Malignancy in systemic lupus erythematosus: what have we learned?

Abstract

What have we learnt about cancer risk in systemic lupus erythematosus (SLE) over the past decade? One important lesson is that data do confirm a slight increased risk in SLE for all cancers combined, compared to the general population. However, it is clear that this is largely driven by an increased risk for hematological malignancies, particularly non-Hodgkin's lymphoma (NHL), although Hodgkin's lymphoma may be increased as well. In addition, there is evidence for a moderately increased risk of lung cancer, and possibly for rarer cancer types, such as hepatobiliary and vulvar/ vaginal malignancies.Unfortunately, the most clinically relevant question, the mechanism underlying the association between cancer and SLE, remains largely unanswered. Key issues remaining under study relate to the links between cancer risk, SLE disease activity, and medication exposures. Much of the recent data suggest that disease-related factors may be at least as important as medication exposures for certain cancers, such as NHL. The independent effects of drug exposures versus disease activity in mediating cancer risk in SLE remain unknown. Work is in progress to further elucidate these important issues.Meanwhile, there is good evidence that cervical dysplasia is increased in women with SLE. This may be mediated by decreased clearance of the human papilloma virus, which some suggest is an innate characteristic of SLE patients. However, an increased risk of cervical dysplasia is also associated with immunosuppressive medication exposures, particularly cyclophosphamide. For these reasons, it is important that women with SLE follow established guidelines for cervical cancer screening.

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

“…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).…”

Malignancies in Autoimmune Rheumatic Diseases – A Mini-Review

“…Common genetic background and Epstein-Barr virus infection may be possible pathogenic factors in this respect. Older age and longer disease duration may be associated with elevated cancer risk in lupus [17,18,[23][24][25] .…”

Renal cell carcinoma with proliferative lupus nephritis

“…There may be a slightly increased risk of cancer in SLE patients compared with the general population, but that seems to be mainly due to the increased incidence of haematological malignancies, especially non-Hodgkin's lymphoma 12 13. The underlying mechanism of the association between lupus and malignancy is still uncertain, and medication exposure seems to be the main culprit.…”