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Lupus and Cancer Risk

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Micrograph of Mantel Cell Lymphoma, Ileum by Nephron under Creative Commons License Uploaded from Wikimedia Commons SLE and Cancer Risk By A.G. Moore 12/30/2013 Nobody likes to think about cancer, and nobody likes to think about being sick. But most of us would like to know our relative risk of developing certain types of cancers and we’d like to know if there is anything we can do to protect ourselves. Today’s blog addresses this issue. The information presented is not meant to reassure or to frighten; it is meant, as all my blogs are, to give the reader a heads up about statistics doctors already work with (or should work with). Over the last several years I’ve read many times that people who have lupus are at increased risk of developing cancer. I never paid much attention to this news because the risk seemed remote and I simply didn’t want to trouble myself about it. However, it is clear that certain types of cancer do occur more frequently in people who have lupus and that taking cytotoxic drugs (cyclophosphamide, for example) increases the risk. As is usually the case with medical research, different studies come to different conclusions about the degree to which people with lupus are at increased risk. The discussion about cancer risk is most useful when confined to specific types: For example, lymphoma is definitely one cancer SLE patients tend to develop at an increased rate–about 3.4% over the general population; non-Hodgkin lymphoma rates are slightly higher: 4.39%. Non-Hodgkin symptoms are not especially specific and seem to overlap with some that lupus patients might be familiar with. A list of these non-Hodgkin symptoms may be found on the Mayo Clinic website. People with SLE also experience increased rates of leukemia, vulva and lung cancer. There is some suspicion that liver cancer may be put on this list, but this finding is not as certain. On a positive note, some rather common cancers appear with decreased frequency in people with SLE. These include breast cancer: .73% lower, endometrial cancer: .44% lower and (possibly) ovarian cancer: .64% lower. Additionally, solid tumor cancers do not seem to occur with greater frequency in people with SLE. Overall, in lupus patients, the net effect of cancers that occur with increased frequency, averaged with those that occur with decreased frequency, yields a modest total increased cancer risk of about 1.14%. All of these cancer statistics need to be put in perspective. Lupus usually gives the patient a proverbial “full plate”. Above all, there is the issue of getting the disease under control. Then there are concerns about treatment side effects, keeping a job, raising a family–the challenge of generally managing life. Cancer is a risk, to be sure, but it’s one of those risks little can be done about. We can be alert to symptoms and seek prompt, top-notch medical care. That’s about all we can do. Those of us who have lupus need to be aware that the disease puts us at increased risk of developing certain cancers. Once we’ve processed this information, we’d probably be wise to get on with our day. Cancer is just one of the bad things that can happen. Some of these things pose an immediate threat; I believe those are the things we should focus on. A list (the most recent I found) of cancers and the increased rate at which they occur in SLE patients (values are derived from the May, 2013 issue of Journal of Autoimmunity): Type of Cancer                                                       Increased Rate ** Hematologic Malignancies, Including Leukemia:              3.02% ** Non-Hodgkin Lymphoma:                                                   4.39% ** Vulva:                                                                                    3.78% ** Lung:                                                                                     1.3% ** Thyroid:                                                                                 1.76% ** Liver: (maybe)                                                                        1.87%

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