8A review on SLE and malignancy
Section snippets
Overall risk of malignancy
Over the last four decades, there have been numerous studies examining the risk of malignancy in adult patients with systemic lupus erythematosus (SLE) compared to a matched general population. These studies are based either on observational clinical cohorts [1] or cohorts identified through administrative data such as hospital discharge [2] and national health insurance databases [3]; they are summarized in Table 1, and additional details are provided in Supplementary Table 1. In most of these
Immunosuppressive therapy and SLE disease activity
It remains unclear whether ISDs influence susceptibility to malignancy in patients with SLE. Mechanistically, ISDs may theoretically lead to the development of cancer by causing direct mutagenesis and cytotoxicity and by increasing susceptibility to or decreasing clearance of oncogenic viruses. The evidence on the risk of overall and site-specific malignancies, notably hematological and cervical neoplasia, with ISD exposure is summarized in Table 3.
As the use of ISDs is highly correlated with
Malignancy screening and HPV vaccination in SLE
Tessier-Cloutier et al. [110] recently reviewed the evidence regarding malignancy screening in SLE. Of the 25 research articles that suggested some form of screening strategy, most recommendations were rudimentary and based on cancer incidence data from observational cohort studies or a case–control design and none compared the value of alternative screening strategies. Eleven of these 25 studies promoted following the general population cancer screening guidelines, while the remaining 14
Summary
There is increasing evidence supporting the association between malignancy and adult-onset SLE. There is an increased risk for malignancy overall as well as for lung, liver, head and neck, thyroid, vulvar/vaginal, and anal malignancies and cervical dysplasia; a substantially increased risk for hematologic malignancies, particularly NHL, has been consistently observed. In contrast, a decreased risk of hormone-sensitive cancers such as breast and prostate has also been reported. Little is known
Conflict of interest
Dr. Clarke has received consulting fees from AstraZeneca/MedImmune and Exagen Diagnostics (less than $10,000).
Dr. Ramsey-Goldman has received consulting fees from Seattle Genetics, AstraZeneca, and Eli Lilly (less than $10,000).
Acknowledgments
Grant support: Dr. Clarke holds The Arthritis Society Research Chair in Rheumatic Diseases at the University of Calgary.
Dr. Ramsey-Goldman's work was supported by the NIH (grants 5UL1TR001422-02 formerly 8UL1TR000150 and UL-1RR-025741, K24-AR-02318, and P60AR064464 formerly P60-AR-48098).
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