Updated June 25, 2015.
Written or reviewed by a board-certified physician. See About.com's Medical Review Board.
The general population is advised to have routine cancer screenings after they reach a certain age. In people with rheumatoid arthritis, routine cancer screenings may be even more important. People with rheumatoid arthritis have an increased risk of developing lymphoma, leukemia, and myeloma. The increased risk does not appear to be associated with some rheumatic diseases, such as ankylosing spondylitis, but it may be associated with other rheumatic diseases that are treated with methotrexate (e.g., psoriatic arthritis).
There has been some question about whether TNF blockers increase the risk of cancer as well. Data from randomized, controlled, clinical trials suggest that increased risk of cancer associated with TNF blockers may be highest in the first few months of treatment. After that, the risk may level off.
According to Kelley's Textbook of Rheumatology, there is twice the risk of lymphoma in people with rheumatoid arthritis compared to those without the disease. There also appears to be an increased risk of lung cancer in patients with rheumatoid arthritis, but a decreased risk of colorectal cancer, breast cancer, and cancer of the urogenital tract in men and women.
Whether it is the type of arthritis, intensity of disease activity, or specific treatment that correlates with an increased risk of cancer, it seems clear that routine cancer screenings are very important for those who do have an increased risk. This, of course, raises a couple of questions. Are rheumatoid arthritis patients receiving cancer screenings at a rate that would be comparable to the general population?
Should rheumatoid arthritis patients have cancer screenings more frequently because of their increased risk?
According to study results published in the July 10, 2012 issue of Arthritis & Rheumatism, data obtained from insurance claims revealed that rheumatoid arthritis patients were undergoing screenings for breast cancer, cervical cancer, and colon cancer at about the same rate as patients without rheumatoid arthritis. That much seemed to be positive news, especially since it had been previously reported that patients with rheumatoid arthritis were not being screened as often as recommended.
But still, the question remained, should an at-risk population, such as people with rheumatoid arthritis, be screened for cancer more often? At this point in time, there have been no clearly-stated guidelines issued which suggest more frequent cancer screenings for rheumatoid arthritis patients. Suggestions from a published article in Nature Reviews | Rheumatology (2009), are clear and well-stated:
- Controlling disease activity using the least-intensive treatment regimen is imperative (i.e., lowest effective doses of medications).
- Patients who are being prescribed disease-modifying anti-rheumatic drugs, including methotrexate and TNF blockers, should undergo routine cancer screening appropriate to their age, sex, and comorbidities, before they start treatment or shortly after starting.
- As cancer tends to develop early in the course of treatment, patients should be observed for signs and symptoms and blood counts monitored during the initial or early treatment period.
Skin cancer screenings were not included in the aforementioned study conclusions, but that too should not be ignored. There is an increased risk of melanoma in rheumatoid arthritis patients.
The Bottom Line
People with rheumatoid arthritis, including myself, must be mindful that routine cancer screenings are a necessity. Because the disease and possibly some treatments increase our risk for cancer we must be vigilant and committed to getting our screenings done when it is time. I had a mammogram, Pap test, and colonoscopy in recent months. While I can't say it was fun, it gave me something even greater -- peace of mind. Follow through with your screenings. Keep track of when you are due to have a cancer screening. If your doctor doesn't bring it up, you're not off the hook. This is your responsibility. Discuss it with you doctor. Decide how often you should have screenings and determine if you are up to date.
Sources:
Kelley's Textbook of Rheumatology. Chapter 37. Cancer Risk in Rheumatic Diseases. Ninth edition. Volume I. Elsevier Saunders. Accessed 05/15/14.
No differences in cancer screening rates in patients with rheumatoid arthritis compared to the general population. Arthritis & Rheumatism. Kim, SC et al. September 27, 2012.
http://onlinelibrary.wiley.com/doi/10.1002/art.34542/abstract
Should cancer screening be routine in rheumatoid arthritis? Eric L. Matteson. Nature. Volume 5. September 2009.
doi:10.1038/nrrheum.2009.173