Abstract
Polymyositis and dermatomyositis (PM/DM) have been associated with cancer, although the long-term risks are poorly understood. To evaluate the risk of cancer by time periods subsequent to PM/DM diagnosis, a cohort of 539 patients hospitalized with PM/DM in Denmark between 1977 and 1989 was identified from the Danish Central Hospital Discharge Register. Cancer incidence among cohort members was ascertained by linkage to the Danish Cancer Registry using a unique personal-identification number. The overall cancer risk was elevated significantly among patients with DM (standardized incidence ratio [SIR]=3.8, 95 percent confidence interval [CI]=2.6–5.4) and to a lesser extent PM (SIR=1.7, CI=1.1–2.4). Significant excesses were observed for cancers of lung, ovary, and lymphatic and hematopoietic system. However, the excess cancer incidence declined steadily with increasing years since initial diagnosis of PM/DM. The cancer risk was increased about sixfold (SIR=5.9, CI=3.8–8.7) during the first year, but was lower during the second year (SIR=2.5, CI=1.1–4.8), with no significant excesses in subsequent years of follow-up. These findings confirm that PM/DM may occur as a paraneoplastic syndrome that calls for steps aimed at early cancer detection and treatment. Among long-term survivors of PM/DM, however, there is little evidence to warrant extensive preventive and screening measures beyond those recommended for the general population.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Plotz PH, Dalakas M, Leff RL, Love LA, Miller FW, Cronin ME. Current concepts in the idiopathic inflammatory myopathies: polymyositis, dermatomyositis, and related disorders. Ann Int Med 1989; 111: 143–57.
Bohan A, Peter JB, Bowman RL, Pearson CM. A computer-assisted analysis of 153 patients with polymyositis and dermatomyositis. Medicine (Baltimore) 1977; 56: 255–86.
Sigurgeirsson B, Lindelöf B, Edhag O, Allander E. Risk of cancer in patients with dermatomyositis or polymyositis: a population-based study. N Engl J Med 1992; 326: 363–7.
Bonnetblanc JM, Bernard P, Fayol J. Dermatomyositis and malignancy: a multicenter cooperative study. Dermatologica 1990; 180: 212–6.
Masi AT, Hochberg MC. Temporal association of polymyositis-dermatomyositis with malignancy: methodologic and clinical considerations. Mt Sinai J Med 1988; 55: 471–8.
Butler RC, Thompson JM, Keat ACS. Paraneoplastic rheumatic disorders: a review. J Roy Soc Med 1987; 80: 168–72.
Lakhanpal S, Bunch TW, Ilstrup DM, Melton LJIII. Polymyositis-dermatomyositis and malignant lesions: does an association exist? Mayo Clin Proc 1986; 61: 645–53.
Manchul LA, Jin A, Pritchard KI, et al. The frequency of malignant neoplasms in patients with polymyositis-dermatomyositis: a controlled study. Arch Intern Med 1985; 145: 1835–9.
Callen JP. The relationship of dermatomyositis/polymyositis to malignancy. J Rheumatol 1991; 18: 1645–6.
World Health Organization. International Classification of Diseases, Eighth Revision. Geneva, Switzerland: WHO, 1967.
Operations- og Behandlingsklassifikation. Copenhagen, Denmark: Danish National Board of Health, 1st ed. 1973, 2nd ed. 1980, 3rd ed. 1988.
Klassifikation of Sygdomme. Copenhagen, Denmark: Danish National Board of Health, 1976.
World Health Organization. International Classification of Diseases. Seventh Revision. Geneva, Switzerland: WHO, 1957.
Storm HH, Manders T, Friis S, Band S. Cancer Incidence in Denmark 1989. Copenhagen, Denmark: Danish Cancer Society, 1992.
Bailar JC, Ederer F. Significance factors for the ratio of a Poisson variable to its expectation. Biometrics 1964: 20: 639–43.
Barnes BE. Dermatomyositis and malignancy: a review of the literature. Ann Intern Med 1976; 84: 68–76.
Schulman P, Kerr LD, Spiera H. A reexamination of the relationship between myositis and malignancy. J Rheumatol 1991; 18: 1689–92.
Bernard P, Bonnetblanc P. Dermatomyositis and malignancy. J Invest Dermatol 1993; 100: 128s-32s.
Kinlen LJ. Immunosuppression and Cancer. Lyon, France: International Agency for Research on Cancer, 1992; IARC Sci. Pub. No. 116: 237–53.
Gridley G, Klippel JH, Hoover RN, Fraumeni JFJr. Incidence of cancer among men with the Felty syndrome. Ann Int Med 1994; 120: 35–9.
Gridley G, McLaughlin JK, Ekbom A, et al. Incidence of cancer among patients with rheumatoid arthritis. INCI 1993; 85: 307–11.
Storm HH, Clemmensen IH, Manders T, Brinton LA. Supravaginal uterine amputation in Denmark 1978–1988 and risk of cancer. Gynecol Oncol 1992; 45: 198–201.
Additional information
Drs Chow, McLaughlin, and Fraumeni, and Ms Gridley are with the Epidemiology and Biostatistics Program, Division of Cancer Etiology, National Cancer Institute, Bethesda, MD, USA. Dr McLaughlin is currently with the International Epidemiology Institute, Rockville, MD. Ms Mellemkjær and Dr Olsen are with the Division for Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark. Address correspondence to Dr Chow, National Cancer Institute 6130 Executive Blvd, EPN/415, Rockville, MD 20852, USA.
Rights and permissions
About this article
Cite this article
Chow, WH., Gridley, G., Mellemkjær, L. et al. Cancer risk following polymyositis and dermatomyositis: a nationwide cohort study in Denmark. Cancer Causes Control 6, 9–13 (1995). https://doi.org/10.1007/BF00051675
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00051675