title: Systemic sclerosis (scleroderma) and cancer risk: systematic review and meta-analysis of observational studies.
abstract: OBJECTIVE
  A higher incidence of cancer in scleroderma patients compared with the general population has been suggested by several observational studies, reporting, however, different estimates. Therefore, we aimed to perform a systematic review and meta-analysis to definitely assess this association.
  
  
  METHODS
  We searched MEDLINE and Embase for all original articles of observational studies on cancer incidence in scleroderma patients without language restriction published up to December 2011. Two independent authors reviewed all titles/abstracts and retrieved detailed full-text of potentially relevant articles to identify studies according to predefined selection criteria. Summary estimates were derived using random-effects model and reported as relative risk (RR). Publication bias was evaluated by trim and fill analysis.
  
  
  RESULTS
  From articles initially identified, 16 original studies, involving more than 7000 patients, were included in the present review. Compared with the general population, the summary RR to develop all invasive cancers in scleroderma patients was 1.75 (95% CI 1.41, 2.18). The results for selected cancer sites indicated a strong association with lung cancer (RR 4.35; 95% CI 2.08, 9.09), and a significant increased risk also for haematological neoplasms (RR 2.24; 95% CI 1.53, 3.29). The relation with breast cancer, suggested in some previous epidemiological studies, was not confirmed (RR 1.05; 95% CI 0.86, 1.29).
  
  
  CONCLUSIONS
  The present meta-analysis, the first on scleroderma and cancer risk, provides definite estimates on the association between scleroderma and cancer.
authors.affiliation: Istituto di Clinica Medica, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Via Tronto 10/A, 60100, Ancona, Italy.
authors.forename: Martina
authors.initials: M
authors.lastname: Bonifazi
authors.forename: Irene
authors.initials: I
authors.lastname: Tramacere
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pomponio
authors.forename: Barbara
authors.initials: B
authors.lastname: Gabrielli
authors.forename: Enrico V
authors.initials: EV
authors.lastname: Avvedimento
authors.forename: Carlo
authors.initials: C
authors.lastname: La Vecchia
authors.forename: Eva
authors.initials: E
authors.lastname: Negri
authors.forename: Armando
authors.initials: A
authors.lastname: Gabrielli
mesh_terms: D015897:Comorbidity; D006801:Humans; D015994:Incidence; D009369:Neoplasms / Q000453:epidemiology*; D012306:Risk; D012595:Scleroderma, Systemic / Q000453:epidemiology*