title: Cancer risk in systemic lupus: an updated international multi-centre cohort study.
abstract: OBJECTIVE
  To update estimates of cancer risk in SLE relative to the general population.
  
  
  METHODS
  A multisite international SLE cohort was linked with regional tumor registries. Standardized incidence ratios (SIRs) were calculated as the ratio of observed to expected cancers.
  
  
  RESULTS
  Across 30 centres, 16,409 patients were observed for 121,283 (average 7.4) person-years. In total, 644 cancers occurred. Some cancers, notably hematologic malignancies, were substantially increased (SIR 3.02, 95% confidence interval, CI, 2.48, 3.63), particularly non-Hodgkin's lymphoma, NHL (SIR 4.39, 95% CI 3.46, 5.49) and leukemia. In addition, increased risks of cancer of the vulva (SIR 3.78, 95% CI 1.52, 7.78), lung (SIR 1.30, 95% CI 1.04, 1.60), thyroid (SIR 1.76, 95% CI 1.13, 2.61) and possibly liver (SIR 1.87, 95% CI 0.97, 3.27) were suggested. However, a decreased risk was estimated for breast (SIR 0.73, 95% CI 0.61-0.88), endometrial (SIR 0.44, 95% CI 0.23-0.77), and possibly ovarian cancers (0.64, 95% CI 0.34-1.10). The variability of comparative rates across different cancers meant that only a small increased risk was estimated across all cancers (SIR 1.14, 95% CI 1.05, 1.23).
  
  
  CONCLUSIONS
  These data estimate only a small increased risk in SLE (versus the general population) for cancer over-all. However, there is clearly an increased risk of NHL, and cancers of the vulva, lung, thyroid, and possibly liver. It remains unclear to what extent the association with NHL is mediated by innate versus exogenous factors. Similarly, the etiology of the decreased breast, endometrial, and possibly ovarian cancer risk is uncertain, though investigations are ongoing.
authors: McGill University Health Centre, 687 Pine Avenue, V Building, Montreal, Quebec H3A 1A1, Canada. sasha.bernatsky@mail.mcgill.ca
authors: Sasha
authors: S
authors: Bernatsky
authors: Rosalind
authors: R
authors: Ramsey-Goldman
authors: Jeremy
authors: J
authors: Labrecque
authors: Lawrence
authors: L
authors: Joseph
authors: Jean-Francois
authors: JF
authors: Boivin
authors: Michelle
authors: M
authors: Petri
authors: Asad
authors: A
authors: Zoma
authors: Susan
authors: S
authors: Manzi
authors: Murray B
authors: MB
authors: Urowitz
authors: Dafna
authors: D
authors: Gladman
authors: Paul R
authors: PR
authors: Fortin
authors: Ellen
authors: E
authors: Ginzler
authors: Edward
authors: E
authors: Yelin
authors: Sang-Cheol
authors: SC
authors: Bae
authors: Daniel J
authors: DJ
authors: Wallace
authors: Steven
authors: S
authors: Edworthy
authors: Soren
authors: S
authors: Jacobsen
authors: Caroline
authors: C
authors: Gordon
authors: Mary Anne
authors: MA
authors: Dooley
authors: Christine A
authors: CA
authors: Peschken
authors: John G
authors: JG
authors: Hanly
authors: Graciela S
authors: GS
authors: Alarcón
authors: Ola
authors: O
authors: Nived
authors: Guillermo
authors: G
authors: Ruiz-Irastorza
authors: David
authors: D
authors: Isenberg
authors: Anisur
authors: A
authors: Rahman
authors: Torsten
authors: T
authors: Witte
authors: Cynthia
authors: C
authors: Aranow
authors: Diane L
authors: DL
authors: Kamen
authors: Kristjan
authors: K
authors: Steinsson
authors: Anca
authors: A
authors: Askanase
authors: Susan
authors: S
authors: Barr
authors: Lindsey A
authors: LA
authors: Criswell
authors: Gunnar
authors: G
authors: Sturfelt
authors: Neha M
authors: NM
authors: Patel
authors: Jean-Luc
authors: JL
authors: Senécal
authors: Michel
authors: M
authors: Zummer
authors: Janet E
authors: JE
authors: Pope
authors: Stephanie
authors: S
authors: Ensworth
authors: Hani
authors: H
authors: El-Gabalawy
authors: Timothy
authors: T
authors: McCarthy
authors: Lene
authors: L
authors: Dreyer
authors: John
authors: J
authors: Sibley
authors: Yvan
authors: Y
authors: St Pierre
authors: Ann E
authors: AE
authors: Clarke
mesh_terms: D000328:Adult; D001208:Asia / Q000453:epidemiology; D001943:Breast Neoplasms / Q000453:epidemiology; D002170:Canada / Q000453:epidemiology; D015331:Cohort Studies; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007391:International Cooperation; D008180:Lupus Erythematosus, Systemic / Q000453:epidemiology*; D008228:Lymphoma, Non-Hodgkin / Q000453:epidemiology; D008297:Male; D009369:Neoplasms / Q000453:epidemiology*; D010051:Ovarian Neoplasms / Q000453:epidemiology; D012306:Risk; D014481:United States / Q000453:epidemiology