Prevalence Of Cancer In Ra

The link between RA and cancers is based on numerous case reports of RA patients who developed solid and lymphoproliferative cancers and on large population-based studies. Cases of non-Hodgkin's lymphoma (NHL) [10], acute and chronic leukemia [11-12], multiple myeloma [13], and lung cancers [14] were all reported in association with RA patients.

Over the last three decades, several studies have reported the rate of cancer among large cohorts of RA patients [5-7]. Furthermore, the contribution of various DMARDs to the overall risk of cancer and to the risk of lymphoproliferative tumors was also reported [15-19].

Mortality and autopsies studies have indicated a low rate of cancer-related deaths among patients with RA compared to the general population [20-22], In three mortality studies, the rate of death as result of cancer was between 7-11%. In a cohort of 1000 patients with RA followed over 3 years between 19701975, cancer was the cause of death in 9% of the total deaths compared to 27% in the general population [21]. In a more recent study [8] from four North American centers, the observed rate of cancer death among the patients with RA was 9.4% compared with 27.7% in the general population.

Epidemiologic studies have shown the frequency of cancers in patients with RA to be between 2-15%.

In three large population-based studies, the prevalence of cancer was 2.6% among 46,101 patients with RA included in the nationwide registry in Finland [5], 7.2% among 11,683 RA patients from Sweden [6], and 9.7% within a cohort of 20,699 patients recorded in the Danish Hospital Discharge Register [7]. Higher rates of cancer were identified among RA patients living in Rochester, Minnesota, USA (16%) [23], among RA patients living in Saskatchewan, Canada (15.8%) [24] among men with Felty's syndrome (15%) [26], and among RA patients who received cyclophosphamide (16-30%) [27-28], Table 1 shows the frequency of cancer within various cohorts.

Tennis et al. [29] estimated the incidence of cancer among 1210 patients with RA who followed over 6539 patient-years in the province of Saskatchewan, Canada. The age adjusted incidence densities of cancer in RA was 8.2 cases/1000 person-years for women and 26.1 cases/1000 person-years for men. In the same study, incidence densities in the general population were, 10.4 cases/1000 persons in women and 16.1 cases/1000 persons per year. Similarly, in a large population-based study [6] of 11,683 Swedish RA patients followed over 101,000 patient-years, the estimated incidence rate of cancer in that cohort was 8.3 cases/1000 person-years.

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