ObjectivesWe determined whether any individual cancers are increased or decreased in a cohort of
595 patients with systemic lupus erythematosus (SLE) followed for up to 32 years at the
University College London Hospitals Lupus Clinic, looking for any associated clinical or
serological factors and the prognosis after cancer diagnosis.MethodsWe undertook a careful retrospective review of the medical records and identified all
individuals diagnosed with cancer. For controls, we selected three other patients in the
cohort who had not developed cancer, carefully matched for age, sex, ethnicity and
disease duration, to determine if any obvious differences emerged in a nested
case-control design.ResultsThirty-three patients developed cancer after being diagnosed with SLE. There was a
statistically insignificant small increase in overall cancer risk, standardized
incidence ratios (SIRs) 1.05 (95% CI 0.52–1.58) and increased SIRs for cervical,
prostate, anal and pancreatic cancers and reduction in breast cancer SIRs.Haematological and musculoskeletal manifestations, anticardiolipin and antithyroid
globulin antibodies were found to be positively associated with cancer risk in
multivariate analysis. There was no drug, dose or duration was associated with cancer
risk. There was a reduction in survival with a cancer fatality rate of 84.2%
(p < 0.0001).ConclusionWe found a very small but statistically insignificant increased cancer risk with
reduction in survival. Whereas some cancers appear to be more common in SLE, notably
prostate and cervical cancer, others, particularly breast cancer, are less frequent.
Multiple clinical and serological factors are involved in the increased risk of
malignancy in SLE. No drug dose or duration effect was identified.