Breast cancer in systemic lupus

Bernatsky, Sasha; Ramsey‐Goldman, Rosalind; Petri, Michelle; Urowitz, Murray B.; Gladman, Dafna D.; Fortin, Paul R.; Ginzler, Ellen M.; Romero-Díaz, Juanita; Peschken, Christine A.; Jacobsen, Søren; Hanly, John G.; Gordon, Caroline; Nived, Ola; Yelin, Edward H.; Isenberg, David; Rahman, Anisur; Bae, Sang Cheol; Joseph, Lawrence; Witte, Torsten; Ruiz‐Irastorza, Guillermo; Aranow, Cynthia; Kamen, Diane L.; Sturfeldt, G.; Foulkes, W. D.; Hansen, James E.; Pierre, Yvan St.; Raymer, P. Chrétien; Tessier‐Cloutier, Basile; Clarke, Ann E.

doi:10.1177/0961203316664595

Cited by 22 publications

(12 citation statements)

References 16 publications

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“…may increase the risk of certain cancers, such as in the lung (35), others show a reduction or absence of such an association (36). We found no association between HS cancers and oral contraception, the number of pregnancies, or menopause, nor has this association been previously demonstrated with breast cancer (33).…”

Section: Discussioncontrasting

confidence: 57%

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Hormonal Dependence and Cancer in Systemic Lupus Erythematosus

Cobo‐Ibáñez

Urruticoechea‐Arana

Rúa-Figueroa

et al. 2020

Arthritis Care & Research

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Objective. To estimate the incidence and analyze any cancer-associated factors in patients with systemic lupus erythematosus (SLE), differentiating between hormone-sensitive (HS) and non-HS cancers.Methods. This was a retrospective multicenter study of a patient cohort from the Systemic Lupus Erythematosus Registry of the Spanish Society of Rheumatology. Included were the first cancer post-SLE diagnosis, clinical and sociodemographic information, cumulative damage, severity, comorbidities, treatments, and refractoriness. Cancers were classified as HS (prostate, breast, endometrium, and ovarian) and non-HS (the remainder). The standardized incidence ratio (SIR) was calculated and logistic regression models were built.Results. A total of 3,539 patients (90.4% women) were included, 154 of whom had cancer (91% female), and 44 had HS cancer (100% female). The cancer SIR was 1.37 (95% confidence interval [95% CI] 1.15-1.59), with higher values in women age <65 years (SIR 2.38 [95% CI 1.84-2.91]). The SIR in women with HS versus non-HS cancer was 1.02 (95% CI 0.13-1.91) and 1.93 (95% CI 0.98-2.89). In HS versus non-HS cancers, SLE diagnostic age (odds ratio [OR] 1.04 [P = 0.002] versus 1.04 [P = 0.019]), and period of disease evolution (OR 1.01 [P < 0.001] versus 1.00 [P = 0.029]) were associated with cancer. The Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (OR 1.27 [P = 0.022]) and angiotensin-converting enzyme (ACE) inhibitor prescriptions (OR 2.87 [P = 0.048]) were associated with non-HS cancers.Conclusion. Cancer incidence in patients with SLE was higher than in the Spanish population, particularly among young women. This increase might be due to non-HS cancers, which would be associated with SLE involving greater cumulative damage where more ACE inhibitors are prescribed. * Values are the number (%) unless indicated otherwise. SLE = systemic lupus erythematosus; SLEDAI = Systemic Lupus Erythematosus Disease Activity Index; IQR = interquartile range; SDI = Systemic Lupus International Collaborating Clinics/ American College of Rheumatology Damage Index; ACE = angiotensin-converting enzyme. † The score corresponding to cancer was excluded when calculating the index.

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Section: Discussioncontrasting

confidence: 57%

“…SLE diagnostic age and period of disease evolution were associated with both HS and non-HS cancers. In other studies, age was associated with cancer in general, in particular with breast cancer and lymphomas (27,33,34). Bernatsky et al (27) have suggested that lupus duration confers a protective effect against cancer onset.…”

Section: Discussionmentioning

confidence: 93%

Hormonal Dependence and Cancer in Systemic Lupus Erythematosus

Cobo‐Ibáñez

Urruticoechea‐Arana

Rúa-Figueroa

et al. 2020

Arthritis Care & Research

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“…This underlined once again the universal importance of smoking cessation, particularly in chronic autoimmune disorders such as SLE [ 51 ]. Bernatsky et al put forward the hypotheses that breast cancer risk in SLE might be influenced by autoantibody profiles or drug exposures, such as nonsteroidal anti-inflammatory drugs and antimalarial drugs, although no definite associations were ultimately revealed [ 52 ]. As for the increased incidence rate of non-Hodgkin’s lymphoma in patients with SLE, Kang et al proposed that abnormal B-cell function and the use of immunosuppressive agents might lead to lymphoma by direct mutagenesis or by disturbing immune surveillance [ 27 ]; other factors include age, underlying genetic factors, environmental triggers.…”

Section: Discussionmentioning

confidence: 99%

The risks of cancer development in systemic lupus erythematosus (SLE) patients: a systematic review and meta-analysis

et al. 2018

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BackgroundAlthough accumulating data have suggested the development of cancer in systemic lupus erythematosus (SLE) patients, these results remain inconsistent. To examine such a putative association, this analysis reports the association between SLE and the risks of 24 cancer types.MethodsOnline databases PubMed, EMBASE, and Web of Science were searched comprehensively for eligible studies, published up to 15 May 2018. Pooled standardized incidence rates (SIRs) with 95% confidence intervals (CIs) were utilized to reveal their associations.ResultsA total of 24 eligible studies were ultimately enrolled. Our results indicated that SLE was associated with increased risk of overall cancers, cancer risk in both genders, non-Hodgkin’s lymphoma, Hodgkin’s lymphoma, leukemia, multiple myeloma, cervix, vagina/vulva, renal, bladder, esophagus, gastric, hepatobiliary, lung, oropharynx, larynx, non-melanoma skin, and thyroid cancers. Additionally, SLE could reduce the risk of prostate cancer and cutaneous melanoma; however, it was not significantly associated with breast, uterus, ovarian, pancreatic, colorectal, or brain cancers.ConclusionsOur results shed light SLE being correlated with increased risk for 16 involved cancers and decreased risk for prostate cancer and cutaneous melanoma. This comprehensive meta-analysis provides epidemiological evidence supporting the associations between SLE and cancer risk. This evidence could be utilized to drive public policies and to help guide personalized medicine to better manage SLE and reduce associated cancer morbidity and mortality.Electronic supplementary materialThe online version of this article (10.1186/s13075-018-1760-3) contains supplementary material, which is available to authorized users.

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“…Immune cell such as T and B and NK lymphocytes express intracellular oestrogen receptors [14]. In this context it is interesting to remember the curious observation that systemic lupus patients had fewer breast cancers than the general population [28]. In lower concentrations it has an opposite action.…”

Section: Discussionmentioning

confidence: 99%

“…It is also known that oestrogens enhance the number and function of regulatory T cells (T reg ), suggesting a potential interaction between this hormone and immune regulatory mechanisms [14]. In this context it is interesting to remember the curious observation that systemic lupus patients had fewer breast cancers than the general population [28]. Therefore, the inverse relationship between ANA and oestrogen receptor presence, although interesting, is not clear at present, but certainly deserves further studies.…”

Section: Discussionmentioning

confidence: 99%

Anti-nuclear antibodies in patients with breast cancer

Nisihara

Machoski

Neppel

et al. 2018

Clinical and Experimental Immunology

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To study the prevalence of anti-nuclear antibodies (ANA) in breast cancer patients and its association with tumour characteristics. Ninety-one patients with breast mass detected by image studies and assigned to conduct diagnostic biopsy and eventual surgical treatment were studied for demographical, tumour data and presence of ANA. Serum of positive ANA patients was screened for the extractable nuclear antigen (ENA) profile. As comparison, 91 healthy individuals matched for age and from the same geographical area were included. In this sample 72 of 91 (79·1%) had malignant lesions (83% ductal infiltrative carcinoma). ANA was positive in 44·4% of patients with malignant tumour and in 15·7% of those with benign lesions (malignant versus benign with P = 0·03). Controls had ANA positivity in 5·4%, and when compared with tumour samples showed P < 0·0001. The most common immunofluorescence pattern was a fine dense speckled pattern. In the ANA-positive patients with malignant lesions, seven had positivity for ENA profile (three for anti-RNP and anti-Sm, one for just anti-RNP, two for anti-Ro and anti-La e two for just anti-La). It was not possible to associate ANA positivity with tumour histological characteristics or staging or with patient's age. A negative association of ANA with hormonal (oestrogen or oestrogen plus progesterone) receptor status was found (P = 0·01). In this sample, there was a high prevalence of ANA positivity in breast cancer patients with a negative association with the presence of hormonal receptors. More studies are needed to understand the real value of this finding.

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Breast cancer in systemic lupus

Cited by 22 publications

References 16 publications

Hormonal Dependence and Cancer in Systemic Lupus Erythematosus

Hormonal Dependence and Cancer in Systemic Lupus Erythematosus

The risks of cancer development in systemic lupus erythematosus (SLE) patients: a systematic review and meta-analysis

Anti-nuclear antibodies in patients with breast cancer

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