–4.31) and liver cancers (SIR = 2.70, 95% CI = 1.54–4.24). Elevated risks of lung, kidney, and thyroid cancers and several hematopoietic malignancies were also observed. Individuals had significantly lower risks of several screenable cancers, including breast, cervix, and prostate.
These data suggest that risks of several cancer types are elevated among SLE patients. Detailed studies of endogenous and exogenous factors that drive these associations are needed.
KeywordsCancer Systemic lupus erythematosus Malignancy Autoimmune diseases Hematologic neoplasms
- 1.Abu-Shakra M, Buskila D, Shoenfeld Y (2000) SLE and cancer. In: Shoenfeld Y, Gershwin ME (eds) Cancer and autoimmunity. Elsevier Science, pp 31–40Google Scholar
- 27.Services USDoHaH (2000) ICD-9-CM: international classification of diseases, 9th Revision, Clinical modification, 6th edition, Washington DCGoogle Scholar
- 28.Cancer Reporting in California (1997) Standards for automated reporting. California cancer reporting system standards, vol II. California Department of Health Services, Cancer Surveillance Section, Sacramento, CA, December 1997Google Scholar
- 29.Cancer Reporting in California (1997) Data standards for regional registries and California Cancer Registry. California cancer reporting system standards, vol III. California Department of Health Services, Cancer Surveillance Section, Sacramento, CA, December 1997Google Scholar
- 30.Cancer Reporting in California (1998) Reporting procedures for physicians. California cancer reporting system standards, vol IV. California Department of Health Services, Cancer Surveillance Section, Sacramento, CA, January 1998Google Scholar
- 31.Cancer Reporting in California (1997) Abstracting and coding procedures for hospitals. California cancer reporting system standards, vol I. California Department of Health Services, Cancer Surveillance Section, Sacramento, CA, June 1997Google Scholar
- 32.Chen VW, Howe HL, Wu XC (2000) Cancer in North America, 1993–1997. Volume I: incidence. North American Association of Central Cancer Registries, SpringfieldGoogle Scholar
- 34.Integrity Program (1999) Data reengineering environment software. Vality Technology Inc., BostonGoogle Scholar
- 35.Allen M (2001) Validation of OSHPD and CCR insurance status. California Association of Central Cancer Registries Technical Conference, Riverside, CAGoogle Scholar
- 36.Fritz A, Percy C, Jack A et al (2000) International classification of diseases for oncology, 3rd edn. World Health Organization, GenevaGoogle Scholar
- 37.Breslow NE, Day NE (1987) Statistical methods in cancer research, Volume II: the design and analysis of cohort studies. International Agency for Research on Cancer, LyonGoogle Scholar
- 51.Elliott RW, Essenhigh DM, Morley AR (1982) Cyclophosphamide treatment of systemic lupus erythematosus: risk of bladder cancer exceeds benefit. Br Med J (Clin Res Ed) 284:1160–1161Google Scholar