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People with Lupus Have High Risk of Cancer, Study Finds
By Katerina Pesheva
People with a type of lupus called systemic lupus erythematosus (SLE) have a higher risk for developing all kinds of cancers, according to a report from the Sixth European Lupus Meeting. The report appeared in the April issue of Rheumatology News, the trade publication of U.S. rheumatologists.
The findings came from a joint study of 9, 587 SLE patients conducted by Systemic Lupus Erythematosus International Collaborating Clinics (SLEICC) and a group of Canadian researchers.
Researchers found that risk of several types of cancer was higher among SLE patients compared to the incidence among people without SLE.
Earlier this year, another study showed that people with SLE had increased risk of heart disease. So how are people diagnosed with SLE to react to this increasingly bad news? There is no need to overreact, advises Dr. Rosalind Ramsey-Goldman, professor of Medicine at Northwestern University Medical School who specializes in lupus research.
"Even though cardiovascular disease and cancer are increased in patients with lupus, an individual's risk of getting one of these complications is low," Ramsey-Goldman says. "Since lupus patients are young, the relative risk or the risk compared with the general population is high when these disease are less likely to occur. However, the message is even though you have lupus, you have to take care of yourself and prevent/treat even common conditions, even when you're young."
Researchers have suspected a cancer-lupus link since at least the late 1970s, so physicians treating people with lupus have always been vigilant about cancer, says Dr. Terry Moore, Chief of Rheumatology for the St. Louis University School of Medicine.
"People with lupus should continue their regular checkups with their physicians," Moore says. "We have known for quite a while about the link between lupus and cancer, and we've always monitored patients very carefully."
The overall risk for cancer among SLE patients was 15 percent, researchers found, which translates into an individual risk of about 1 percent, a relatively low risk, Ramsey-Goldman explains.
It is impossible to screen all people with SLE for cancer. However, effective tests for cancer, such as the Pap smear, yearly breast exams, mammograms, blood-stool test and skin examination, should be done routinely. Any further screening and testing for specific cancers should be done based on the person's medical history, symptoms and physical exam, Ramsey-Goldman says.
Researchers found that cancers of the lymphatic system and the blood had the highest incidence among people with SLE. There were 67 such cancers in the group, compared to the expected 24. Non-Hodgkin lymphoma, a cancer of the lymphatic system, ran an alarming 400 percent increased risk with 42 cases in the group, compared to the expected 12.
Researchers are not sure what the mechanism is. It has been hypothesized that a combination of genetic predisposition and environmental factors, such as infection with a specific virus, might play a role in upping cancer risk among people with SLE.
Another possible explanation for the higher rate of cancer among people with SLE is suppressed immune system. Normally, the human body has a number of safe-check mechanisms that screen for cancer cells and kill them when they begin to develop. However, in immuno-compromised people, these regulatory mechanisms may not work as well, thereby letting cancerous cells develop more easily, Moore says.
Risk was the highest in the first five years following diagnosis, researchers found.
"This is usually the time it takes to get lupus under control," says Dr. Michelle Petri, professor of Rheumatology and co-director of the Johns Hopkins Lupus Pregnancy Center.
Another possible explanation for this spike is that people with SLE take the highest doses of immuno-suppressing drugs in the first several years after diagnosis, Moore says.
For related story on lupus and heart disease, go to: www.marrtc.org/media/stories/050520lupuscvd.html
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