title: Risk of cancer in patients receiving non-biologic disease-modifying therapy for rheumatoid arthritis compared with the UK general population.
abstract: OBJECTIVE
  To quantify the risk of cancer and compare it with that for the general population in a modern cohort of UK patients with RA and to identify risk factors for cancer among this cohort.
  
  
  METHODS
  The study population comprised biologic-naïve RA subjects receiving non-biologic disease-modifying therapy recruited to the British Society for Rheumatology Biologics Register from 2002 to 2009. Standardized incidence ratios (SIRs) for cancers were calculated using age- and gender-specific cancer rates in the English population. Poisson regression models adjusted for age and gender using England general population data were used to determine the association of other predictors with incident malignancy.
  
  
  RESULTS
  The cohort comprised 3771 individuals with RA contributing 13 315 person-years of follow-up. One hundred and eighty-two cancers were reported: 156 solid and 26 myelo- or lymphoproliferative cancers. The overall SIR was 1.28 (95% CI 1.10, 1.48). Risks of lung cancer (SIR 2.39, 95% CI 1.75, 3.19), Hodgkin lymphoma (SIR 12.82, 95% CI 4.16, 29.92) and non-Hodgkin lymphoma (SIR 3.12, 95% CI 1.79, 5.07) were higher compared with the general population and risks of prostate cancer (SIR 0.35, 95% CI 0.11, 0.82) and cancers of the female genital organs (SIR 0.35, 95% CI 0.10, 0.90) were reduced. Within the cohort, cancer risk was more than 2-fold higher in current or ex-smokers than in non-smokers.
  
  
  CONCLUSIONS
  The overall incidence of cancer was increased in this national cohort of subjects with RA. The association of RA with certain cancers needs to be considered when studying the effects of biologic therapy, such as anti-TNF, on cancer risk.
authors.affiliation: Arthritis Research UK Epidemiology Unit, Stopford Building, University of Manchester, Manchester Academic Health Science Centre, Oxford Road, Manchester M13 9PT, UK.
authors.forename: Louise K
authors.initials: LK
authors.lastname: Mercer
authors.forename: Rebecca
authors.initials: R
authors.lastname: Davies
authors.forename: James B
authors.initials: JB
authors.lastname: Galloway
authors.forename: Audrey
authors.initials: A
authors.lastname: Low
authors.forename: Mark
authors.initials: M
authors.lastname: Lunt
authors.forename: William G
authors.initials: WG
authors.lastname: Dixon
authors.forename: Kath D
authors.initials: KD
authors.lastname: Watson
authors.forename: Deborah P M
authors.initials: DP
authors.lastname: Symmons
authors.forename: Kimme L
authors.initials: KL
authors.lastname: Hyrich
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018501:Antirheumatic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology* / Q000209:etiology; D012042:Registries; D012306:Risk; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D018501:Antirheumatic Agents