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Clinical Epidemiology and Outcomes Research
CE-22 Cancer in systemic lupus erythematosus: results from the slicc inception cohort
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  1. Sasha Bernatsky1,
  2. Murray B Urowitz2,
  3. John Hanly3,
  4. Ann E Clarke4,
  5. Caroline Gordon5,
  6. Juanita Romero-Diaz6,
  7. Graciela S Alarcon7,
  8. Sang-Cheol Bae8,
  9. Michelle Petri9,
  10. Joan Merrill10,
  11. Daniel J Wallace11,
  12. Paul R Fortin12,
  13. Dafna D Gladman2,
  14. David Isenberg13,
  15. Anisur Rahman13,
  16. Susan Manzi14,
  17. Ola Nived15,
  18. Gunnar K Sturfelt15,
  19. Christine A Peschken16,
  20. Jorge Sanchez-Guerrero2,
  21. Guillermo Ruiz-Irastorza17,
  22. Cynthia Aranow18,
  23. Ronald van Vollenhoven19,
  24. Asad A Zoma20,
  25. Kristjan Steinsson21,
  26. Munther A Khamashta22,
  27. Ellen Ginzler23,
  28. Anca Askanase24,
  29. Kenneth C Kalunian25,
  30. Mary Anne Dooley26,
  31. SSam Lim27,
  32. Diane Kamen28,
  33. Soren Jacobsen29,
  34. Manuel Ramos-Casals30,
  35. Murat Inanc31,
  36. Jennifer L Lee32 and
  37. Rosalind Ramsey-Goldman33
  1. 1Divisions of Rheumatology and Clinical Epidemiology, McGill University Health Centre, Montreal, QC, Canada
  2. 2Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, ON, Canada
  3. 3Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, NS, Canada
  4. 4Division of Rheumatology, University of Calgary, Calgary, AB, Canada
  5. 5Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
  6. 6Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico
  7. 7Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
  8. 8Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
  9. 9Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
  10. 10Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
  11. 11Cedars-Sinai/David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
  12. 12Division of Rheumatology, Centre Hospitalier Universitaire de Québec et Université Laval, Quebec City, QC, Canada
  13. 13Centre for Rheumatology, Department of Medicine, University College London, UK
  14. 14Division of Rheumatology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
  15. 15Department of Rheumatology, University Hospital Lund, Lund, Sweden
  16. 16University of Manitoba, Winnipeg, Manitoba, Canada
  17. 17Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Spain
  18. 18Feinstein Institute for Medical Research, Manhasset, NY, USA
  19. 19Academic Medical Centre, Dept of Clinical Immunology and Rheumatology, Amsterdam; The Netherlands
  20. 20Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland UK
  21. 21Center for Rheumatology Research, Landspitali University hospital, Reykjavik, Iceland
  22. 22Lupus Research Unit, The Rayne Institute, St Thomas’ Hospital, King’s College London School of Medicine, UK, London, UK
  23. 23Department of Medicine, SUNY Downstate Medical Centre, Brooklyn, NY, USA
  24. 24Hospital for Joint Diseases, NYU, Seligman Centre for Advanced Therapeutics, New York, NY USA
  25. 25UCSD School of Medicine, La Jolla, CA, USA
  26. 26Thurston Arthritis Research Centre, University of North Carolina, Chapel Hill, NC, USA
  27. 27Emory University School of Medicine, Division of Rheumatology, Atlanta, Georgia, USA
  28. 28Medical University of South Carolina, Charleston, South Carolina, USA
  29. 29Department of Rheumatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
  30. 30Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain
  31. 31Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
  32. 32Division of Clinical Epidemiology, McGill University Health Centre, Montreal, QC, Canada
  33. 33Northwestern University and Feinberg School of Medicine, Chicago, IL, USA

Abstract

Background To describe cancer incidence in the largest inception SLE cohort in the world.

Materials and methods Patients meeting ACR criteria for new-onset SLE were enrolled across 32 centres. At enrolment and annual assessments, new cancer diagnoses (in the intervening year) were recorded by the examining physician. Confirmation of cancers was done by reviewing medical files including pathology reports. Of 1848 patients enrolled (across 1999–2011), 1676 had at least one follow-up. Patients were followed until death, last visit, or end of study interval for this analysis (August 2015).

Results Of 1676 patients followed, the majority (88.7%) were female and 828 (49.4%) were Caucasian (16.5% black, 15.2% Asian, 15.2% Hispanic, 3.7% other). Average age at SLE diagnosis was 34.6 (standard deviation, SD 13.3) years. At baseline, 1085 (64.7%) patients were never-smokers; the remainder were current (n = 248) or ex-smokers (n = 342). Average follow-up from cohort entry was 6.9 (SD 3.6) years. Two patients had cancer (one squamous cell skin and one breast cancer) prior to their SLE diagnosis; these cancers were not included in our analyses.

We observed 46 cancers in 46 subjects (with three other subjects reported to have cervical intraepithelial neoplasia, a premalignant condition). At cancer diagnosis, the average age was 51.7 (SD 15.3) years and the average SLE duration was 4.8 (SD 3.1) years. The most common cancer type was breast (n = 9), followed by non-melanoma skin cancer (n = 8, six of which were basal cell), lung (n = 6), prostate (n = 5), four head and neck (tonsillar, tongue, and two oral), cervical (n = 2), thyroid (n = 2), melanoma (n = 2) and one each of Non-Hodgkin lymphoma, leukaemia, multiple myeloma, meduloblastoma brain cancer, renal carcinoma, gastric carcinoid, thymoma, and cutaneous dermatofibrosarcoma. Most of the cancer cases were female (34 cases, 73.9%) and Caucasian (34 cases, 73.9%). Four cancer cases were Hispanic, 4 were black, and 4 were Asian. Twenty of the 46 patients (43.5%) who developed cancers were current (n = 4) or ex-smokers (n = 16); five of the six lung cancers were current (n = 1) or ex-smokers (n = 4).

Conclusions Just under 3% of the incident SLE cohort developed a cancer over an average follow-up of 6.9 years. The most common cancers were breast, non-melanoma skin, and lung cancers. The vast majority of lung cancers were smokers, supporting the belief that lung cancer risk in SLE (as in the general population) is largely driven by smoking. Further analyses will determine the standardised incidence rates for these cancers in SLE, versus the general population.

Acknowledgements We thank all SLICC investigators and their patients for their invaluable data and dedication to SLE research

https://doi.org/10.1136/lupus-2016-000179.101

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