Some Immune-Mediated Diseases May Increase Cancer Risk

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Having an immune-mediated disease may increase a person’s risk of developing cancer, according to a large study published in JAMA Oncology

Researchers identified immune-mediated diseases associated with an elevated risk of cancer in the involved organs, near and distant organs, and different systems.

For this study, the researchers assessed the risk of total and individual cancers associated with 48 immune-mediated diseases.

The study included 478,753 participants from the UK Biobank prospective cohort. The patients’ mean age was 56.4 years, 54% were women, and 95% were White. There were 61,496 patients (13%) with at least 1 immune-mediated disease.

The median follow-up was 10 years. During that time, 2834 cases of cancer were recorded in 61,496 patients with immune-mediated diseases, and 26,817 cancer cases were recorded in 417,257 patients without immune-mediated diseases.

In a model adjusted for confounding factors (such as age, history of cancer, and body mass index), the risk of cancer was significantly higher among patients with immune-mediated diseases (hazard ratio [HR], 1.08; 95% CI, 1.04-1.12; P <.001).

A few individual immune-mediated diseases were significantly associated with an increased risk of cancer overall. These included ulcerative colitis (HR, 1.33; 95% CI, 1.17-1.51; P <.001), asthma (HR, 1.06; 95% CI, 1.01-1.12; P =.03), and primary biliary cholangitis (HR, 1.74; 95% CI, 1.10-2.76; P =.02).

Patients with any immune-mediated disease had an elevated risk of developing lung cancer (HR, 1.36; 95% CI, 1.20-1.53; P <.001), lymphoma (HR, 1.49; 95% CI, 1.26-1.75; P <.001), liver cancer (HR, 1.75; 95% CI, 1.30-2.36; P <.001), and a few other cancers.

Researchers identified 5 organ-specific immune-mediated diseases that were significantly associated with an elevated risk of local cancers only. Examples include asthma with lower airway cancer (HR, 1.34; 95% CI, 1.14-1.56; P <.001) and idiopathic thrombocytopenic purpura (ITP) with hematologic cancer (HR, 6.94; 95% CI, 3.94-12.25; P <.001).

The researchers also identified 9 immune-mediated diseases that were significantly associated with an increased risk of cancer in the involved organs, such as asthma with lung cancer (HR, 1.34; 95% CI, 1.14-1.57; P <.001) and celiac disease with small intestinal cancer (HR, 6.89; 95% CI, 2.18-21.75, P <.001).

In addition, 13 immune-mediated diseases were associated with an increased risk of cancer in the near organs, distant organs, or different systems. Examples include Crohn’s disease with liver cancer (HR, 4.01; 95% CI, 1.65-9.72; P =.002), autoimmune hepatitis with tongue cancer (HR, 27.75; 95% CI, 3.82-199.91; P =.001), and ITP with liver cancer (HR, 11.96; 95% CI, 3.82-37.42; P <.001).

Among all cancers, lymphoma was most extensively associated with immune-mediated diseases, such as rheumatoid arthritis (HR, 2.01; 95% CI, 1.34-3.01) and ITP (HR, 7.72; 95% CI, 3.67-16.23).

“The findings suggest that immune-mediated diseases are associated with risk of cancer at the local and systemic levels, supporting the role of local and systemic immunoregulation in carcinogenesis,” the researchers concluded.

Reference

He MM, Lo CH, Wang K, et al. Immune-mediated diseases associated with cancer risks. JAMA Oncol. Published online December 2, 2021. doi:10.1001/jamaoncol.2021.5680



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