Open Access Research article

Cancer risk in childhood-onset systemic lupus

Sasha Bernatsky123*, Ann E Clarke12, Jeremy Labrecque12, Emily von Scheven4, Laura E Schanberg5, Earl D Silverman6, Hermine I Brunner7, Kathleen A Haines8, Randy Q Cron9, Kathleen M O’Neil10, Kiem Oen11, Alan M Rosenberg12, Ciarán M Duffy13, Lawrence Joseph12, Jennifer L Lee2, Mruganka Kale1, Elizabeth M Turnbull2 and Rosalind Ramsey-Goldman14

Author Affiliations

1 McGill University, 1020 Pine Avenue West, Montreal H3A 1A2, QC, Canada

2 Research Institute of the McGill University Health Centre, 687 Pine Avenue West, V-Building, Montreal H3A 1A1, QC, Canada

3 Divisions of Rheumatology and Clinical Epidemiology, McGill University Health Centre, 687 Pine Avenue West, V-Building, Montreal H3A 1A1, QC, Canada

4 Department of Pediatric Rheum, University of California at San Francisco, 505 Parnassus Box 0107, San Francisco 94143, CA, USA

5 Department of Pediatrics, Duke University Medical Center, PO Box 3212, Durham 27715-3212, NC, USA

6 Division of Rheumatology, Hospital for Sick Children, 555 University Avenue, Toronto M5G 1X8, ON, Canada

7 Rheumatology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati 45229, OH, USA

8 Department of Pediatrics, Hackensack University Medical Center, 30 Prospect Ave, Hackensack 07601, NJ, USA

9 Pediatric Rheumatology, University of Alabama-Birmingham, 1530 Third Ave South, SHEL 176, Birmingham 35294-2182, AL, USA

10 Division of Pediatric Rheumatology, Riley Hospital for Children, 699 Riley Hospital Drive, Indianapolis 46202, IN, USA

11 Pediatrics RR149 Rehab Ctr, University of Manitoba, 800 Sherbrook Street, Winnipeg R3A 1M4, MB, Canada

12 Department of Pediatrics, Royal University Hospital, 103 Hospital Dr, Saskatoon S7N 0W8, SK, Canada

13 Pediatrics, Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa K1H 8M5, ON, Canada

14 Northwestern University Feinberg School of Medicine, McGaw Pavilion, 240 E. Huron Street, Suite M-300, Chicago 60611, IL, USA

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Arthritis Research & Therapy 2013, 15:R198  doi:10.1186/ar4388

Published: 22 November 2013

Abstract

Introduction

The aim of this study was to assess cancer incidence in childhood-onset systemic lupus erythematosus (SLE).

Methods

We ascertained cancers within SLE registries at 10 pediatric centers. Subjects were linked to cancer registries for the observational interval, spanning 1974 to 2009. The ratio of observed to expected cancers represents the standardized incidence ratio (SIR) or relative cancer risk in childhood-onset SLE, versus the general population.

Results

There were 1020 patients aged <18 at cohort entry. Most (82%) were female and Caucasian; mean age at cohort entry was 12.6 years (standard deviation (SD) = 3.6). Subjects were observed for a total of 7,986 (average 7.8) patient-years. Within this interval, only three invasive cancers were expected. However, 14 invasive cancers occurred with an SIR of 4.7, 95% confidence interval (CI) 2.6 to 7.8. Three hematologic cancers were found (two non-Hodgkin’s lymphoma, one leukemia), for an SIR of 5.2 (95% CI 1.1 to 15.2). The SIRs stratified by age group and sex, were similar across these strata. There was a trend for highest cancer occurrence 10 to 19 years after SLE diagnosis.

Conclusions

These results suggest an increased cancer risk in pediatric onset SLE versus the general population. In absolute terms, this represents relatively few events. Of note, risk may be highest only after patients have transferred to adult care.