Lupus and Cancer

Lupus and cancer have a tricky connection. For some cancers, having lupus raises your risk, while for others, it lowers it.

Even the medicines for lupus can change your risk.

Let’s dig into how lupus and cancer are linked, and learn how you can lower your own risk.

What is Lupus?

Lupus is a chronic autoimmune disease, which means that your body’s immune system attacks your own tissues and organs. The exact cause of lupus is unknown, but it’s likely a combination of genetics and environment.

Inflammation caused by lupus can affect many different body systems — including your joints, skin, kidneys, blood cells, brain, heart, and lungs.

Lupus can be difficult to diagnose because its signs and symptoms often mimic those of other ailments. The most distinctive sign of lupus — a facial rash that resembles the wings of a butterfly unfolding across both cheeks — occurs in many but not all cases of lupus.

There are four types of lupus:

Systemic Lupus Erythematosus (SLE) – This is the most common type of lupus, and it can affect many parts of the body including the skin, joints, and internal organs.
Cutaneous Lupus Erythematosus – This form of lupus is limited to the skin.
Drug-induced Lupus – This is a lupus-like disease caused by certain prescription drugs.
Neonatal Lupus – This is a rare condition that affects infants of women who have lupus.

While there’s no cure for lupus, treatments can help control symptoms.

Warning Signs of Lupus

Lupus is a chronic autoimmune disease with a wide range of symptoms that can vary greatly from person to person.

Some people may experience only a few mild symptoms, while others may have many severe symptoms. The most common symptoms of lupus include:

Fatigue: A feeling of being extremely tired or exhausted is often one of the first symptoms of lupus.
Joint pain, stiffness, and swelling: Lupus can cause pain, swelling, and stiffness in your joints, particularly in the morning.
Skin rashes: A butterfly-shaped rash across the cheeks and nose (malar rash) is a distinctive sign of lupus. Other types of rashes may also occur.
Skin lesions: These typically occur (or worsen) when exposed to the sun.
Fever: People with lupus may experience unexplained fevers.
Chest pain: Lupus can cause inflammation of the chest cavity lining (pleurisy) leading to sharp chest pain, especially during deep breathing.
Shortness of breath: This can be caused by inflammation or fluid in the lungs.
Headaches, confusion, and memory loss: Some people with lupus have these symptoms.
Dry eyes: Lupus can cause dryness in eyes, mouth and other body parts.
Raynaud’s phenomenon: Fingers and toes turn white or blue when exposed to cold or during stressful periods.

Lupus, Cancer, and their Interconnection

For a long time, researchers have been trying to figure out why some people with lupus seem to have a higher chance of getting cancer than others.

They’ve also discovered that for some cancers, the risk is actually lower if you have lupus, making this a tough puzzle to solve.

By studying different types of cancer, they’re hoping to get a clearer picture of who with lupus is most likely to get cancer, and why?

While lupus itself is not a cancer, research indicates that people with lupus may have an increased risk for certain types of cancer, especially hematological cancers and to a lesser extent some specific solid tumors.

Leukemia: Some studies indicate an elevated risk of leukemia in lupus patients.
Lung Cancer: Some research suggests that people with lupus may have an elevated risk of lung cancer. Lung cancer appears to be more common in lupus patients compared to the general population, with a notable occurrence of rare lung cancer types. However, many lupus patients who develop lung cancer are smokers, highlighting the importance of smoking cessation for this group.
Cervical Cancer: Women with lupus might have a slightly increased risk of cervical cancer, particularly if they are treated with immunosuppressive drugs. Some women with lupus having more abnormal PAP tests. This could be due to a reduced ability to fight off the human papilloma virus (HPV).
Breast Cancer: Evidence suggests that women with lupus may face a higher risk of breast cancer, possibly due to increased estrogen levels.

The Lupus-Lymphoma Link

People with lupus have been found to be at a higher risk of developing both Hodgkin’s and non-Hodgkin lymphoma. This higher risk could be due to the lupus disease process itself, such as overactive B-cells and defects in the immune system’s ability to monitor and control these cells. Immunosuppressive drugs could also contribute to this increased risk, especially after long-term use. Another important consideration is the presence of Sjogren’s syndrome, often seen in lupus patients, which further heightens the risk of lymphoma.

The Role of NSAIDs

Interestingly, it has been observed that patients with rheumatoid arthritis, another autoimmune disease, have a lower incidence of colorectal cancer.

This may be attributed to long-term use of non-steroidal anti-inflammatory drugs (NSAIDs) and aspirin.

Long-term aspirin and NSAID use may also reduce the risk of colorectal, breast, and prostate cancer in the general population. However, while these benefits might extend to people with lupus, it does not mean that aspirin and NSAIDs should be taken specifically for this purpose.

Long-term use of NSAIDs can raise cardiovascular disease risk, so it’s important to only take medications as directed by a healthcare provider.

Significance of Routine Cancer Checks

Even though individuals with lupus face a higher risk of cancer, research shows they often have the same or even fewer cancer screenings than the general public.

As a result, it’s crucial that you discuss lupus and its potential connection to cancer with your doctor.

This will help ensure you get the right cancer screenings at the recommended times.

Risk factors and Preventions

Various risk factors, like

Smoking
Obesity
Hormone replacement therapy
The use of immunosuppressive drugs

can boost the likelihood of getting cancer. As such, it’s crucial to maintain a healthy lifestyle.

Being overweight can also raise the risk for certain cancers, so aim to consume a diet that supports a healthy body weight.
Sunlight can trigger lupus flare-ups and increase skin cancer risk. Those with lupus should try to stay out of the sun as much as possible.
When outside, use sunscreen with an SPF of 85 or higher, and make sure it includes Helioplex for protection against both UV-A and UV-B rays.

Cancer Therapy Considerations in Lupus Patients

When cancer strikes, special care must be taken while planning and administering cancer treatments, like chemotherapy, in those with lupus.

If a person has both antiphospholipid antibodies and cancer, for instance, they may not be able to use certain breast cancer treatments like aromatase inhibitors or other estrogen analogs due to a heightened risk of blood clots.

Medical professionals may even choose to halt all lupus treatment during chemotherapy to avoid potential health risks, despite the possibility of lupus flare-ups. In such cases, the urgency of cancer treatment might outweigh the risks of lupus flares.

However, pausing lupus treatment could carry risks that go beyond triggering a lupus flare. According to a 2021 study published in Arthritis Care & Research, while lupus patients have a lower risk of breast cancer, older women with lupus who do develop the disease face a higher risk of early-stage mortality.

Interestingly, the elevated death risk might not be directly linked to cancer itself. Researchers suggest that the higher mortality rate might be due to stopping lupus treatment during chemotherapy, which can increase the likelihood of other health complications.

In the past, lupus patients sometimes received radiation therapy, a common cancer treatment, to manage their lupus symptoms.

However, this practice is now infrequent due to concerns over long-term toxicity, making it typically unsuitable as a cancer treatment option for those with lupus.

Wrapping Up

Although the prospect of cancer can be frightening, it’s important to remember that it only poses a relatively minor increased risk for most people living with lupus.

Just like lupus, cancer affects everyone differently. If you are at a higher risk, your healthcare provider can monitor any substantial changes to your symptoms and adjust your lupus treatment plan accordingly.

Understanding your own risks and actively collaborating with your healthcare team can significantly reduce anxiety and help ensure the best possible health outcomes for you!