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Arthritis Research & Therapy

Open Access

Cancer risk factors in systemic lupus erythematosus: multivariate regression analysis in 16,409 patients

  • Sasha Bernatsky1Email author,
  • Rosalind Ramsey-Goldman2,
  • Jean-François Boivin3,
  • Lawrence Joseph1,
  • Michelle A Petri4,
  • Asad Zoma5,
  • Susan Manzi6,
  • Murray B Urowitz7,
  • Dafna D Gladman7,
  • Paul R Fortin8,
  • Ellen M Ginzler9,
  • Edward Yelin10,
  • Sang-Cheol Bae11,
  • Daniel J Wallace12,
  • Steven M Edworthy13,
  • Soren Jacobsen14,
  • Caroline Gordon15,
  • Mary A Dooley16,
  • Christine A Peschken17,
  • John G Hanly18,
  • Graciela S Alarcón19,
  • Ola Nived20,
  • Guillermo Ruiz-Irastorza21,
  • David Isenberg22,
  • Anisur Rahman22,
  • Torsten Witte23,
  • Cynthia Aranow24,
  • Diane L Kamen25,
  • Kristján Steinsson26,
  • Anca Askanase27,
  • Susan G Barr13,
  • Lindsey A Criswell10,
  • Gunnar Sturfelt20,
  • Neha M Patel9,
  • Jean-Luc Senécal28,
  • Michel Zummer28,
  • Janet E Pope29,
  • Stephanie Ensworth30,
  • Hani El-Gabalawy17,
  • Timothy McCarthy17,
  • Yvan St Pierre1 and
  • Anne E Clarke13
Arthritis Research & Therapy201416(Suppl 1):A35

Published: 18 September 2014


Systemic Lupus ErythematosusCancer RiskSystemic Lupus Erythematosus PatientMultivariate Regression AnalysisStandardize Incidence Ratio


Patients with systemic lupus erythematosus (SLE) experience an increased risk of cancer, which is particularly driven by hematological malignancies. Our objective was to determine whether certain factors (demographics, SLE duration and calendar year) were associated with cancer risk in SLE, relative to the general population, using a large multicenter clinical cohort.


We present detailed analyses of a multisite international SLE cohort (30 centers, 16,409 patients). Cancers were ascertained by registry linkage. Standardized incidence ratios (SIR; ratio of observed to expected cancers) were calculated for overall and for hematological cancer risk, representing the relative risk of cancer for SLE patients, versus the age, sex, and calendar-year-matched general. We used Poisson hierarchical regression to assess for potential independent effects of the factors examined (sex, race/ethnicity, age group, SLE duration, calendar-year period) on the SIRs among the SLE cohort members. The hierarchical nature of the model allowed for differences in effects from one country to the next.


In adjusted analyses (Table 1), we demonstrated lower SIR estimates for overall cancer risk, in black versus white SLE patients, in SLE patients of older versus younger age, and for patients with SLE duration of 5 years or more (versus lower duration). Female sex and calendar year were not clearly associated with any differences in the SIR estimates for SLE patients. Regarding hematological cancer specifically, SLE duration of 5 years or more again appeared to be associated with lower SIR estimates.
Table 1

Results of adjusted multivariate regression to determine independent effect of variables on SIR* estimates for cancer in SLE


Adjusted effectsa

95% confidence interval

Female sex


0.77 to 1.30




Reference group




0.58 to 0.97



0.85 to 1.62




Reference group


  40 to 59


0.55 to 0.94



0.42 to 0.73

SLE duration


  <5 years

Reference group


  ≥5 years


0.61 to 0.89

Calendar-year period



Reference group




0.79 to 1.15

aVariables adjusted concomitantly for all others (sex, race/ethnicity, age, SLE duration, calendar-year period).


Although cancer risk in SLE is increased relative to the general population, patients most at risk appear to be those of white race/ethnicity, younger age, and of shorter SLE duration.

Authors’ Affiliations

McGill University Health Centre, Montreal, Canada
Northwestern University Feinberg School of Medicine, Chicago, USA
McGill University, Montreal, Canada
Johns Hopkins University School of Medicine, Baltimore, USA
Hairmyres Hospital, East Kilbride, UK
West Penn Allegheny Health System, Temple University, Pittsburgh, USA
Toronto Western Hospital, Toronto, Canada
Université Laval, Canada
State University of New York, Downstate Medical Center, Brooklyn, USA
University of California, San Francisco, USA
Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
Cedars-Sinai Medical Center/David Geffen School of Medicine at UCLA, Los Angeles, USA
University of Calgary, Canada
Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
University of Birmingham, College of Medical and Dental Sciences, Birmingham, UK
University of North Carolina at Chapel Hill, USA
University of Manitoba, Winnipeg, Canada
Dalhousie University and Capital Health, Halifax, Canada
The University of Alabama, Birmingham, USA
Lund University Hospital, Lund, Sweden
Rheumatic Diseases Research Unit, Bizkaia, Spain
University College, London, UK
Hannover Medical School, Hannover, Germany
The Feinstein Institute for Medical Research, Manhasset, USA
Medical University of South Carolina, Charleston, USA
Landspitali University Hospital, Reykjavik, Iceland
New York University School of Medicine, New York, USA
Université de Montréal, Canada
University of Western Ontario, London, Canada
University of British Columbia, Vancouver, Canada


© Bernatsky et al.; licensee BioMed Central Ltd. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.