Malignancy risk and screening

Several studies have provided persuasive evidence that patients with systemic lupus erythematosus (SLE) have an altered cancer risk profile when compared with the general population. SLE patients display a higher risk of certain malignancies (e.g., hematologic, lung), whereas they seem at lower risk of others (e.g., breast cancer). This altered risk is probably explained by multiple factors, including immunosuppressant drugs, susceptibility to certain viruses, genetic factors, clinical factors, race/ethnicity, immune dysregulation, cytokines, and hormonal factors. We review what is known about the epidemiology and the specific risk factors of key cancers in SLE. We also explore current guidelines on cancer screening and recommend strategies for physicians and patients to help manage malignancy risk in SLE.