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J Rheumatol. 2018 Mar;45(3):393-396. doi: 10.3899/jrheum.170652. Epub 2018 Jan 15.

Smoking Is the Most Significant Modifiable Lung Cancer Risk Factor in Systemic Lupus Erythematosus.

Author information

1
From The Research Institute of the McGill University Health Centre, Montreal; Université de Laval, Service de rheumatologie, Quebec City, Quebec; Toronto Western Hospital, Toronto, Ontario; Dalhousie University and Capital Health, Halifax, Nova Scotia; University of Manitoba, Winnipeg, Manitoba; Division of Rheumatology, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada; Northwestern University Feinberg School of Medicine, Chicago, Illinois; Johns Hopkins University School of Medicine, Baltimore, Maryland; University of California at San Francisco, Department of Medicine, San Francisco, California; State University of New York-Downstate Medical Center, Brooklyn; The Feinstein Institute for Medical Research, Manhasset, New York; Therapeutic Radiology, Yale University, New Haven, Connecticut, USA; University of Birmingham, College of Medical and Dental Sciences, Birmingham; University College London, Faculty of Medicine, Department of Rheumatology, London, UK; Lund University Hospital, Lund, Sweden; The Hospital for Rheumatic Diseases, Hanyang University, Seoul, Korea. sasha.bernatsky@mcgill.ca.
2
S. Bernatsky, MD, PhD, The Research Institute of the McGill University Health Centre; R. Ramsey-Goldman, MD, MPH, Northwestern University Feinberg School of Medicine; M. Petri, MD, MPH, Johns Hopkins University School of Medicine; M.B. Urowitz, MD, Toronto Western Hospital; D.D. Gladman, MD, Toronto Western Hospital; P.R. Fortin, MD, MPH, Université de Laval, Service de rheumatologie; E.H. Yelin, PhD, MCP, University of California, Department of Medicine; E. Ginzler, MD, MPH, State University of New York-Downstate Medical Center; J.G. Hanly, MD, Dalhousie University and Capital Health; C. Peschken, MD, MSc, University of Manitoba; C. Gordon, MD, University of Birmingham, College of Medical and Dental Sciences; O. Nived, MD, PhD, Lund University Hospital; C. Aranow, MD, The Feinstein Institute for Medical Research; S.C. Bae, MD, PhD, MPH, The Hospital for Rheumatic Diseases, Hanyang University; D. Isenberg, MD, University College, Faculty of Medicine, Department of Rheumatology; A. Rahman, MB, ChB, PhD, University College, Faculty of Medicine, Department of Rheumatology; J.E. Hansen, MD, MS, Therapeutic Radiology, Yale University; Y. St. Pierre, MSc, The Research Institute of the McGill University Health Centre; A.E. Clarke, MD, MSc, Division of Rheumatology, Cumming School of Medicine. sasha.bernatsky@mcgill.ca.
3
From The Research Institute of the McGill University Health Centre, Montreal; Université de Laval, Service de rheumatologie, Quebec City, Quebec; Toronto Western Hospital, Toronto, Ontario; Dalhousie University and Capital Health, Halifax, Nova Scotia; University of Manitoba, Winnipeg, Manitoba; Division of Rheumatology, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada; Northwestern University Feinberg School of Medicine, Chicago, Illinois; Johns Hopkins University School of Medicine, Baltimore, Maryland; University of California at San Francisco, Department of Medicine, San Francisco, California; State University of New York-Downstate Medical Center, Brooklyn; The Feinstein Institute for Medical Research, Manhasset, New York; Therapeutic Radiology, Yale University, New Haven, Connecticut, USA; University of Birmingham, College of Medical and Dental Sciences, Birmingham; University College London, Faculty of Medicine, Department of Rheumatology, London, UK; Lund University Hospital, Lund, Sweden; The Hospital for Rheumatic Diseases, Hanyang University, Seoul, Korea.
4
S. Bernatsky, MD, PhD, The Research Institute of the McGill University Health Centre; R. Ramsey-Goldman, MD, MPH, Northwestern University Feinberg School of Medicine; M. Petri, MD, MPH, Johns Hopkins University School of Medicine; M.B. Urowitz, MD, Toronto Western Hospital; D.D. Gladman, MD, Toronto Western Hospital; P.R. Fortin, MD, MPH, Université de Laval, Service de rheumatologie; E.H. Yelin, PhD, MCP, University of California, Department of Medicine; E. Ginzler, MD, MPH, State University of New York-Downstate Medical Center; J.G. Hanly, MD, Dalhousie University and Capital Health; C. Peschken, MD, MSc, University of Manitoba; C. Gordon, MD, University of Birmingham, College of Medical and Dental Sciences; O. Nived, MD, PhD, Lund University Hospital; C. Aranow, MD, The Feinstein Institute for Medical Research; S.C. Bae, MD, PhD, MPH, The Hospital for Rheumatic Diseases, Hanyang University; D. Isenberg, MD, University College, Faculty of Medicine, Department of Rheumatology; A. Rahman, MB, ChB, PhD, University College, Faculty of Medicine, Department of Rheumatology; J.E. Hansen, MD, MS, Therapeutic Radiology, Yale University; Y. St. Pierre, MSc, The Research Institute of the McGill University Health Centre; A.E. Clarke, MD, MSc, Division of Rheumatology, Cumming School of Medicine.

Abstract

OBJECTIVE:

To assess lung cancer risk in systemic lupus erythematosus (SLE), relative to demographics, drug exposures, smoking, and disease activity.

METHODS:

We analyzed data from 14 SLE cohorts. We calculated adjusted HR estimates for lung cancer in SLE, relative to demographics, smoking, time-dependent medication exposures, and cumulative disease activity [mean adjusted SLE Disease Activity Index (SLEDAI) scores]. This project was approved by the ethics boards of all participating institutions, including the Institutional Review Board of the McGill University Health Centre. The ethics approval number for the Cancer Risk study is GEN-06-031.

RESULTS:

Within these 14 SLE cohorts, 49 incident lung cancers occurred. Among lung cancer cases, 59.0% were in the highest SLEDAI quartile at baseline versus 40.8% of lung cancer-free SLE controls. The vast majority (84.2%) of SLE lung cancer cases were ever-smokers at baseline, versus 40.1% of those without lung cancer. In adjusted models, the principal factors associated with lung cancer were ever smoking (at cohort entry) and current age. Estimated adjusted effects of all drugs were relatively imprecise, but did not point toward any drug exposures as strong lung cancer risk factors.

CONCLUSION:

We saw no clear evidence for drugs as a trigger for lung cancer risk in SLE, although drug risk estimates were relatively imprecise. Smoking may be the most significant modifiable lung cancer risk factor in SLE.

KEYWORDS:

LUNG CANCER; SYSTEMIC LUPUS ERYTHEMATOSUS

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