{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T00:07:56Z","timestamp":1792454876695,"version":"4.5.0"},"reference-count":24,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2020,10,29]],"date-time":"2020-10-29T00:00:00Z","timestamp":1603929600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["acrjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthritis Care &amp;amp; Research"],"published-print":{"date-parts":[[2020,11]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To quantify the burden of cancer in systemic sclerosis (SSc).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Standardized incidence ratios (SIRs) and standardized mortality ratios relative to the general Australian population were derived. Cox proportional hazards regression was used to estimate survival in patients with SSc with cancer compared to patients without. Determinants of cancer were identified using logistic regression. Health care cost was quantified through cross\u2010jurisdictional data linkage.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>This SSc cohort of 1,727 had a cancer incidence of 1.3% per year and a prevalence of 14.2%, with a SIR of 2.15 (95% confidence interval [95% CI] 1.84\u20132.49). The most common cancers were breast, melanoma, hematologic, and lung. Anti\u2013RNA polymerase III (RNAP) antibody was associated with an increased risk of cancer (odds ratio [OR] 2.9, <jats:italic>P<\/jats:italic> = 0.044), diagnosed within 5 years of SSc disease onset. Calcium channel blockers were associated with a higher risk of overall cancer (OR 1.47, <jats:italic>P<\/jats:italic> = 0.016), breast cancer (OR 1.61, <jats:italic>P<\/jats:italic> = 0.051), and melanoma (OR 2.01, <jats:italic>P<\/jats:italic> = 0.042). Interstitial lung disease (ILD) was associated with lung cancer (OR 2.83, <jats:italic>P<\/jats:italic> = 0.031). Incident SSc cancer patients had &gt;2\u2010fold increased mortality compared to patients with SSc without cancer (hazard ratio 2.85 [95% CI 1.51\u20135.37], <jats:italic>P<\/jats:italic> = 0.001). Patients with SSc and cancer utilized more health care than those without cancer, with an excess annual health care cost of $1,496 Australian (<jats:italic>P<\/jats:italic> &lt; 0.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>SSc carries an increased risk of developing cancer, particularly lung cancer associated with ILD, and breast cancer and melanoma occurring close to SSc disease onset in association with RNAP antibodies. Compared to those patients without cancer, patients with SSc and cancer had higher mortality and an increased health care cost, with an annual excess per patient cost of $1,496 Australian (<jats:italic>P<\/jats:italic> &lt; 0.001).<\/jats:p><\/jats:sec>","DOI":"10.1002\/acr.24076","type":"journal-article","created":{"date-parts":[[2019,9,20]],"date-time":"2019-09-20T11:25:03Z","timestamp":1568978703000},"page":"1625-1635","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":54,"title":["Incidence, Risk Factors, and Outcomes of Cancer in Systemic Sclerosis"],"prefix":"10.1002","volume":"72","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3840-3967","authenticated-orcid":false,"given":"Kathleen","family":"Morrisroe","sequence":"first","affiliation":[{"name":"The University of Melbourne at St Vincent\u2019s Hospital  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dylan","family":"Hansen","sequence":"additional","affiliation":[{"name":"St Vincent\u2019s Hospital  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Molla","family":"Huq","sequence":"additional","affiliation":[{"name":"The University of Melbourne at St Vincent\u2019s Hospital  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wendy","family":"Stevens","sequence":"additional","affiliation":[{"name":"St Vincent\u2019s Hospital  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanne","family":"Sahhar","sequence":"additional","affiliation":[{"name":"Monash University and Clayton and Monash Health  Clayton Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gene\u2010Siew","family":"Ngian","sequence":"additional","affiliation":[{"name":"Monash University and Clayton and Monash Health  Clayton Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nava","family":"Ferdowsi","sequence":"additional","affiliation":[{"name":"St Vincent\u2019s Hospital  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Hill","sequence":"additional","affiliation":[{"name":"Queen Elizabeth Hospital Woodville, and Royal Adelaide Hospital and University of Adelaide  Adelaide South Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janet","family":"Roddy","sequence":"additional","affiliation":[{"name":"Royal Perth Hospital  Perth Western Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Walker","sequence":"additional","affiliation":[{"name":"Flinders Medical Centre  Adelaide South Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susanna","family":"Proudman","sequence":"additional","affiliation":[{"name":"Royal Adelaide Hospital and University of Adelaide  Adelaide South Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mandana","family":"Nikpour","sequence":"additional","affiliation":[{"name":"The University of Melbourne at St Vincent\u2019s Hospital  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,10,29]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.semarthrit.2007.05.003"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.40027"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.37969"},{"key":"e_1_2_7_5_1","doi-asserted-by":"crossref","first-page":"231","DOI":"10.4236\/ojra.2013.34037","article-title":"Epidemiology of cancer in systemic sclerosis: systematic review and meta\u2010analysis of cancer incidence, predictors and mortality","volume":"3","author":"Nevskaya SC","year":"2013","journal-title":"Open J Rheumatol Autoimmune Dis"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kes303"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.14740\/jocmr2606w"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000003540"},{"key":"e_1_2_7_9_1","doi-asserted-by":"crossref","first-page":"1170","DOI":"10.1136\/annrheumdis-2018-212999","article-title":"Autoantibodies and scleroderma phenotype define subgroups at high\u2010risk and low\u2010risk for cancer","volume":"77","author":"Igusa T","year":"2018","journal-title":"Ann Rheum Dis"},{"issue":"113","key":"e_1_2_7_10_1","first-page":"53","article-title":"Determinants of health\u2010related quality of life in a multinational systemic sclerosis inception cohort","volume":"36","author":"Morrisroe K","year":"2018","journal-title":"Clin Exp Rheumatol"},{"key":"e_1_2_7_11_1","unstructured":"Australian Institute of Health and Welfare.Australia\u2019s health 2016. 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