Risk of lung cancer in rheumatoid arthritis and in relation to autoantibody positivity and smoking
Objective Lung cancer is a common malignancy in rheumatoid arthritis (RA). Since smoking is a risk factor for both (seropositive) RA and lung cancer, it remains unclear whether RA, in itself, increases lung cancer risk.Methods We performed a population-based cohort study of patients with RA and indi...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2022-10-01
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| Series: | RMD Open |
| Online Access: | https://rmdopen.bmj.com/content/8/2/e002465.full |
| _version_ | 1797989602919710720 |
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| author | Johan Askling Katerina Chatzidionysiou Daniela Di Giuseppe Jonas Söderling Anca Catrina |
| author_facet | Johan Askling Katerina Chatzidionysiou Daniela Di Giuseppe Jonas Söderling Anca Catrina |
| author_sort | Johan Askling |
| collection | DOAJ |
| description | Objective Lung cancer is a common malignancy in rheumatoid arthritis (RA). Since smoking is a risk factor for both (seropositive) RA and lung cancer, it remains unclear whether RA, in itself, increases lung cancer risk.Methods We performed a population-based cohort study of patients with RA and individually matched general population reference individuals identified in Swedish registers and from the Epidemiological Investigation of RA early RA study, prospectively followed for lung cancer occurrence 1995–2018. We calculated incidence rates and performed Cox regression to estimate HRs including 95% CIs of lung cancer, taking smoking and RA serostatus into account.Results Overall, we included 44 101 patients with RA (590 incident lung cancers, 56 per 100 000), and 216 495 matched general population individuals (1691 incident lung cancers, 33 per 100 000), corresponding to a crude HR (95% CI) of 1.76 (1.60 to 1.93). In subset analyses, this increased risk remained after adjustment for smoking (HR 1.77, 95% CI 1.06 to 2.97). Compared with general population subjects who were never smokers, patients with RA who were ever smokers had almost seven times higher risk of lung cancer. In RA, seropositivity was a significant lung cancer risk factor, even when adjusted for smoking, increasing the incidence 2–6 times. At 20 years, the risk in patients with RA was almost 3%, overall and over 4% for patients who were ever smokers and had at least one RA autoantibody.Conclusions Seropositive RA is a risk factor for lung cancer over and above what can be explained by smoking, although residual confounding by smoking or other airway exposures cannot be formally excluded. There is a need for increased awareness and potentially for regular lung cancer screening, at least in a subset of patients with RA. |
| first_indexed | 2024-04-11T08:21:57Z |
| format | Article |
| id | doaj.art-fb84049b263e4e809ee3c64f1c25a601 |
| institution | Directory Open Access Journal |
| issn | 2056-5933 |
| language | English |
| last_indexed | 2024-04-11T08:21:57Z |
| publishDate | 2022-10-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | RMD Open |
| spelling | doaj.art-fb84049b263e4e809ee3c64f1c25a6012022-12-22T04:34:56ZengBMJ Publishing GroupRMD Open2056-59332022-10-018210.1136/rmdopen-2022-002465Risk of lung cancer in rheumatoid arthritis and in relation to autoantibody positivity and smokingJohan Askling0Katerina Chatzidionysiou1Daniela Di Giuseppe2Jonas Söderling3Anca Catrina4Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, SwedenRheumatology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, SwedenClinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden5 Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, SwedenRheumatology Unit, Department of Gastroentorogy, Dematology and Rheumatology, Karolinska University Hospital, Stockholm, SwedenObjective Lung cancer is a common malignancy in rheumatoid arthritis (RA). Since smoking is a risk factor for both (seropositive) RA and lung cancer, it remains unclear whether RA, in itself, increases lung cancer risk.Methods We performed a population-based cohort study of patients with RA and individually matched general population reference individuals identified in Swedish registers and from the Epidemiological Investigation of RA early RA study, prospectively followed for lung cancer occurrence 1995–2018. We calculated incidence rates and performed Cox regression to estimate HRs including 95% CIs of lung cancer, taking smoking and RA serostatus into account.Results Overall, we included 44 101 patients with RA (590 incident lung cancers, 56 per 100 000), and 216 495 matched general population individuals (1691 incident lung cancers, 33 per 100 000), corresponding to a crude HR (95% CI) of 1.76 (1.60 to 1.93). In subset analyses, this increased risk remained after adjustment for smoking (HR 1.77, 95% CI 1.06 to 2.97). Compared with general population subjects who were never smokers, patients with RA who were ever smokers had almost seven times higher risk of lung cancer. In RA, seropositivity was a significant lung cancer risk factor, even when adjusted for smoking, increasing the incidence 2–6 times. At 20 years, the risk in patients with RA was almost 3%, overall and over 4% for patients who were ever smokers and had at least one RA autoantibody.Conclusions Seropositive RA is a risk factor for lung cancer over and above what can be explained by smoking, although residual confounding by smoking or other airway exposures cannot be formally excluded. There is a need for increased awareness and potentially for regular lung cancer screening, at least in a subset of patients with RA.https://rmdopen.bmj.com/content/8/2/e002465.full |
| spellingShingle | Johan Askling Katerina Chatzidionysiou Daniela Di Giuseppe Jonas Söderling Anca Catrina Risk of lung cancer in rheumatoid arthritis and in relation to autoantibody positivity and smoking RMD Open |
| title | Risk of lung cancer in rheumatoid arthritis and in relation to autoantibody positivity and smoking |
| title_full | Risk of lung cancer in rheumatoid arthritis and in relation to autoantibody positivity and smoking |
| title_fullStr | Risk of lung cancer in rheumatoid arthritis and in relation to autoantibody positivity and smoking |
| title_full_unstemmed | Risk of lung cancer in rheumatoid arthritis and in relation to autoantibody positivity and smoking |
| title_short | Risk of lung cancer in rheumatoid arthritis and in relation to autoantibody positivity and smoking |
| title_sort | risk of lung cancer in rheumatoid arthritis and in relation to autoantibody positivity and smoking |
| url | https://rmdopen.bmj.com/content/8/2/e002465.full |
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