Risk of malignancy among patients with rheumatic conditions

Abstract

Previous studies have described an increased risk of malignancy in subjects diagnosed with rheumatic conditions, most notably rheumatoid arthritis (RA). Our aim was to quantify and compare risks for site‐specific malignancy among hospitalized patients with RA, osteoarthritis (OA) and other rheumatic conditions in a nationwide, population‐based cohort. Subjects were identified from Scottish hospital in‐patient records from 1981 to 1996 and followed up by computer linkage of the Scottish Cancer Registry and the national registry of deaths. Expected cancer incidence was calculated from national cancer rates and related to the observed incidence by the standardized incidence ratio (SIR). Among RA patients, there was an increased risk for hematopoietic [males SIR= 2.13, 95% confidence interval (CI) 1.7–2.7; females SIR = 1.76, 95% CI 1.5–2.1], lung (males SIR = 1.32, 95% CI 1.2–1.5; females SIR = 1.44, 95% CI 1.3–1.6) and prostate (SIR = 1.26, 95% CI 1.0–1.6) cancers. Reduced risk were seen for colorectal cancer (males SIR = 0.87, 95% CI 0.7–1.1; females SIR = 0.71, 95% CI 0.6–0.9) and, among females, stomach cancer (SIR = 0.70, 95% CI 0.5–1.0). The excess risk for hematopoietic cancer and the reduced risk for colorectal and stomach cancers were sustained over 10 years of follow‐up. An overall decreased risk of cancer was observed for patients with OA; the greatest reductions were observed for colorectal (males SIR = 0.88, 95% CI 0.8–1.0; females SIR = 0.84, 95% CI 0.8–0.9), stomach (males SIR = 0.79, 95% CI 0.7–0.9; females SIR = 0.66, 95% CI 0.6–0.8) and lung (males SIR = 0.72, 95% CI 0.7–0.8; females SIR = 0.84, 95% CI 0.8–0.9) malignancies, with decreased risks generally still evident at 10 years of follow‐up. Our results support several previous findings regarding the incidence of hematopoietic and colorectal malignancies in RA patients. In addition, we have shown a large decrease in stomach cancer among patients with OA and females with RA that warrants further investigation since it may provide clues to possible prevention strategies. To further our knowledge about the underlying mechanisms of altered risk in cancer patients with rheumatic conditions, population studies requiring primary data collection are required. Int. J. Cancer 88:497–502, 2000. © 2000 Wiley‐Liss, Inc.

Nonsteroidal anti‐inflammatory drugs and risk of lung cancer

“…Analgesics might be prescribed to treat conditions that could be directly or indirectly associated with the risk of cancer (e.g., patients with osteoarthritis might have a reduced risk of lung cancer). 32 We adjusted for cardiovascular and osteoarticular disorders, the main indications for long-term use of aspirin and NA-NSAIDs, respectively, as well as for other relevant medical and demographic characteristics. The lack of detailed smoking history (e.g., time from starting or quitting) limited our ability to control for smoking habits.…”

Prostate cancer and use of nonsteroidal anti-inflammatory drugs: systematic review and meta-analysis

“…Aspirin is also used in the primary and secondary prevention of coronary heart disease. There are very few studies that examined the association between these conditions and prostate cancer, and they were generally indicative of a small increase in risk among those patients (Gridley et al, 1993;Thomas et al, 2000). There is no evidence that any of the indications of NSAID use is inversely associated with prostate cancer risk such that a spurious beneficial effect is created.…”

Immunomodulator agent-related lymphoproliferative disorders

“…2,3 However, as with all therapies, these new therapies are not without side effects and complications. TNFa inhibitors, [4][5][6][7] as well as other monoclonal antibody-based antiinflammatory agents, [8][9][10][11] have been associated with the development of lymphoproliferative disorders. Most of these reports have involved small numbers of patients.…”