Malignancies in systemic lupus erythematosus

Abstract

The purpose of this review is to underline important advancements in the understanding of cancer risks in systemic lupus erythematosus (SLE). In SLE, there is an increased risk of specific kinds of malignancy. For example, the risk of non-Hodgkin's lymphoma is increased several-fold in SLE versus the general population. In addition, heightened risks for lung cancer, thyroid cancer and cervical dysplasia in SLE have been found. Some have postulated that immunosuppressive drugs play a role, as well as other important mediators, such as lupus disease activity itself. One new frontier being explored is the significant finding of a decreased risk of certain nonhematologic cancers (e.g., breast, ovarian, endometrial and prostate) in SLE. The reasons for this are currently under study. Keywordscancer; immunosuppressive drug; malignancy; risk; systemic lupus erythematosus In systemic lupus erythematosus (SLE), there appears to be specific differences in cancer susceptibility, compared with the general population. To date, data indicate an overall increase in cancer in SLE (10-15%) [1], with definite increases in hematologic cancers, particularly non-Hodgkin's lymphoma (NHL) as well as lung, thyroid and vulvar cancer [1][2][3][4]. Cervical dysplasia (a precancerous lesion) is another condition of potential concern.It has been postulated that immunosuppressive drugs may play a role in increased cancer risk in SLE, but there may also be other important factors, including SLE activity itself. According to recent findings, the risk for certain nonhematologic cancers, such as breast, endometrial and ovarian cancers in women [5], and prostate cancers in men, may be decreased in individuals with SLE [6,7]. Exploring the reasons for this is itself a whole new avenue of potential research, as will be discussed.

Incidence, mortality and risk factors of cervical cancer in the world

“…On the other hand, the screening rate for cervical cancer is lower in people with lupus (Kiss et al, 2010).…”

“…Several studies have investigated the role of inflammatory diseases in cervical cancer (Bernatsky et al, 2009;Kiss et al, 2010;Simon et al, 2015). The results of a population-based cohort study showed that women with rheumatoid arthritis and systemic lupus erythematosus are 1.5 times more likely to develop cervical dysplasia and cervical cancer (Kim et al, 2014).…”

Immunologic pathomechanism of Hodgkin's lymphoma

“…There is evidence that, in certain autoimmune diseases, there is an increased risk of developing lymphoid malignancies. The background of this phenomenon includes common genetic predisposition, viral infection (e.g., EBV virus), use of immunosuppressive agents, persistent antigen stimuli, chronic inflammation, uncontrolled B cell proliferation, and defected apoptosis [28].…”

Autoimmune Disorders and Lymphomas

“…The role of immunosuppressive therapy is controversial; it may impair immune defence resulting in an increased risk of lymphomagenesis. However, SLE patients who have never been treated with immunosuppressive agents have the highest rate of NHL incidence during the first year from diagnosis, suggesting that the increased risk is not related to cumulative doses of therapy (Kiss et al, 2010). A nested case-cohort study performed to assess the HR for cancer within a multi-site international SLE cohort after exposure to immunosuppressive drugs (anti-malarial drugs, systemic glucocorticoids, NSAIDs, aspirin) showed an adjusted HR for overall cancer risk of 0.82.…”