@article{discovery10151093,
          volume = {73},
            note = {This version is the author accepted manuscript. For information on re-use, please refer to the publisher's terms and conditions.},
           pages = {1789--1795},
          number = {12},
           month = {October},
       publisher = {WILEY},
           title = {Cancer Risk in a Large Inception Systemic Lupus Erythematosus Cohort: Effects of Demographic Characteristics, Smoking, and Medications},
            year = {2021},
         journal = {Arthritis Care \&  Research},
        keywords = {Science \& Technology, Life Sciences \& Biomedicine, Rheumatology, DISEASE-ACTIVITY, MALIGNANCY, HYDROXYCHLOROQUINE, AUTOPHAGY},
             url = {https://doi.org/10.1002/acr.24425},
        abstract = {Objective: To assess cancer risk factors in incident systemic lupus erythematosus (SLE). Methods: Clinical variables and cancer outcomes were assessed annually among incident SLE patients. Multivariate hazard regression models (overall risk and most common cancers) included demographic characteristics and time-dependent medications (corticosteroids, antimalarial drugs, immunosuppressants), smoking, and the adjusted mean Systemic Lupus Erythematosus Disease Activity Index 2000 score. Results: Among 1,668 patients (average 9 years follow-up), 65 cancers occurred: 15 breast, 10 nonmelanoma skin, 7 lung, 6 hematologic, 6 prostate, 5 melanoma, 3 cervical, 3 renal, 2 each gastric, head and neck, and thyroid, and 1 each rectal, sarcoma, thymoma, and uterine cancers. Half of the cancers (including all lung cancers) occurred in past/current smokers, versus one-third of patients without cancer. Multivariate analyses indicated that overall cancer risk was related primarily to male sex and older age at SLE diagnosis. In addition, smoking was associated with lung cancer. For breast cancer risk, age was positively associated and antimalarial drugs were negatively associated. Antimalarial drugs and higher disease activity were also negatively associated with nonmelanoma skin cancer risk, whereas age and cyclophosphamide were positively associated. Disease activity was associated positively with hematologic and negatively with nonmelanoma skin cancer risk. Conclusion: Smoking is a key modifiable risk factor, especially for lung cancer, in SLE. Immunosuppressive medications were not clearly associated with higher risk except for cyclophosphamide and nonmelanoma skin cancer. Antimalarials were negatively associated with breast cancer and nonmelanoma skin cancer risk. SLE activity was associated positively with hematologic cancer and negatively with nonmelanoma skin cancer. Since the absolute number of cancers was small, additional follow-up will help consolidate these findings.},
          author = {Bernatsky, Sasha and Ramsey-Goldman, Rosalind and Urowitz, Murray B and Hanly, John G and Gordon, Caroline and Petri, Michelle A and Ginzler, Ellen M and Wallace, Daniel J and Bae, Sang-Cheol and Romero-Diaz, Juanita and Dooley, Mary Anne and Peschken, Christine A and Isenberg, David A and Rahman, Anisur and Manzi, Susan and Jacobsen, Soren and Lim, S Sam and van Vollenhoven, Ronald and Nived, Ola and Kamen, Diane L and Aranow, Cynthia and Ruiz-Irastorza, Guillermo and Sanchez-Guerrero, Jorge and Gladman, Dafna D and Fortin, Paul R and Alarcon, Graciela S and Merrill, Joan T and Kalunian, Kenneth C and Ramos-Casals, Manuel and Steinsson, Kristjan and Zoma, Asad and Askanase, Anca and Khamashta, Munther A and Bruce, Ian and Inanc, Murat and Clarke, Ann E}
}