The relationship between lupus and cancer is very complex.  There is a higher risk for some cancers, a lower risk for others, and even some lupus medications can increase the risks.  Read on to take a closer look at the links between living with lupus and the risk for cancer, and find out what you can do to decrease your own risk.

• Introduction to Lupus and Cancer
• What Is the Cancer Risk in Lupus?
• What Affects Cancer Risk?
• Cancer Treatment in Lupus
• Mitigating Cancer Risks
• In Conclusion

Introduction to Lupus and Cancer

For years, scientists have tried to unlock the mystery of why certain individuals with lupus appear to be at greater risk for developing cancer than others. They have also found that the risk for some cancers decreases for those with lupus, adding to the complexity of this contentious relationship. Researchers have looked at many types of cancer to determine the risk among those living with SLE to understand better who may be in the greatest danger of getting cancer and why.

What Is the Cancer Risk in Lupus?

In one of the largest studies, Chinese researchers analyzed the data from several studies that surveyed the risk of cancer for those living with lupus and other autoimmune diseases. The 2018 study found that while the risk isn’t significantly higher than the general population, some living with lupus may be predisposed to develop certain malignancies. These cancers include:

• bladder cancers,
• lymphatic and blood system cancers, including Hodgkin’s and non-Hodgkin’s lymphoma, leukemia, and myeloma,
• cervical cancer,
• digestive cancers, including esophageal and gastric cancers,
• respiratory cancers, including lung, larynx, and oropharynx cancers,
• non-melanoma skin cancers such as basal cell skin cancer and squamous cell skin cancer, and
• thyroid cancers.

No significant associations were found between lupus and brain, colorectal, pancreatic, or uterine cancer.

Interestingly, there appears to be a decreased risk for several cancers. These include:

• breast cancer
• melanoma, and
• prostate cancer.

What Affects Cancer Risk in Lupus?

Researchers of a 2021 literature review funded by pharmaceutical company AstraZeneca analyzed data from over 41 studies that investigated the risk of 40 malignancies for those living with lupus. The researchers identified several factors that may be implicated in a higher cancer risk. They include:

• chronic immune stimulation due to SLE activity and flares,
• viral infectionssuch as Epstein-Barr virus, viral hepatitis, and human papillomavirus (HPV)
• chronic inflammation,
• antiphospholipid autoantibodyactivity,
• genetics and heredity,
• smoking— those with lupus are already at 1.4 times higher risk for lung cancer, including some rare lung cancers,
• sexually-transmitted disease,
• the use of cyclophosphamide, which is associated with bladder cancer and leukemia,
• azathioprine(Imuran), methotrexate, and TNF-inhibitors, which have been associated with non-melanoma skin cancer

Conversely, several factors may decrease the risk of some malignancies in lupus. For example, there is a reduced risk of some hormone-sensitive cancers.  This may correspond to a decrease in naturally-occurring hormones in early menopause or by avoiding synthetic hormones through oral contraceptives and hormone replacement therapy (HRT). In addition, those with lupus who are photosensitive, use sun protection measures, and avoiding the sun may significantly decrease anyone’s risk of melanoma.

A 2021 Johns Hopkins University literature review also found that the duration of SLE may contribute to the development of some cancers – though, again, it is a mixed bag. For example, if lymphoma appears in an individual with lupus, it usually develops in the early years of their lupus diagnosis. Conversely, lung and skin cancer may develop later as lupus has progressed.

Cancer Treatment in Lupus

If cancer occurs, care needs to be taken when administering cancer treatment therapies, such as chemotherapy. The Hospital for Specialty Surgery notes that those with lupus who already take chemotherapeutic agents such as cyclophosphamide to treat lupus symptoms will need to adjustment their treatment plans to accommodate treating both lupus and cancer effectively without causing other health dangers.

For example, suppose an individual has antiphospholipid antibodies and cancer. In that case, they may not be able to use aromatase inhibitors or other estrogen analogs to treat breast cancer because of the increased risk of blood clots. A practitioner may stop all lupus treatment during chemotherapy to avoid health risks. While this may trigger lupus flares, treating the cancer may be worth the risk.

However, stopping lupus treatment may come with risks more significant than a lupus flare. Researchers of a 2021 article published in Arthritis Care & Research found that even though the risk of breast cancer is lower in those with lupus, older women who develop the malignancy have a higher risk of death in the early stages of the disease. Moreover, he risk of death may not be from cancer itself.  Instead, these researchers believe the increased risk of death may be due to the discontinuing of SLE treatment during chemotherapy, which can increase the risk of developing other health complications.

In the past, radiation therapy, a common treatment for some cancers, was sometimes given to lupus patients to treat their symptoms and is often used to treat cancer. However, that practice is rare now because it is thought to increase long-term toxicity and is usually not a cancer treatment option for those with lupus.

Mitigating Cancer Risks – What You Can Do

While it may be impossible to prevent certain cancers, several things can be done to lower the risk. Scientists think that one of the reasons for the decreased risk of some cancers in lupus is that these individuals may more strictly follow recommended guidelines for health screenings and preventative care than much of the general population due to the nature of lupus and the need for ongoing care. This makes a strong case for regularly speaking with a healthcare practitioner to take preemptive measures to stay on top of health conditions and fully understand any cancer risks.

Some additional steps those with lupus can take to mitigate the risk of developing cancer include:

• learning family health history that includes any malignancies and reporting them to a healthcare practitioner,
• eating healthy, maintaining a healthy weight, and getting plenty of exercise,
• using sun protection and avoiding direct sun when possible,
• quitting smoking and avoiding excessive alcoholuse, and
• immediately reporting any changes in health to a practitioner.

In Conclusion

While the thought of cancer is scary, overall, it represents a relatively small increased risk to most living with lupus. Yet, as with lupus, cancer can strike each person differently.  Even if an individual finds themselves at a higher risk, a healthcare practitioner can make sure to look for any significant changes to symptoms and modify their existing lupus treatment plans as needed.  Finally, it is important to understand your own risks and to actively work with your healthcare providers.  This can go a long way to alleviate as much fear as possible and to make sure you achieve your best possible outcomes!

 

 

References

Bernatsky, S. Ramsey-Goldman, R., Petri, M., Urowitz M., Gladman, D., Fortin, R., Yelin, D., Ginzler, E., Hanly, J., Peschken, C., Gordon, C., Nived, O., Aranow, C., Bae, S., Isenberg, D., Rahman, A., Hansen, J., St. Pierre, Y., & Clarke, A. (2018). Smoking is the most significant modifiable lung cancer risk factor in systemic lupus erythematosus. The Journal of Rheumatology, 45(3), 393-396. https://doi.org/10.3899/jrheum.170652

Bruera, S. Lei, X. Pundole, X., Zhao, H., Giordano, S., Vinod, S., & Suarez-Almazor, M. (2021). Systemic lupus erythematosus is a risk factor for mortality in elderly patients with early breast cancer [abstract]. Arthritis Care & Research. https://doi.org/10.1002/acr.24793

Cappelli, L. & Shah, A. (2020). The relationships between cancer and autoimmune rheumatic diseases. Best Practices & Research: Clinical Rheumatology, 34(1), 101472. https:// doi.org/10.1016/j.berh.2019.101472

Clark, A., Pooley, N., Marjenberg, Z., Langham, J., Nicholson, L., Langham, S., Embleton, N., Wang, X., Desta, B., Barut, V., & Hammond, E. (2021). Risk of malignancy in patients with systemic lupus erythematosus Systematic review and meta-analysis. Seminars in Arthritis and Rheumatism, 51(6), 1230-1241. doi.org/10.1016/j.semarthrit.2021.09.009

Erkan, D. & Lockshin, M. (11, March 2021). What should lupus patients know about radiation treatment for cancer and elective cosmetic enhancement procedures? Hospital for Specialty Surgery. https://www.hss.edu/conditions_lupus-radiation-cosmetic-enhancement.asp

Lupus and cancer. (2022). Johns Hopkins Lupus Center. https://www.hopkinslupus.org/lupus-info/lifestyle-additional-information/lupus-cancer/ 

Song, L., Wang, Y., Zhang, J., Song, N, Xu, X., & Lu, Y. (2018). The risks of cancer development in systemic lupus erythematosus (SLE) patients: a systematic review and meta-analysis. Arthritis Research & Therapy, 20(1). https://doi.org/10.1186/s13075-018-1760-3

 

Author: Liz Heintz

Liz Heintz is a professional health and education writer who received her BA in Communications, Advocacy, and Relational Communications from Marylhurst University in Lake Oswego, Oregon.  She loves to read and write, and especially loves to educate through her writing. A native of San Francisco, California, Liz now calls the beautiful Pacific Northwest home.

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