Lupus and Cancer Risk: Learn to Prevent Cancer! [2003]

Beat cancer woman with pink gloves and pink ribbon for breast cancer

I just realized that many websites discussing lupus and cancer are outdated, using old research information. So, I decided to write this article with up-to-date information.

“Is lupus a type of cancer?”

This is not an uncommon question when someone is first diagnosed with systemic lupus erythematosus (SLE). Most newly diagnosed SLE patients have never even heard of lupus before. They want to know if it is contagious (the answer is “no”) and “is lupus a type of cancer?” Fortunately, the answer is “no.”

However, unfortunately, SLE patients are at increased risk of getting 24 types of cancer. This article will tell you which ones occur most commonly, but more importantly, it will tell you how to reduce your risk of getting many of them.

Graphic of a cancer risk meter pointing to maximum.
Lupus and Cancer: SLE patients get 24 cancers more commonly than the general population

Lupus Patients get Cancer More often than the General Population

A 2018 study by Song et al. reported 16 cancers occurring more commonly in SLE patients. This resulted in a flurry of online articles about lupus an cancer, discussing the article and its troublesome implications.

This was followed up by the 2020 report “Cancer and Systemic Lupus Erythematosus by Ladouceur A et al. with even more up-to-date data. An even more recent report showed that SLE is a risk factor in developing 17 different cancers.

A 2021 study by Clarke et al. showed an increase in 24 cancers in SLE patients.


The report “Association Between Systemic Lupus Erythematosus and Cancer Morbidity and Mortality: Findings From Cohort Studies” by Zhang et al.  is one of the most large-scale and most recent studies, assessing 48 studies containing 247,575 SLE patients. I will present data from all of these below. I’ll list them in order of most common to least most common per the Zhang study:

Lupus and cancers that appear to occur more commonly in SLE patients:

Chart showing cancers that are increased in SLE. The figures are detailed in the paragraph below.

  • All lymphomas (predominantly non-Hodgkin’s , especially in those with Sjögren’s disease overlap): 5 times more likely
  • Anal (due to human papillomavirus, HPV): 4.7 times more likely (get that Gardasil vaccine!)
  • Vulva/vaginal (HPV infection): 4.3 times more likely
  • Lip, mouth, and pharynx back of the mouth (many from HPV infection): 3.85 times more likely
  • Hodgkin’s lymphoma: 3 times more likely
  • Kidney cancer: 3 times more likely
  • Liver: 3 times the risk
  • Larynx (in the throat): 3 times more likely
  • Blood cancers (lymphoma, leukemia, multiple myeloma) = 3 times higher risk
  • Hepatobiliary (liver tubes carrying bile): 2.9 times more common
  • Leukemia (white blood cell cancer): 2.4 times more common
  • Thyroid: 2.3 times more common
  • Cervical cancer (due to HPV): 2.2 times more likely
  • Skin cancers (all as a group): Twice as likely
  • Multiple myeloma (white blood cell cancer): 1.7 times more likely
  • Urinary bladder cancer (especially if received cyclophosphamide): 1.7 times more likely
  • Esophagus: 1.6 times more likely
  • Colon: 1.6 times more likely
  • Squamous cell carcinoma (SCC) and basal cell carcinoma skin cancers (especially if treated with cyclophosphamide, methotrexate, cyclosporin, tacrolimus, and maybe other immunosuppressants; and in those with sun-damaged skin): 1.5 times more likely
  • Brain: 1.5 times more likely
  • Lung (especially in smokers; and possibly increased in those with lupus pneumonitis or lung scarring or pulmonary fibrosis): 1.4 times more likely
  • Pancreas: 1.4 times more likely
  • Stomach: 1.2 times more likely

No apparent difference in cancer risk from the general population:

Cancers that appear to occur slightly less commonly in SLE patients (possibly due to hormonal influences):

  • Endometrial (uterine, womb) cancer
  • Prostate

Why do SLE Patients get Cancer More Often

Cancer is One of the Most Common Causes of Death in Lupus

Cancer regularly appears among the top four common causes of death in SLE patients. The 2021 study by Zhang et al. showed that patients with SLE had a 50% increased risk of dying from cancer than the general public. A 2023 California study even showed that cancer was the third most common cause of death in their SLE patients (cardiovascular events and lupus were the most common causes).


SLE patients who smoke were especially at high risk, almost 2 ½ times more likely to die from lung cancer than non-lupus patients (Zhang et al). Smoking and lupus are a deadly combination for many reasons. I tell patients that stopping smoking is a requirement and doing so is non-negotiable.

It is crucial to catch cancers at an early, curable stage (do screening tests) and do things to prevent cancers… as listed below.

Doctor holding cancer prevention sign

Reduce your Risk of Getting Cancer

This is the most important part of this blog post! There is good news! You can actively do things to reduce your risk of cancer significantly.

Lupus and cancer screening sign

Keep up with your cancer screening tests:

  • Important cancer screening tests for SLE patients include the following. Ask your doctor.
    • 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.

I hope this information empowers the reader to work on preventing cancer and keep up with cancer screening tests to catch cancer early if it does occur.

Practice “The Lupus Secrets” to live a long, healthy life


By Donald Thomas, MD

PLEASE COMMENT IN THE COMMENTS SECTION

What are your thoughts.? Do you have an experience or advice you’d like to share? Answer in the comment section.

18 Comments

  1. It’s interesting to me that in 2000 I was diagnosed with aggressive BCell non Hodgkin’s lymphoma. It wasn’t until 2017 that I was diagnosed with Sjogrens and Lupus. My rheumatologist tested me for Sjogrens because, while she was taking my medical history on my first visit, I mentioned the history of NHL. She later explained the connection between Sjogrens and NHL. She suspected I had Sjogrens in 2000 but no one would have tested me for it then. I had consistently complained of dry eyes, throat, nose and ears, but again no one listened to me. Thankfully aggressive chemo put me in remission.

  2. Are there blood tests that can be done to determine whether a patient has had/been exposed to EBV at any time in the past? Or can blood tests only detect an active case of EBV, not a past case of EBV?

    • Anon: Yes. IgG EBV is positive if you have had an EBV infection in the distant past. Many people were infected but did not get the full-blown mononucleosis infection (severe fatigue, fever, swollen glands, etc)
      Donald Thomas, MD

  3. This is important information to have – thank you very much for this detailed post!

    Would it be possible someday to find or make a chart/graphic showing the absolute risk for each of these cancers for the general population compared to the lupus study population? This would be a very nice add-in to help put the relative risk into perspective.

  4. Is the Gardasil vaccine safe especially for those with family history of Lupus?

  5. I was relieved to see breast cancer isn’t on your list. I don’t have a history of breast cancer in my family, but I am taking Synthroid (which I read can increase chance of cancer?). I understand there is a higher rate of hypothyroidism in populations with Lupus than in the general population. Do you know if Lupus has any impact on that risk? Thank you for this great post!

    • you are correct about hypothyroidism from Hashimoto’s disease being more common in SLE patients. I do not think it impacts cancer risks (the SLE does)… however, I am not sure it has even been studied (so not sure). Some studies showed less breast cancer in SLE patients. However, that was always questioned because a high percentage of the patients in those studies were of racial backgrounds that also have lower risks. The more recent Zhang study showed similar rates of breast cancer in SLE as in the general public. Donald Thomas, MD

    • Jan Lee: Thank you for reading my post. The article from Taiwan, Wu CC et al suggested a 50% increase in some cancers in levothyroxine users. However, this is a great example of a study which can have major flaws. It is a retrospective study (goes backwards in time) rather than a prospective (forwards) randomized placebo-controlled trial (RCT, the best type). It does not remove other possibilities. For example, what is people with Hashimoto’s thyroiditis or people who have hypothyroidism automatically have an increased risk for cancers? We know this occurs in other autoimmune diseases (like lupus, Sjogren’s and rheumatoid). What we need is a prospective RCT of people with very mild hypothyroidism. Have half take Synthroid, the other half none… follow them over time, then see if there is a difference.

      Here is a nice editorial regarding flaws of the study: https://www.restartmed.com/does-levothyroxine-cause-cancer/

      Thanks for commenting!

      Donald Thomas, MD

  6. Great information to keep us vigilant In monitoring our health. With so many camera on the list, it will be nice when they have a blood test that screens generally for cancer-I thought I read that one is in development.

  7. Dr Thomas thank you so much for keeping us informed so we can discuss matters with our health care providers. Is it possible to have Scleroderma even if it is not shown on a blood test? I have SLE and have been diagnosed Scleroderma of the esophagus after an endoscopy by a GI doctor. My rheumatologist tested me for Scleroderma and the blood test was negative. With Scleroderma of the esophagus is it possible that it will become systemic?

  8. Dr Thomas

    Thanks for writing this article very informative. If a patient is 45 years + they need to get the Gardasil vaccine? The article didn’t mention a higher age group.

    • Towanda: Great question. The answer is “yes.” Nothing is set in stone. If someone were 50 years old, out again on the dating scene, then it could be a good decision to get it. This is where the patient-doctor conversation comes into play regarding the pros and cons. I know I would probably want to get it. However, the cost would probably have to be covered by the patient. Insurance would most likely not cover it.

      Donald Thomas, MD

  9. Great post! Question on the list of cancer screenings, do you have a list of what age to start those screenings or with what frequency? Is it the same standard screening frequencies as healthy people? Or is it a different schedule?

    Thanks so much!

    • Dear Brandy: Thank you for reading my post and your kind words. I decided not to be specific regarding specifics on screenings. Reason being: the recommendations are repeatedly tweaked by the major cancer organizations as new science pops up (regarding age, who, when, how to deal with results, etc). Therefore, I left that part out and ask that people proactively discuss with their doctors.

      Thanks for commenting!

      Donald Thomas, MD

  10. Thank you very much Dr. Thomas for all your wonderful help. I’m wondering if you have an article on free kappa light chains in lupus, Mine were slightly high but the ratio was normal. I’m hoping to find information on this and how it relates to my SLE. My Rheumatologist ran this blood test. Also I’ve had tendon involvement in my hands/ fingers thumbs but normal sed rate. I’m wondering if there is an article or info on having this type of tendon involvement with normal sed rate. Thank you for your help.


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