published February 28, 2014
Studies explore higher cancer risk in children with lupus
by Mercedes Pitzer
When people think of the fight against lupus, they usually think of the long and winding path full of different hurdles that a person living with the chronic disease must learn to overcome. But did you ever think that one of those hurdles could be cancer?
Well, according to Nancy Walsh of MedPage Today, recent studies have shown that “children with systemic lupus erythematosus (SLE) had an increased risk for cancer, particularly for malignancies that were hematologic in origin.”
When asked about this information, Mary Hoppe of New Brighton said, “As a mother of a daughter diagnosed with lupus – or SLE – at the young age of 13, the information is very scary, but not shocking.”
Since diagnosis, her daughter has undergone chemotherapy, and during a discussion with her doctors, they had made it clear what the possible long-term side effects may be. These side effects included infertility and the onset of cancer, thus Hoppe was not as taken aback by such information, as one would expect her to be.
Sasha Bernatsky, MD, of McGill University in Montreal, along with her colleagues, conducted a study in which 1,020 patients younger than age 18 were followed for almost eight years. In their findings, they discovered that there were 14 cases of “invasive cancer” when only three cases were expected to exist among such a large cohort of children.
Of the 14 cases, three were hematologic, dealing with blood. While two were non-Hodgkin’s lymphoma (NHL) and one was leukemia. These results were stated in Arthritis Research & Therapy online.
Even though this information is valuable, there is still very little known about the cancer risk in children living with lupus. With adults on the other hand, there have been many advancements about cancer relating to lupus in recent years. For example, in a Spanish study conducted this past November, it was discovered that “the incidence of cancer in adults was four times the expected rate.”
The reason researchers are now focusing on the tie between lupus and cancer in relation to children is because it’s insufficient to theorize that the experience with adults will be equal to that of children. This is due to the fact that SLE “is much different in organ system involvement, disease activity, and therapies used.”
The researchers involved in the study also made a point that “this is an important knowledge gap since pediatric patients have a very long disease duration and heavy burden of severity.”
During another study conducted by Bernatsky and her colleagues, they searched SLE registries at 10 different pediatric rheumatology centers throughout the United States and Canada for patients with cancer between the years 1974 and 2009. They found that the most of the patients within the cohort were young, white females who were approximately 13 years old.
It was noted that there appeared to be an increased risk of having cancer among those who have had SLE for 10 to 19 years. However, there was also a high risk “for those whose SLE had been diagnosed less than a year earlier.”
This means that Bernatsky and her colleagues were dealing with two polar opposite results. While one was saying that the longer a child deals with SLE, the more likely they are to develop cancer, the other one was saying that the shorter the amount of time a child is diagnosed with SLE, the more likely they are to develop cancer.
These results proposed the idea that for the recent-onset cases, “what appeared to be manifestations of lupus, could have been paraneoplastic syndrome.”
According to the Mayo Clinic website, paraneoplastic syndrome is when cancer-fighting antibodies mistakenly attack normal cells of the nervous or muscular system. This explains why it can easily be mistaken for lupus.
When asked about these findings, Hoppe agreed that “it only makes sense that cancer, unfortunately, could be one outcome due to the harsh treatments absorbed in (children’s) young bodies … for such a long period of their lifetime, compared to an adult diagnosed later in life.”
As for being more precautious of her daughter’s condition based on the information presented in Walsh’s article, Hoppe explained that they will continue to not focus on the negative and less desirable information on the internet and instead, simply trust her daughter’s team of physicians that they are treating her “the best way they know how based on current medical advancements.”
It is clear that research on the risks of hematologic cancer in children with SLE will continue, as none of the findings are yet conclusive. There is still much to explore.