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Ann Rheum Dis. Oct 2005; 64(10): 1421–1426.
Published online Apr 13, 2005. doi:  10.1136/ard.2004.033993
PMCID: PMC1755244

Risks of solid cancers in patients with rheumatoid arthritis and after treatment with tumour necrosis factor antagonists


Background: Existing studies of solid cancers in rheumatoid arthritis (RA) reflect cancer morbidity up until the early 1990s in prevalent cohorts admitted to hospital during the 1980s.

Objective: To depict the cancer pattern of contemporary patients with RA, from updated risk data from prevalent and incident RA populations. To understand the risk of solid cancer after tumour necrosis factor (TNF) treatment by obtaining cancer data from cohorts treated in routine care rather than trials.

Methods: A population based study of three RA cohorts (one prevalent, admitted to hospital 1990–2003 (n = 53 067), one incident, diagnosed 1995–2003 (n = 3703), and one treated with TNF antagonists 1999–2003 (n = 4160)), which were linked with Swedish nationwide cancer and census registers and followed up for cancer occurrence through 2003.

Results: With 3379 observed cancers, the prevalent RA cohort was at marginally increased overall risk of solid cancer, with 20–50% increased risks for smoke related cancers and +70% increased risk for non-melanoma skin cancer, but decreased risk for breast (–20%) and colorectal cancer (–25%). With 138 cancers, the incident RA cohort displayed a similar cancer pattern apart from non-decreased risks for colorectal cancer. TNF antagonist treated patients displayed solid cancer (n = 67) risks largely similar to those of other patients with RA.

Conclusion: The cancer pattern in patients treated with TNF antagonists mirrors those of other contemporary as well as historic RA cohorts. The consistent increase in smoking associated cancers in patients with RA emphasises the potential for smoking cessation as a cancer preventive measure in RA.

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Selected References

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  • Wolfe Frederick, Michaud Kaleb. Lymphoma in rheumatoid arthritis: the effect of methotrexate and anti-tumor necrosis factor therapy in 18,572 patients. Arthritis Rheum. 2004 Jun;50(6):1740–1751. [PubMed]
  • Symmons Deborah P M, Silman Alan J. Anti-tumor necrosis factor alpha therapy and the risk of lymphoma in rheumatoid arthritis: no clear answer. Arthritis Rheum. 2004 Jun;50(6):1703–1706. [PubMed]
  • Gridley G, McLaughlin JK, Ekbom A, Klareskog L, Adami HO, Hacker DG, Hoover R, Fraumeni JF., Jr Incidence of cancer among patients with rheumatoid arthritis. J Natl Cancer Inst. 1993 Feb 17;85(4):307–311. [PubMed]
  • Kauppi M, Pukkala E, Isomäki H. Elevated incidence of hematologic malignancies in patients with Sjögren's syndrome compared with patients with rheumatoid arthritis (Finland). Cancer Causes Control. 1997 Mar;8(2):201–204. [PubMed]
  • Mellemkjaer L, Linet MS, Gridley G, Frisch M, Møller H, Olsen JH. Rheumatoid arthritis and cancer risk. Eur J Cancer. 1996 Sep;32A(10):1753–1757. [PubMed]
  • Thomas E, Brewster DH, Black RJ, Macfarlane GJ. Risk of malignancy among patients with rheumatic conditions. Int J Cancer. 2000 Nov 1;88(3):497–502. [PubMed]
  • Pincus Theodore, Sokka Tuulikki. Clinical trials in rheumatic diseases: designs and limitations. Rheum Dis Clin North Am. 2004 Nov;30(4):701–vi. [PubMed]
  • Lipsky PE, van der Heijde DM, St Clair EW, Furst DE, Breedveld FC, Kalden JR, Smolen JS, Weisman M, Emery P, Feldmann M, et al. Infliximab and methotrexate in the treatment of rheumatoid arthritis. Anti-Tumor Necrosis Factor Trial in Rheumatoid Arthritis with Concomitant Therapy Study Group. N Engl J Med. 2000 Nov 30;343(22):1594–1602. [PubMed]
  • Lunde AS, Lundeborg S, Lettenstrom GS, Thygesen L, Huebner J. The person-number systems of Sweden, Norway, Denmark, and Israel. Vital Health Stat 2. 1980;(84):1–59. [PubMed]
  • Söderlin MK, Börjesson O, Kautiainen H, Skogh T, Leirisalo-Repo M. Annual incidence of inflammatory joint diseases in a population based study in southern Sweden. Ann Rheum Dis. 2002 Oct;61(10):911–915. [PMC free article] [PubMed]
  • Feltelius N, Fored CM, Blomqvist P, Bertilsson L, Geborek P, Jacobsson LT, Lindblad S, Lysholm J, Rantapä-Dahlqvist S, Saxne T, et al. Results from a nationwide postmarketing cohort study of patients in Sweden treated with etanercept. Ann Rheum Dis. 2005 Feb;64(2):246–252. [PMC free article] [PubMed]
  • Mattsson B, Wallgren A. Completeness of the Swedish Cancer Register. Non-notified cancer cases recorded on death certificates in 1978. Acta Radiol Oncol. 1984;23(5):305–313. [PubMed]
  • Myllykangas-Luosujärvi R, Aho K, Isomäki H. Mortality from cancer in patients with rheumatoid arthritis. Scand J Rheumatol. 1995;24(2):76–78. [PubMed]
  • Symmons DP. Neoplasms of the immune system in rheumatoid arthritis. Am J Med. 1985 Jan 21;78(1A):22–28. [PubMed]
  • Bendix G, Bjelle A, Holmberg E. Cancer morbidity in rheumatoid arthritis patients treated with Proresid or parenteral gold. Scand J Rheumatol. 1995;24(2):79–84. [PubMed]
  • Cibere J, Sibley J, Haga M. Rheumatoid arthritis and the risk of malignancy. Arthritis Rheum. 1997 Sep;40(9):1580–1586. [PubMed]
  • Speerstra F, Boerbooms AM, van de Putte LB, van Beusekom HJ, Kruijsen MW, Vandenbroucke JP. Side-effects of azathioprine treatment in rheumatoid arthritis: analysis of 10 years of experience. Ann Rheum Dis. 1982;41 (Suppl 1):37–39. [PMC free article] [PubMed]
  • van den Borne BE, Landewé RB, Houkes I, Schild F, van der Heyden PC, Hazes JM, Vandenbroucke JP, Zwinderman AH, Goei The HS, Breedveld FC, et al. No increased risk of malignancies and mortality in cyclosporin A-treated patients with rheumatoid arthritis. Arthritis Rheum. 1998 Nov;41(11):1930–1937. [PubMed]
  • Lewis P, Hazleman BL, Hanka R, Roberts S. Cause of death in patients with rheumatoid arthritis with particular reference to azathioprine. Ann Rheum Dis. 1980 Oct;39(5):457–461. [PMC free article] [PubMed]
  • Terry Mary Beth, Gammon Marilie D, Zhang Fang Fang, Tawfik Heba, Teitelbaum Susan L, Britton Julie A, Subbaramaiah Kotha, Dannenberg Andrew J, Neugut Alfred I. Association of frequency and duration of aspirin use and hormone receptor status with breast cancer risk. JAMA. 2004 May 26;291(20):2433–2440. [PubMed]
  • Sørensen HT, Friis S, Nørgård B, Mellemkjaer L, Blot WJ, McLaughlin JK, Ekbom A, Baron JA. Risk of cancer in a large cohort of nonaspirin NSAID users: a population-based study. Br J Cancer. 2003 Jun 2;88(11):1687–1692. [PMC free article] [PubMed]
  • Stolt P, Bengtsson C, Nordmark B, Lindblad S, Lundberg I, Klareskog L, Alfredsson L. Quantification of the influence of cigarette smoking on rheumatoid arthritis: results from a population based case-control study, using incident cases. Ann Rheum Dis. 2003 Sep;62(9):835–841. [PMC free article] [PubMed]
  • Maini R, St Clair EW, Breedveld F, Furst D, Kalden J, Weisman M, Smolen J, Emery P, Harriman G, Feldmann M, et al. Infliximab (chimeric anti-tumour necrosis factor alpha monoclonal antibody) versus placebo in rheumatoid arthritis patients receiving concomitant methotrexate: a randomised phase III trial. ATTRACT Study Group. Lancet. 1999 Dec 4;354(9194):1932–1939. [PubMed]
  • Geborek P, Bladström A, Turesson C, Gulfe A, Petersson IF, Saxne T, Olsson H, Jacobsson LTH. Tumour necrosis factor blockers do not increase overall tumour risk in patients with rheumatoid arthritis, but may be associated with an increased risk of lymphomas. Ann Rheum Dis. 2005 May;64(5):699–703. [PMC free article] [PubMed]

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