A Systematic Review and Meta-Analysis to Inform Cancer Screening Guidelines in Idiopathic Inflammatory Myopathies

Alexander Oldroyd; Andrew B Allard; Jeffrey P Callen; Hector Chinoy; Lorinda  Chung; David Fiorentino; Michael D George; Patrick  Gordon; Kate Kolstad; Drew J B  Kurtzman; Pedro M Machado; Neil J McHugh; Anna  Postolova; Albert  Selva-O'Callaghan; Jens Schmidt; Sarah Tansley; Ruth Ann Vleugels; Victoria P  Werth; Rohit Aggarwal

doi:10.1093/rheumatology/keab166

A Systematic Review and Meta-Analysis to Inform Cancer Screening Guidelines in Idiopathic Inflammatory Myopathies

Alexander Oldroyd, Andrew B Allard, Jeffrey P Callen, Hector Chinoy, Lorinda Chung, David Fiorentino, Michael D George, Patrick Gordon , Kate Kolstad, Drew J B Kurtzman, Pedro M Machado, Neil J McHugh, Anna Postolova, Albert Selva-O'Callaghan, Jens Schmidt, Sarah Tansley, Ruth Ann Vleugels, Victoria P Werth , Rohit Aggarwal

Research output: Contribution to journal › Review article › peer-review

Abstract

Objectives: To identify clinical factors associated with cancer risk in the idiopathic inflammatory myopathies (IIMs) and to systematically review the existing evidence related to cancer screening. Methods: A systematic literature search was carried out on Medline, Embase and Scopus. Cancer risk within the IIM population (i.e. not compared with the general population) was expressed as risk ratios (RR) for binary variables and weighted mean differences (WMD) for continuous variables. Evidence relating to cancer screening practices in the IIMs were synthesized via narrative review. Results: Sixty-nine studies were included in the meta-analysis. DM subtype (RR 2.21), older age (WMD 11.19), male sex (RR 1.53), dysphagia (RR 2.09), cutaneous ulceration (RR 2.73) and anti-transcriptional intermediary factor-1 gamma positivity (RR 4.66) were identified as being associated with significantly increased risk of cancer. PM (RR 0.49) and clinically amyopathic DM (RR 0.44) subtypes, Raynaud's phenomenon (RR 0.61), interstitial lung disease (RR 0.49), very high serum creatine kinase (WMD -1189.96) or lactate dehydrogenase (WMD -336.52) levels, and anti-Jo1 (RR 0.45) or anti-EJ (RR 0.17) positivity were identified as being associated with significantly reduced risk of cancer. Nine studies relating to IIM-specific cancer screening were included. CT scanning of the thorax, abdomen and pelvis appeared to be effective in identifying underlying asymptomatic cancers. Conclusion: Cancer risk factors should be evaluated in patients with IIM for risk stratification. Screening evidence is limited but CT scanning could be useful. Prospective studies and consensus guidelines are needed to establish cancer screening strategies in IIM patients.

Original language	English
Pages (from-to)	2615-2628
Number of pages	14
Journal	Rheumatology (Oxford)
Volume	60
Issue number	6
DOIs	https://doi.org/10.1093/rheumatology/keab166
Publication status	Published - 1 Jun 2021

Keywords

CT scanning
autoantibodies
epidemiology
meta-analysis
muscle
myositis
neoplasia
Guidelines as Topic
Age Factors
Lung Diseases, Interstitial/complications
Humans
Male
Risk
Tomography, X-Ray Computed
Dermatomyositis/complications
Adenosine Triphosphatases/immunology
DNA-Binding Proteins/immunology
L-Lactate Dehydrogenase/blood
Publication Bias
Female
Raynaud Disease/complications
Myositis/blood
Deglutition Disorders/complications
Neoplasms/diagnosis
Antibodies, Antinuclear/blood
Sex Factors
Transcription Factors/immunology
Creatine Kinase/blood
Skin Ulcer/complications

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1093/rheumatology/keab166

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Oldroyd, A., Allard, A. B., Callen, J. P., Chinoy, H., Chung, L., Fiorentino, D., George, M. D., Gordon , P., Kolstad, K., Kurtzman, D. J. B., Machado, P. M., McHugh, N. J., Postolova, A., Selva-O'Callaghan, A., Schmidt, J., Tansley, S., Vleugels, R. A., Werth , V. P., & Aggarwal , R. (2021). A Systematic Review and Meta-Analysis to Inform Cancer Screening Guidelines in Idiopathic Inflammatory Myopathies. Rheumatology (Oxford), 60(6), 2615-2628. https://doi.org/10.1093/rheumatology/keab166

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title = "A Systematic Review and Meta-Analysis to Inform Cancer Screening Guidelines in Idiopathic Inflammatory Myopathies",

abstract = "Objectives: To identify clinical factors associated with cancer risk in the idiopathic inflammatory myopathies (IIMs) and to systematically review the existing evidence related to cancer screening. Methods: A systematic literature search was carried out on Medline, Embase and Scopus. Cancer risk within the IIM population (i.e. not compared with the general population) was expressed as risk ratios (RR) for binary variables and weighted mean differences (WMD) for continuous variables. Evidence relating to cancer screening practices in the IIMs were synthesized via narrative review. Results: Sixty-nine studies were included in the meta-analysis. DM subtype (RR 2.21), older age (WMD 11.19), male sex (RR 1.53), dysphagia (RR 2.09), cutaneous ulceration (RR 2.73) and anti-transcriptional intermediary factor-1 gamma positivity (RR 4.66) were identified as being associated with significantly increased risk of cancer. PM (RR 0.49) and clinically amyopathic DM (RR 0.44) subtypes, Raynaud's phenomenon (RR 0.61), interstitial lung disease (RR 0.49), very high serum creatine kinase (WMD -1189.96) or lactate dehydrogenase (WMD -336.52) levels, and anti-Jo1 (RR 0.45) or anti-EJ (RR 0.17) positivity were identified as being associated with significantly reduced risk of cancer. Nine studies relating to IIM-specific cancer screening were included. CT scanning of the thorax, abdomen and pelvis appeared to be effective in identifying underlying asymptomatic cancers. Conclusion: Cancer risk factors should be evaluated in patients with IIM for risk stratification. Screening evidence is limited but CT scanning could be useful. Prospective studies and consensus guidelines are needed to establish cancer screening strategies in IIM patients.",

keywords = "CT scanning, autoantibodies, epidemiology, meta-analysis, muscle, myositis, neoplasia, Guidelines as Topic, Age Factors, Lung Diseases, Interstitial/complications, Humans, Male, Risk, Tomography, X-Ray Computed, Dermatomyositis/complications, Adenosine Triphosphatases/immunology, DNA-Binding Proteins/immunology, L-Lactate Dehydrogenase/blood, Publication Bias, Female, Raynaud Disease/complications, Myositis/blood, Deglutition Disorders/complications, Neoplasms/diagnosis, Antibodies, Antinuclear/blood, Sex Factors, Transcription Factors/immunology, Creatine Kinase/blood, Skin Ulcer/complications",

author = "Alexander Oldroyd and Allard, {Andrew B} and Callen, {Jeffrey P} and Hector Chinoy and Lorinda Chung and David Fiorentino and George, {Michael D} and Patrick Gordon and Kate Kolstad and Kurtzman, {Drew J B} and Machado, {Pedro M} and McHugh, {Neil J} and Anna Postolova and Albert Selva-O'Callaghan and Jens Schmidt and Sarah Tansley and Vleugels, {Ruth Ann} and Werth, {Victoria P} and Rohit Aggarwal",

note = "Publisher Copyright: {\textcopyright} 2021 The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Rheumatology. {\textcopyright} The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Rheumatology.",

year = "2021",

month = jun,

day = "1",

doi = "10.1093/rheumatology/keab166",

language = "English",

volume = "60",

pages = "2615--2628",

journal = "Rheumatology (Oxford)",

issn = "1462-0324",

publisher = "Oxford University Press",

number = "6",

}

Oldroyd, A, Allard, AB, Callen, JP, Chinoy, H, Chung, L, Fiorentino, D, George, MD, Gordon , P, Kolstad, K, Kurtzman, DJB, Machado, PM, McHugh, NJ, Postolova, A, Selva-O'Callaghan, A, Schmidt, J, Tansley, S, Vleugels, RA, Werth , VP & Aggarwal , R 2021, 'A Systematic Review and Meta-Analysis to Inform Cancer Screening Guidelines in Idiopathic Inflammatory Myopathies', Rheumatology (Oxford), vol. 60, no. 6, pp. 2615-2628. https://doi.org/10.1093/rheumatology/keab166

TY - JOUR

T1 - A Systematic Review and Meta-Analysis to Inform Cancer Screening Guidelines in Idiopathic Inflammatory Myopathies

AU - Oldroyd, Alexander

AU - Allard, Andrew B

AU - Callen, Jeffrey P

AU - Chinoy, Hector

AU - Chung, Lorinda

AU - Fiorentino, David

AU - George, Michael D

AU - Gordon , Patrick

AU - Kolstad, Kate

AU - Kurtzman, Drew J B

AU - Machado, Pedro M

AU - McHugh, Neil J

AU - Postolova, Anna

AU - Selva-O'Callaghan, Albert

AU - Schmidt, Jens

AU - Tansley, Sarah

AU - Vleugels, Ruth Ann

AU - Werth , Victoria P

AU - Aggarwal , Rohit

N1 - Publisher Copyright: © 2021 The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Rheumatology. © The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Rheumatology.

PY - 2021/6/1

Y1 - 2021/6/1

N2 - Objectives: To identify clinical factors associated with cancer risk in the idiopathic inflammatory myopathies (IIMs) and to systematically review the existing evidence related to cancer screening. Methods: A systematic literature search was carried out on Medline, Embase and Scopus. Cancer risk within the IIM population (i.e. not compared with the general population) was expressed as risk ratios (RR) for binary variables and weighted mean differences (WMD) for continuous variables. Evidence relating to cancer screening practices in the IIMs were synthesized via narrative review. Results: Sixty-nine studies were included in the meta-analysis. DM subtype (RR 2.21), older age (WMD 11.19), male sex (RR 1.53), dysphagia (RR 2.09), cutaneous ulceration (RR 2.73) and anti-transcriptional intermediary factor-1 gamma positivity (RR 4.66) were identified as being associated with significantly increased risk of cancer. PM (RR 0.49) and clinically amyopathic DM (RR 0.44) subtypes, Raynaud's phenomenon (RR 0.61), interstitial lung disease (RR 0.49), very high serum creatine kinase (WMD -1189.96) or lactate dehydrogenase (WMD -336.52) levels, and anti-Jo1 (RR 0.45) or anti-EJ (RR 0.17) positivity were identified as being associated with significantly reduced risk of cancer. Nine studies relating to IIM-specific cancer screening were included. CT scanning of the thorax, abdomen and pelvis appeared to be effective in identifying underlying asymptomatic cancers. Conclusion: Cancer risk factors should be evaluated in patients with IIM for risk stratification. Screening evidence is limited but CT scanning could be useful. Prospective studies and consensus guidelines are needed to establish cancer screening strategies in IIM patients.

AB - Objectives: To identify clinical factors associated with cancer risk in the idiopathic inflammatory myopathies (IIMs) and to systematically review the existing evidence related to cancer screening. Methods: A systematic literature search was carried out on Medline, Embase and Scopus. Cancer risk within the IIM population (i.e. not compared with the general population) was expressed as risk ratios (RR) for binary variables and weighted mean differences (WMD) for continuous variables. Evidence relating to cancer screening practices in the IIMs were synthesized via narrative review. Results: Sixty-nine studies were included in the meta-analysis. DM subtype (RR 2.21), older age (WMD 11.19), male sex (RR 1.53), dysphagia (RR 2.09), cutaneous ulceration (RR 2.73) and anti-transcriptional intermediary factor-1 gamma positivity (RR 4.66) were identified as being associated with significantly increased risk of cancer. PM (RR 0.49) and clinically amyopathic DM (RR 0.44) subtypes, Raynaud's phenomenon (RR 0.61), interstitial lung disease (RR 0.49), very high serum creatine kinase (WMD -1189.96) or lactate dehydrogenase (WMD -336.52) levels, and anti-Jo1 (RR 0.45) or anti-EJ (RR 0.17) positivity were identified as being associated with significantly reduced risk of cancer. Nine studies relating to IIM-specific cancer screening were included. CT scanning of the thorax, abdomen and pelvis appeared to be effective in identifying underlying asymptomatic cancers. Conclusion: Cancer risk factors should be evaluated in patients with IIM for risk stratification. Screening evidence is limited but CT scanning could be useful. Prospective studies and consensus guidelines are needed to establish cancer screening strategies in IIM patients.

KW - CT scanning

KW - autoantibodies

KW - epidemiology

KW - meta-analysis

KW - muscle

KW - myositis

KW - neoplasia

KW - Guidelines as Topic

KW - Age Factors

KW - Lung Diseases, Interstitial/complications

KW - Humans

KW - Male

KW - Risk

KW - Tomography, X-Ray Computed

KW - Dermatomyositis/complications

KW - Adenosine Triphosphatases/immunology

KW - DNA-Binding Proteins/immunology

KW - L-Lactate Dehydrogenase/blood

KW - Publication Bias

KW - Female

KW - Raynaud Disease/complications

KW - Myositis/blood

KW - Deglutition Disorders/complications

KW - Neoplasms/diagnosis

KW - Antibodies, Antinuclear/blood

KW - Sex Factors

KW - Transcription Factors/immunology

KW - Creatine Kinase/blood

KW - Skin Ulcer/complications

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U2 - 10.1093/rheumatology/keab166

DO - 10.1093/rheumatology/keab166

M3 - Review article

C2 - 33599244

SN - 1462-0324

VL - 60

SP - 2615

EP - 2628

JO - Rheumatology (Oxford)

JF - Rheumatology (Oxford)

IS - 6

ER -

A Systematic Review and Meta-Analysis to Inform Cancer Screening Guidelines in Idiopathic Inflammatory Myopathies

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Keywords

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