title: A meta-analysis of the incidence of malignancy in adult patients with rheumatoid arthritis.
abstract: BACKGROUND
  The risk of malignancies in patients with rheumatoid arthritis (RA) has raised some concern, particularly with immunosuppressive approaches to disease management.
  
  
  METHODS
  We conducted a systematic review of the literature and meta-analysis characterizing the associated risk of overall malignancy and four site-specific malignancies (lymphoma, lung, colorectal, and breast cancer) in patients with RA. A Medline search from 1990 to 2007 was conducted using specified search terms and predefined inclusion criteria for identification of relevant observational studies that provide estimates of relative risk of malignancy associated with RA. Study-specific estimates of the relative risk, as measured by standardized incidence ratios (SIRs) and estimated in comparison with the general population, were combined using a random effects model.
  
  
  RESULTS
  A total of 21 publications were identified, of which 13 reported the SIR for overall malignancy, 14 for lymphoma, 10 for colorectal, 12 for lung, and 9 for breast cancer. Compared with the general population, the overall SIR estimates suggest that RA patients have approximately a two-fold increase in lymphoma risk (SIR 2.08, 95% confidence interval [CI] 1.80 to 2.39) and greater risk of Hodgkin than non-Hodgkin lymphoma. The risk of lung cancer was also increased with an SIR of 1.63 (95% CI 1.43 to 1.87). In contrast, a decrease in risk was observed for colorectal (SIR 0.77, 95% CI 0.65 to 0.90) and breast (SIR 0.84, 95% CI 0.79 to 0.90) cancer. The SIR for overall malignancy was 1.05 (95% CI 1.01 to 1.09).
  
  
  CONCLUSIONS
  Patients with RA appear to be at higher risk of lymphoma and lung cancer and potentially decreased risk for colorectal and breast cancer compared with the general population.
authors.affiliation: Duke University School of Medicine, Duke South, Durham, NC, 27710 USA. Allison.Smitten@bms.com
authors.forename: Allison L
authors.initials: AL
authors.lastname: Smitten
authors.forename: Teresa A
authors.initials: TA
authors.lastname: Simon
authors.forename: Marc C
authors.initials: MC
authors.lastname: Hochberg
authors.forename: Samy
authors.initials: S
authors.lastname: Suissa
mesh_terms: D000328:Adult; D001172:Arthritis, Rheumatoid / Q000150:complications*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D009369:Neoplasms / Q000150:complications* / Q000453:epidemiology*; D012307:Risk Factors