Lupus

Saturday, November 26, 2011

Lupus and cancer

     Lupus can cause and or put one at higher risk of certain cancers.  Sometimes the drugs used to treat SLE can also cause certain cancers.  A lot of people do not know this about lupus and I think it is very important to have knowledge on  this subject when one has lupus or when a friend or family member is suffering.  It is also not so well known that one that suffers with major organ involvement in lupus use the same chemotherapy drugs as someone being treated for cancer.  I want to spread understanding  and knowledge about how potentially serious this disease can become and that it can cause the big C word.

Lupus Linked to Increased Risk of Cancer

Higher Lymphoma Rates Among Systemic Lupus Patients Appears to Drive Trend
By
WebMD Health News
Reviewed by Laura J. Martin, MD
40-ish woman
Nov. 9, 2010 (Atlanta) -- People with systemic lupus are 15% times more likely to develop cancer compared with the general population, suggest findings of a study involving nearly 13,500 people with systemic lupus.
The higher malignancy rate among people with systemic lupus is driven mainly by an increased risk of cancers of the white blood cells, particularly a threefold increased risk of lymphoma, says researcher Sasha R. Bernatsky, MD, assistant professor in the divisions of rheumatology and clinical epidemiology at McGill University in Montreal.
Because lymphoma is a relatively rare cancer, however, the absolute risk of any person with lupus developing it is still quite low, she tells WebMD.
"If you follow 200 patients with lupus for a year, maybe you would see one lymphoma," Bernatsky says. "Although important ... we don't want to be overstating the finding."
Not all the news is bad. In what she calls one of the most surprising findings, she says that women with systemic lupus were less likely to develop estrogen-sensitive cancers, specifically those of the breast (30% decreased risk), endometrium (51% decreased risk), and ovary (44% decreased risk).
"This raises the possibility that something about how women with lupus metabolize estrogen may be involved," Bernatsky says.
She presented the findings here at the American College of Rheumatology Annual Scientific Meeting.

More Cancer Cases Than Expected Among People With Systemic Lupus

Systemic lupus is a chronic inflammatory disease that can affect the skin, joints, nervous system, kidneys, lungs, and other organs in the body. The most common symptoms include skin rashes and arthritis, often accompanied by fatigue and fever. Lupus occurs mostly in women and typically develops in people in their 20s and 30s.
The same research group previously demonstrated an association between systemic lupus and cancer in a smaller study. The current study was designed to more precisely estimate cancer rates among people with lupus, compared with the general population.
The study involved 13,492 people with lupus from 24 medical centers followed for an average of nine years. Using regional tumor registries, the researchers pinpointed people with systemic lupus and compared their cancer rates to what was expected in the general population.
Over the course of the study, 632 cases of cancer were noted among people with systemic lupus, "more than what we expected," Bernatsky says.

Younger Women With Systemic Lupus at Particularly High Risk of Cancer

Compared with the general population, people with systemic lupus were:
  • 3.4 times more likely to develop non-Hodgkin's lymphoma
  • 3.2 times more likely to develop any lymphoma
  • 2.8 times more likely to develop vulvo-vaginal cancers
  • 2. 2 times more likely to develop liver cancer
  • 1.7 times more likely to develop leukemia
  • 1.7 times more likely to develop cervical cancer
  • 1.2 times more likely to develop lung cancer
"When stratified by age, people with lupus who are younger than 40 appear to have a particularly high risk. They are 1.7 times more likely to develop cancer than the general population,"

Lupus Linked to Increased Risk of Cancer

Higher Lymphoma Rates Among Systemic Lupus Patients Appears to Drive Trend
(continued)

Drugs, Disease May Drive Tumor Growth in People With Systemic Lupus

The study does not prove cause and effect, and no one knows for sure why people with lupus are at increased risk of certain cancers, Bernatsky says.
"The drugs used to treat lupus may play a role," she says. "But there is just as much evidence that lupus itself may drive tumor growth."
In the case of cervical cancer, "lupus patients are more likely to get precancerous lesions of the cervix and they are less likely to get regular screening because of their disease."
"It's important for these women to get regular Pap smears," Bernatsky says.


Lupus and Cancer

The Johns Hopkins Lupus Center

Systemic lupus erythematosus (“lupus” or “SLE”) and other autoimmune diseases are linked to an increased risk of certain types of cancer. Specifically, lupus patients may experience an elevated risk of lymphoma and other cancers, such as cancer of the cervix. Researchers have elucidated certain connections between lupus and cancer. For example, it is widely accepted that immunosuppressive medications, such as azathioprine (Imuran) and mycophenolate mofetil (Cellcept) contribute to elevated cancer risk. However, one of the largest studies to investigate this connection suggests that the risk of cancer is actually greatest during the earlier stages of lupus, indicating that exposure to immunosuppressive therapy is not the only link between lupus and cancer. Physicians do not yet understand the precise relationship between lupus and cancer.

Lupus and lymphoma

Studies show an increased risk of both Hodgkin’s and non-Hodgkin lymphoma in lupus patients. It is believed that the elevated risk of lymphoma results from the disease process of lupus—specifically the overstimulation of B-cells coupled with defects in the immune system’s surveillance system—and not just from medications or other associated risk factors. Some suggest that immunosuppressive medications also increase the risk of lymphoma and other blood cancers, especially 5 or more years after taking the drug. In addition, people with Sjogren’s syndrome, which is relatively common in lupus, experience an even greater elevation of lymphoma risk, suggesting that lymphoma in lupus patients may also be linked to this condition.

Lupus and breast cancer

Some data indicate that women with lupus experience an increased risk of breast cancer. Increased estrogen levels might contribute to a higher risk of breast cancer in women with lupus.

Lupus and lung cancer

Lung cancer is about 1.4 times more common in people with lupus than in the general population. Interestingly, people with lupus and lung cancer are more likely to experience rare types of lung cancer. However, like the general population, many of the people with lupus who develop lung cancer are smokers. In fact, 85% of lung cancer is caused by tobacco. It is very important that people with lupus do not smoke. Smoking not only increases the chance of developing lung cancer, it also ups the risk for cardiovascular disease (which is also markedly increased in people with lupus), and prevents lupus drugs like Plaquenil from working properly. If you need help quitting, talk to your doctor. S/he can help you find the most effective strategy to curb your smoking habit.

Lupus and cervical cancer

Certain studies have shown an elevated risk of cervical cancer and abnormal PAP tests in women with lupus. One study linked the increased incidence of abnormal PAP tests with histories of sexually transmitted disease, contraceptive use, and immunosuppressive medications. Some physicians suggest that either the use of immunosuppressives or flawed inherent immunity lead to a decrease in the ability of lupus patients to fight off human papilloma virus (HPV), a virus associated with cervical cancer. [Gardasil (the HPV vaccine)  is recommended for young women with lupus to reduce the risk of later cervical cancer.] However, like much of our knowledge of cancer in lupus, these connections are not fully known or understood.

Lupus and endometrial cancer

New evidence suggests that lupus patients also experience an elevated incidence of endometrial cancer, although the cause for this risk is unknown.

NSAIDs and cancer

It has been found that people with Rheumatoid Arthritis, another autoimmune disease, experience a lower incidence of colorectal cancer than the general population. Although the precise cause of this phenomenon is unknown, it has been attributed to the long-term (10 years or more) use of non-steroidal anti-inflammatory drugs (NSAIDS) and aspirin. Evidence has also been found that long-term aspirin and NSAID use may also reduce the risk of colorectal, breast, and prostate cancer in the general population. It is likely that this benefit also holds for people with lupus, but that does not mean that one should begin taking aspirin and NSAIDs for this reason. In fact, long term NSAID use can increase cardiovascular disease. Therefore, you should only take medications as directed by your physician.

The importance of regular cancer screenings

Despite the increased risk of cancer in people with lupus, studies show that lupus patients are actually equally or even less likely than the general population to undergo cancer screenings. Thus, it is very important that you speak with your doctor about lupus and cancer to ensure that you see the appropriate physicians for cancer screenings as often as recommended.

Healthy habits

Certain risk factors, such as smoking, obesity, hormone replacement therapy, and exposure to immunosuppressive medications, increase the chance that an individual will develop cancer. Therefore, it is also important that you practice healthy lifestyle habits. Obesity also increases the risk of certain cancers, so try to eat foods that help you maintain a healthy weight.
Sunlight causes lupus flares and also increases the risk of skin cancer. People with lupus should avoid the sun whenever possible. If you need to be outdoors, wear sunscreen with an SPF of 85 or greater and be sure that your sunscreen contains Helioplex to protect you from both UV-A and UV-B rays.

Sources

  • Gayed M, Bernatsky S, Ramsey-Goldman R, Clarke A, Gordon C. Lupus and cancer. Lupus. 209; 18(6); 479-85.

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