Cancer risk mixed in rheumatoid arthritis patients | Arthritis Information

 

People with rheumatoid arthritis are more likely to develop lymphoma or lung cancer, but are less likely to develop colorectal cancer or breast cancer, according to American and Canadian researchers.

The findings come from pooling data from several studies, in a so-called meta-analysis.

"Previous studies appeared contradictory, with studies finding either higher, lower or equal rates of cancer in patients with rheumatoid arthritis compared with the general population," Dr. Samy Suissa of McGill University Health Centre, Montreal, told Reuters Health. "Our meta-analysis brings some clarity; the studies were not contradictory at all. Indeed, it was not overall cancer that should have been looked at, but the site-specific cancers."

The highest risk observed for a specific malignancy in people with rheumatoid arthritis was for lymphoma, the team reports in Arthritis Research & Therapy, with a 2-fold greater risk than in the general population. The risk of lung cancer among rheumatoid arthritis patients was 63 percent higher than in the general population.

Conversely, the risks of colorectal and breast cancer were lower in people with rheumatoid arthritis than in the general population, at 23 percent and 16 percent, respectively.

The researchers found the overall risk of malignancy for people with rheumatoid arthritis was "near parity" with the general population.

"Clinicians treating patients with rheumatoid arthritis should be on the lookout for possible early signs of lung cancer and lymphoma," Suissa advised.

SOURCE: Arthritis Research & Therapy, online April 23, 2008.

Yikes with the lung cancer rate. More reason for me to question the risk/benefits of me using Humira. Too many family members died of lung cancer and I am an ex smoker.I can understand your reluctance. I don't know about the rates for lung cancer, but I do know that a lot of the risk of lymphoma has to do with the severity of RA.

According to a study done by Dr. Eva Baecklund and published in Arthritis and Rheumatism in 2006, those with a low degree RA had the lowest risk of developing lymphoma, while those with a moderate level of RA had seven times the risk. Those patients with the highest level of RA had 71 times the risk of developing this cancer.

"The risk of lymphoma is substantially increased in a subset of patients with RA: those with very severe disease," wrote Baecklund.

More importantly, the team found no connection between many standard RA treatments and the development of lymphoma. The study included such RA treatment as methotrexate, anti-malarial agents, oral steroids, non-steroidal anti-inflammatory drugs (NSAIDs) and aspirin.


Lynn492008-05-20 07:29:07So it's the RA itself that raises the risk and not the medications?

[QUOTE=Lovie]So it's the RA itself that raises the risk and not the medications? Here's a copy of the article concerning that particular study.

The chronic inflammation and stimulation of the immune system in RA likely leads to cancer through as-yet unspecified pathways, the researchers speculated.


"The association between lymphoma risk and very high and/or longstanding disease activity indicates that most patients with RA will never have any clinically relevant increased lymphoma risk," the authors said. "In contrast, those who do may have highly increased risks, but can be readily identified based on their accrued inflammatory burden."


They added, "Conventional medical treatment to suppress and alleviate disease activity is not by itself a risk factor for lymphoma. Rather, it is possible that aggressive treatment may reduce lymphoma risk by reducing cumulative inflammation."





http://www.medpagetoday.com/Rheumatology/Arthritis/tb/2749 [QUOTE=Lynn49]Here's a copy of the article concerning that particular study.

The chronic inflammation and stimulation of the immune system in RA likely leads to cancer through as-yet unspecified pathways, the researchers speculated.


"The association between lymphoma risk and very high and/or longstanding disease activity indicates that most patients with RA will never have any clinically relevant increased lymphoma risk," the authors said. "In contrast, those who do may have highly increased risks, but can be readily identified based on their accrued inflammatory burden."


They added, "Conventional medical treatment to suppress and alleviate disease activity is not by itself a risk factor for lymphoma. Rather, it is possible that aggressive treatment may reduce lymphoma risk by reducing cumulative inflammation."





http://www.medpagetoday.com/Rheumatology/Arthritis/tb/2749[/QUOTE]

Help!  Is it me, or does the statement I bolded kind of contradict every other statement in the passage????  
Not really...The risk is there, but it apparently is not that great except when dealing with uncontrolled RA. Control the inflammation and you reduce the risk. At least that's my interpetation..

http://findarticles.com/p/articles/mi_m0857/is_7_12/ai_n17214266hi lynn hope you dont indme adding this..
interesting post..

Boney
patients with rheumatoid arthritis (RA), a chronic inflammatory autoimmune disease, have a high risk of death from disease - at least double the risk of the general population, studies overwhelmingly show. Evidence has been less clear on whether RA patients are exceptionally vulnerable to dying from cancer.

The first study to investigate whether patients with RA who develop cancer have a decreased rate of survival, featured in the March 2007 issue of Arthritis & Rheumatism, also examined the impact of rheumatic disease on overall cancer incidence. Conducted by a team of researchers in the United Kingdom, it focused on 2,105 patients with recent onset inflammatory polyarthritis (IP). Over time, a large proportion of new-onset IP cases evolve into RA, meeting the diagnostic criteria of the American College of Rheumatology.

Researchers followed the IP patients over a 10-year period to detect the occurrence of cancer. Among the group, they identified 123 cases of cancer for analysis. These cases included bone, lung, breast, prostate, urinary, colon, and brain cancers; cancers of the digestive, respiratory, and central nervous systems; cancers of the blood cells and cancerous tumors; but excluding non-melanotic skin cancers. Then, they compared these rates with the rates of cancer in the general population from the same geographic area, Norfolk, adjusting for difference in age and sex. Overall, the incidence of cancer was not increased in the IP subjects compared with the general population. However, the risk of blood cell cancers was increased among the IP sample, a finding researchers expected given the association between RA and lymphoma.

The study also compared the number of deaths in patients with cancer and inflammatory arthritis with that of cancer patients without a history of inflammatory arthritis. The finding was striking: a 40 percent increase in mortality in patients who suffered both IP, or RA, and cancer.

"The results of this study demonstrated that 5-year cancer survival in patients with IP is substantially reduced in comparison with that in the general population, even after adjusting for differences in age, sex, and cancer site, whereas the overall cancer incidence does not seem to be increased," observes Alan Silman, M.D., an epidemiologist with the University of Manchester and the study's leading researcher. Whether targeted cancer therapies could improve the survival rate for RA patients remains a subject for further research.

[QUOTE=Lynn49]Not really...The risk is there, but it apparently is not that great except when dealing with uncontrolled RA. Control the inflammation and you reduce the risk. At least that's my interpetation..

http://findarticles.com/p/articles/mi_m0857/is_7_12/ai_n17214266[/QUOTE]

"The association between lymphoma risk and very high and/or longstanding disease activity indicates that most patients with RA will never have any clinically relevant increased lymphoma risk,"

"Very high and/or longstanding disease" seems uncontrolled to me.

"Never have any clinically relevant increased lymphoma risk" doesn't seem like there would be much risk to reduce to me.
hi guys i thought part of the risks of cancer was due to some meds
suppresing the bodies own natural deffences against canerouse cells..
allso people whith paraprotein in the blood liable for myelanomas..
Boney
The risk of lung cancer among rheumatoid arthritis patients was 63 percent higher than in the general population.

Has anyone been diagnosed with lymphoma while taking various medications for ra?

Now that's a good question Pip! I haven't seen anyone ever mention it.no .. i was monitored for chronic leukemia for many years as itis a slow onset..
my wbc being 24 .. heamatologist said. he is 99.9 percent i dont have leukemia
and as i am monitored by rheumatology hospital if wbc raises they would refer me back.
he said wbc is high but not high enough for treatment . he says this probably due
to severe ra and prednisone usage ...

Boney
oh you guys i do not know if i want to be this informed???    i had an aunt 22 years ago who died with lung cancer.  she had ra and smoked.   at the end of her life she said her ra hurt worse than dying with cancer.i've been on message boards for RA for over 10 years and in all that time I have never encountered anyone who has said they've been diagnosed with lymphoma.  Lymphoma is a rare cancer to begin with and even though people with RA supposedely have a much higher chance of getting it that simply raises the number from 1 out of 1000 to 3 out 1000.  When looked at that way it isn't quite as scarey.  [QUOTE=buckeye]i've been on message boards for RA for over 10 years and in all that time I have never encountered anyone who has said they've been diagnosed with lymphoma.  Lymphoma is a rare cancer to begin with and [/QUOTE]

Well I am a lymphoma survivor. It's not at all rare, my dad had it twice and I knew several people in my work environment who have had it or leukemia. And lymphoma is remarkably close to leukemia. The problem with lymphoma is that it has no status. Breast cancer and lung cancer are much more identifiable (most people know someone famous who has had either cancer) along with skin cancer. That's not true about lymphoma.  It's invisible to the world at large. When I was diagnosed with lymphoma I had to go home and look it up because I knew nothing about it even though my dad had it.

Lymphoma acts on the immune system in ways that are not entirely unlike RA. Once you have had one immune system disease, you are more vulnerable to others. How much more all depends. You can't blame one for the other. I don't think it has all that much to do with some of the treatments, but if the immune system is weakened, the possibility does arise. I had a bout of pneumonia on chemo. If it had gotten the best of me, would I have died from pneumonia, chemo, or lymphoma. Pneumonia of course, but who cares? I would have surely died from the lymphoma. The chemo stinks, but it has kept me alive so I could be here to complain!

Even though I do not have RA, I have largely the same issues as someone who does in that I've also got a compromised immune system from my cancer. And that's where cancers and infections and other nasty things are more likely to look for a victim. Screenings as mentioned are very much the thing to do. Don't put them off.


Ok, maybe I'm chronically stupid, but in lay-terms please...RA increase the risks of lymphoma or the meds we take for it?

I recently read that newer studies conclude no increased risk of lung cancer in RA  patients.  If you click the link to the article posted and look at the references below it, you'll see that the article is based on studies that are several years old.  

Audrey,

From what I've read and the research I've seen, having uncontrolled RA is probably the greatest risk factor for lymphoma.

LynnLynn492008-05-21 04:27:04Nancy R Thank you Lynn49 for this info. Very interesting.
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