Lupus patients are protected from cancer

Abstract

The title of this short editorial is deliberately provocative. The fact is that, perhaps surprisingly, there are no major, or even remotely definitive studies of the subject. The article in this issue of Lupus by Xu and Wiernik 1 provides a thoughtful review hinting at a positive rather than a negative association between the two diseases.Yet in the experience of this physician with 30 years' lupus practice, and currently with 2500 lupus patients on the clinic register, the association between lupus and cancer seems rare -unusually rare. The number of malignancies in this large patient cohort (remembered vividly) is low. These are patients with aberrations in their immune response. Patients treated for months and years with immunosuppressive drugs. Patients treated with intravenous infusions and transplants. Patients exposed to hospital admissions. Patients in whom, for example, abnormal cervical smear tests are extremely frequent. And yet, it appears to me, malignancy is rare. This observation is not supported as yet by statistically acceptable data.Epidemiology will have to tread through the usual minefields. Lupus patients are young. Cancer is less frequent in this age group. Yet, the literature has numerous case reports and series reporting malignancy with lupus. My own group is as guilty as most in publishing anecdotal reports of the association (two of our papers are cited by Xu and Wiernick). In retrospect, we probably felt that there was likely to be an increased lymphoma=cancer risk in lupus patients, and wished to highlight the fact.Certainly, a cousin of lupus -Sjogren's syndrome, is linked with lymphoma. Patient and animal data from many sources over the past 30 years, led by the observations of Norman Talal and colleagues, predict that some patients with primary Sjogren's syndrome will develop lymphoma -an important clinical observation. But Sjogren's syndrome -particularly the 40 year old with enlarged parotids, lymphadenopathy and anti-Ro -is a far cry from lupus -both clinically, and maybe in terms of malignancy risk.It is possible that some published series concentrate on 'atypical' lupus (the series of nine patients pub-

Malignancy and systemic lupus erythematosus

“…Although the point estimates of several of the studies support an increased risk of malignancy in lupus, the wide CIs (which include the null value in 50% of the studies) make it impossible to draw a definitive conclusion. A recent editorial by a leading researcher of lupus, based on anecdotal experience, argues that the risk of malignancy may be decreased in SLE [45].…”

Cancer incidence in multiple sclerosis and effects of immunomodulatory treatments

“…The long-term exposure of patients suffering from these disorders to immunosuppressive therapy may have confounded the association with cancer. On the other hand, it has been suggested that the autoimmune 'haplotype' [14] protects against infections and malignancy. MS is a putative autoimmune disease affecting the central white matter and results in progressive neurological disability over time.…”

Long-Lasting Remission of Pulmonary Metastases of Renal Cell Cancer under IFN-b Therapy in a Patient with Multiple Sclerosis

“…teraction between cancer and autoimmunity is not yet fully understood [14,15]. On the one hand, there are studies suggesting a protective effect of autoimmunity against cancer [7,[14][15][16][17][18][19], on the other hand, several studies have indicated an increased cancer risk of autoimmune disease. However, in these latter studies, particularly malignant lymphoproliferative diseases seem to be increased [7], which might be a consequence of either chronic antigenic hyperstimulation or viral reactivation under long-term immunosuppressive treatment.…”