Lupus and Cancer: Lupus Encyclopedia

posted in Cancer and lupus on September 4, 2025 by

Donald Thomas, MD

Updated September 7, 2025

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As if dealing with lupus alone wasn’t enough, there is an association between Lupus and Cancer. Lupus patients are at increased risk of developing over a dozen different cancers. In this article, we explore how lupus may increase cancer risks, and offer guidance on prevention and screening.

NOTE: Johns Hopkins University Press, publisher of The Lupus Encyclopedia, is a nonprofit publisher. If you purchase JHUP books, like The Lupus Encyclopedia, you support projects like Project MUSE.

Cancer is the fourth most common cause of death (after lupus, cardiovascular events, and infections) in systemic lupus erythematosus (SLE) according to many studies from developed countries, including the United States. Many cancers are potentially preventable, and many can be detected at early, curable stages.

The Lupus Encyclopedia (2nd ed.), p. 461

How Are Lupus and Cancer Linked?

Recent research has identified a connection between lupus and cancer. Although it is not a form of cancer, lupus increases the risk of some cancers. This happens due to several reasons:

Why do SLE Patients get Cancer More Often

• SLE is due to the immune system not working correctly. The white blood cells are responsible for removing cancer cells from our bodies as they occur. This occurs less efficiently in SLE patients.
• SLE is a disease where the white blood cells are overactive and stay alive longer than they should. This could allow cancerous white blood cells to overtake the immune system (resulting in lymphoma, leukemia, or multiple myeloma)
• SLE patients are much more likely to be infected with HPV when diagnosed with SLE. This is probably related to their immune system being unable to protect the patient as much from the infection. SLE patients are at much higher risk of HPV-caused cancers (cervical, throat, skin, anal). Fortunately, the risk CAN be significantly decreased with a vaccine. See below.
• There is a lot of evidence that Epstein-Barr virus (EBV) infection is most likely a trigger for some SLE patients developing lupus. EBV is a well-known cause of some cancers.
• Cyclophosphamide, especially for skin and cervical. Possible role in bladder cancer in those who develop hemorrhagic cystitis from it.
• Other immunosuppressants (especially methotrexate, tacrolimus, and cyclosporin) may increase the risk for non-melanoma skin cancer. This is not known for sure. Some experts suggest that something called “selection bias” may be playing a role with there seemingly being an association with skin cancer in some research studies.
• Smoking (including secondhand smoke) dramatically increases the risk of lung cancer.

Do the Drugs that Treat Lupus Cause Cancer?

Other than the cancers related to cyclophosphamide and the possibility of an increased risk of skin cancer from some drugs (see below), the immunosuppressants used to treat SLE have not been shown to increase the risk for other cancers.

Cyclophosphamide Increases the Risk of Cancer

Cyclophosphamide increases the risk of cancers: primarily bladder cancer and hematologic cancers (lymphoma and leukemia).

Getting Skin Cancer from Lupus Drugs

Methotrexate, azathioprine, mycophenolate mofetil, mycophenolic acid, cyclophosphamide, JAK inhibitors (Xeljanz, Olumiant, Rinvoq), and calcineurin inhibitors (cyclosporin, voclosporin, tacrolimus) may possibly increase the risk for squamous cell carcinoma and basal cell carcinoma of the skin. Abatacept (Orencia) may increase the risk of melanoma. The American Academy of Dermatology recommends skin screening exams for non-transplant patients treated with the following drugs:

– Abatacept: Screen for melanoma skin cancer

– Cyclophosphamide: Screen patients beginning 2 years after starting treatment.

– Calcineurin inhibitors (CNI): Should be screened if treated for a year or longer with a CNI.

– Azathioprine: Should be screened if exposed for 5 or more years.

– Methotrexate: Should be screened if exposed for more than one year.

– JAK inhibitors (Xeljanz, Olumiant, Rinvoq): Screen all patients.

Patients at High Risk for Skin Cancer Should be Screened More Often:

Per the American Adademy of Dermatology, people who are at particularly high risk of skin cancer includes those over 49 years old, men, those with a history of skin cancer, and those with a history of prolonged sun exposure.

– Those treated with the drugs listed above and who have had numerous SCCs or BCCs, or a high-risk SCC, should have a full-body skin cancer screening examination every 3 months.

– Those with a history of melanoma, actinic keratosis (precancer), low-risk squamous cell carcinoma, or basal cell carcinoma should be screened every 6 months.

– Those without risk factors should get yearly exams.

– All patients should do a monthly self-examination of their skin.

Hydroxychloroquine Reduces the Risk of Cancer

Several studies have shown that SLE patients who take hydroxychloroquine regularly have a lower risk of developing cancer.

Increased Cancer Risks in Lupus Patients

Studies show that people with lupus may be at higher risk for specific types of cancers. Here are some:

1. Non-Hodgkin’s Lymphoma (NHL)

This blood cancer affects lymphocytes, a type of white blood cell. Lupus patients, especially those who also have Sjogren’s disease, face a higher risk of developing non-Hodgkin’s lymphoma. Swollen glands that do not go away, an enlarged parotid gland in the back cheek area that persists, or unexplained night sweats/weight loss/fevers are some symptoms of NHL.

Other blood cancers that occur more commonly in SLE include Hodgkins lymphoma, leukemia, and multiple myeloma.

2. Lung Cancer

Lung cancer risk appears elevated in individuals with lupus, particularly smokers or those exposed to secondhand smoke.

3. Cervical Cancer

Women with SLE experience a higher risk of cervical dysplasia, a precursor to cervical cancer. This is almost always caused by HPV infection. Regular Pap smears are essential for early detection. Getting the Gardasil vaccine at a young age to prevent this is important.

4. Other cancers that occur more commonly in SLE

– Anal

– Vulva and vaginal

– Throat and mouth

– Liver and pancreas

– Kidney

– Thyroid

– Skin cancer

– Brain cancer

– Esophagus, stomach, colon

Lower Risk of Certain Cancers

Interestingly, lupus patients seem to have a reduced risk of certain cancers, such as endometrial and prostate cancer. SLE patients have similar rates of breast, rectal, malignant melanoma, and ovarian cancers as does the general population.

How Lupus Symptoms May Mask Cancer Warning Signs

One major challenge with lupus and cancer is overlapping symptoms. Fatigue, weight loss, and joint pain occur in both conditions. This can delay cancer diagnosis, especially when patients and doctors attribute symptoms to lupus flares.

To reduce risk, lupus patients should stay alert to new or changing symptoms, including:

• Unexplained lumps
• Persistent pain in one area
• Unusual bleeding
• Chronic cough or voice changes
• Skin changes or wounds that do not heal

Early detection improves cancer survival rates. Regular check-ups and screening tests are essential.

Cancer Screening Recommendations for Lupus Patients

Regular screenings are important for everyone, but especially for people living with lupus. Early detection can significantly improve treatment outcomes. Recommended screenings include:

• PAP smears

• pelvic exams

• mammograms

• colonoscopies

• chest CT scan (if there is a history of smoking)

• prostate screening tests

• thyroid exams

• dermatologic skin cancer screenings (especially if you have sun-damaged skin or have been treated with cyclophosphamide, methotrexate, tacrolimus, or cyclosporin).

• Yearly urine cytology in patients treated with cyclophosphamide (to rule out bladder cancer).

•  SLE patients tend to not keep up with these tests. We keep you so busy doing so many things; it is no wonder. However, it pays off to keep up with these. Ask your doctor.

Patients should discuss personalized screening plans with their rheumatologist and primary care provider.

How to Reduce Cancer Risk in Lupus

Although lupus increases some cancer risks, certain lifestyle choices can lower overall risk. Here are key strategies:

• Take your hydroxychloroquine regularly, because it reduces cancer risks, especially skin and breast).
• Get the Gardasil vaccine at 9 to 26 years old. The sooner, the better, hopefully before sexual activity. Note that of the first seven cancers occurring more commonly in SLE patients, six are due to HPV.
• Get the Gardasil vaccine if you are 26 to 45 years old and not in a monogamous relationship.
• Do NOT smoke; stay away from secondhand smoke also.
• Maintain normal body weight; lose weight if you are overweight. Discuss treatment options with your doctor if you have trouble losing weight.
• Eat a healthy diet.
• Exercise regularly: it especially reduces breast cancer, colon cancer, and prostate cancer.
• Use sunscreen religiously on discoid lupus erythematosus (DLE) lesions to prevent squamous cell cancer from occurring in the DLE lesions. Also, always wear a wide-brimmed hat outside.
• Drink at least 9 glasses of water daily if you are on cyclophosphamide. Dilutes the urine to reduce bladder cancer.
• If you are a woman and drink alcohol, limit it to 1 serving a day or less. Alcohol may increase the risk of getting breast cancer, so take folic acid daily, which may reduce your risk of breast cancer.
• If you have a family history of breast cancer, and you have decreased bone density (osteopenia or osteoporosis), ask your doctor about raloxifene (Evista) to prevent breast cancer. Do NOT take raloxifene if you have antiphospholipid antibodies (ask your doctor); it can increase the risk of blood clots in people who are at increased risk.

Taking control of your health starts with small, consistent actions.

Mental Health and Emotional Support

Living with both lupus and cancer or the fear of developing cancer can be emotionally exhausting. Anxiety, depression, and chronic stress often affect patients. Support networks and mental health services play a vital role in overall well-being.

• Support groups: Connecting with others facing similar challenges
• Therapy: Helps manage anxiety and depression
• Mindfulness practices: Meditation, yoga, and breathing exercises reduce stress

Seeking mental health support is a strength, not a weakness.

Taking Proactive Steps for Better Health

The relationship between lupus and cancer is complex but manageable. While lupus increases the risk of certain cancers, early detection and healthy lifestyle choices offer strong defenses. Patients should maintain open communication with their healthcare team and undergo regular screenings. Understanding the risks empowers patients to act early and protect their long-term health.

To learn more about SLE and cancer go to: https://www.lupusencyclopedia.com/lupus-and-cancer/

For more in-depth information on Lupus and Cancer: Lupus Encyclopedia:

Read more in The Lupus Encyclopedia, edition 2

Look up your symptoms, conditions, and medications in the Index of The Lupus Encyclopedia

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This article includes contributions from

Gavin Abson