Risk Of Cancer In Ra Compared To The General Population

Several studies were designed to determine whether, or not, RA is associated with:

(a) an increased risk for the development of all cancers;

(b) an increased risk for the development of specific cancer types;

(c) no link occurs between RA and malignancy; and

(d) low risk for the development of certain cancers. The risk of cancer among patients with RA was studied in small and large cohorts of RA patients followed at certain rheumatology clinics and in large population-based studies. Table 1 shows the relative risk of cancer among patients with RA compared to the general population. The table shows that while some of the studies indicate that the overall risk of cancer in RA is not increased [5, 6, 15, 23, 24], others have shown a significantly increased risk of cancer in patients with RA compared with the general population [7,25, 27, 28],

In three large population-based long-term studies of RA patients living in Scandinavia, the overall risk of cancer was not increased in two cohorts [5, 6], and a significant 11% increase in all cancers was observed within the third cohort [7], The studies populations comprised 46,101 RA patients living in Finland [5], 11,683 RA patients from Sweden [6] and 20,699 RA patients living in Denmark [7]. The standardized incidence ratios (SIR) (observed/expected) for cancer were 1.06 in the first study [5], 0.95 in the second [6], and 1.11 (1.7 for hematopoeitic cancers, 1.08 for nonhematopoietic cancers) in the third [7].

A significantly increased risk of cancer compared with the general population was observed in RA patients treated with cyclophosphamide (SIR = 3.7) [28], and in RA patients with Felty's syndrome (SIR = 2.09) [25],

Taken together, the data suggest that the overall risk of cancer among patients with RA is not increased, or is slightly increased. However, patients with severe RA and particularly those with Felty's syndrome [25], and those who received cyclophosphamide [28], have a clinically and statistically significant increased risk for development of cancers.

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