Breast and gynecological cancer risk in systemic lupus erythematosus: A meta-analysis of cohort studies

Abstract

Objective

To evaluate the association between systemic lupus erythematosus (SLE) and the risk of breast and gynecological cancers through a systematic review and meta-analysis of cohort studies.

Methods

A comprehensive search was conducted in PubMed, Embase, and the Cochrane Library. The quality of the studies was assessed using the Newcastle-Ottawa Scale (NOS). Statistical analyses were performed, with separate analyses for standardized incidence ratios (SIRs) and 95 % confidence intervals (CIs). Sensitivity analyses, publication bias assessment using funnel plots and Egger's regression test, and subgroup analyses were conducted.

Results

The meta-analysis found no significant association between SLE and risk of breast cancer (SIR = 0.84, 95 % CI 0.64–1.11), I² = 97.8 %, P = 0.000) or ovarian cancer (SIR = 0.96, 95 % CI 0.72–1.28, I² = 60.9 %, P = 0.003). However, a significant increase in uterine cancer risk was observed (SIR = 1.41, 95 % CI 1.09–1.82, I² = 94.3 %, P = 0.000). The strongest association was found for vaginal/vulvar cancer (SIR = 3.61, 95 % CI 2.41–5.41, I² = 66.6 %, P = 0.006). Subgroup analyses indicated significant regional variations. European patients showed reduced breast cancer risk (SIR = 0.73, 95 % CI 0.57–0.94), while no significant association was observed in Asian or North American populations. Patients from developed countries had lower ovarian cancer risk than those from developing countries (SIR = 0.82, 95 % CI 0.59–1.60).

Conclusion

SLE is associated with an increased risk of uterine and vaginal/vulvar cancers, but not with breast or ovarian cancers. Subgroup analyses reveal regional differences in the relationship between SLE and breast/gynecological cancers.