RA and cancer risk in the biologic era Save

Rheumatoid arthritis (RA) is known to be historically associated with site specific cancers, especially lung skin and lymphomas. This risk was described as likely to be supported by chronic systemic inflammation before the biologic era.

This nationwide population-based study, by Beydon et al. (OP0044), has performed a more recent (2010-2020) analysis of cancer incidence in people living with RA within the French national claim database, compared to general population, measured in the French Network of Population-Based Cancer Registries.

In the 255000+ patients analysed over 10 years, the risk of overall malignancy, all treatment groups combined, was increased of 20% (standardized incidence ratio SIR 1.20). Some site-specific cancers were particularly increased such as lung 40%, bladder (SIR 2.4), ears-nose-throat 40%, cervix 80%, prostate 8%, melanoma 37% and haematological malignancies such as diffuse large B cell 79%, and Hodgkin (SIR 2.68) lymphomas, and multiple myeloma 50%. Interestingly, pancreatic cancer was 10% less frequent in men, but not in women while breast and uterine body cancers was less 9% and 23% less increased in women. Generally, the risk of overall malignancy was significantly less increased in women (SIR 1.08) than in men (SIR 1.34) (p < 0.001). 

As it stands these reports suggests a higher rate of overall cancers in RA patients treated w/ cs and bDMARDs, which is discordant with other reports suggesting a reduction of risk in bDMARDs treated population1. However, one should be careful to not jump into conclusions as the present data do not draw any causal relationship between treatments and cancer incidence. In fact, a comparison with historical populations or data collected before the era of biologics would allow a better understanding of these figures. 

Interestingly, the reduction of breast and uterine cancer incidence in women with RA has already been reported and warrants further investigations.

References

1. Zhang Y, Lin J, You Z, Tu H, He P, Li J, Gao R, Liu Z, Xi Z, Li Z, Lu Y, Hu Q, Li C, Ge F, Huo Z, Qiao G. Cancer risks in rheumatoid arthritis patients who received immunosuppressive therapies: Will immunosuppressants work? Front Immunol. 2022 Dec 20;13:1050876. doi: 10.3389/fimmu.2022.1050876. PMID: 36605209; PMCID: PMC9807750.