For People With Rheumatoid Arthritis, Lung Cancer is Something to Worry About

A study of Veterans Health Administration patients with rheumatoid arthritis (RA) confirmed other research showing that RA is associated with an increased risk of lung cancer and death from the death, especially among those with RA and interstitial lung disease.

Corresponding author Bryant R. England, M.D., Ph.D., of the Department of Veterans Affairs Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center and his colleagues, found that RA was associated with 58% greater risk of getting lung cancer compared with not having RA and that the increased risk was similar among those who never smoked. The lung cancer risk was three times among those with RA and interstitial lung disease, according to the results reported by England and his colleagues in the December 2024 issue of the journal Arthritis & Rheumatology.

“Because patients with RA and RA-ILD [interstitial lung disease] represent high-risk populations for developing lung cancer, enhanced screening may be warranted to achieve earlier diagnoses and reduce mortality,” the authors argued in the conclusion of the study.

The findings are not surprising. As England and his colleagues explained in the introduction of their paper, meta-analyses of the research into RA and lung cancer have shown a 40% to 60% increase in lung cancer risk. They also noted that lung cancer is leading cause of cancer death among people with RA. A great deal of research has shown that inflammation may be causative factor in cancer, and RA is associated with chronic inflammation. One complicating factor in the research showing a connection between RA and lung cancer is that some of the studies haven’t adequately controlled for smoking, England and his colleagues said.

To conduct their study, the researchers used Veteran Health Administration records to identify almost 73,000 patients with an RA diagnosis and matched them to approximately 633,000 patients without RA. Then they looked at the number of incident lung cancer cases in the two groups using Veteran Health Administration cancer registries. The data, analyzed in several ways, point in the same direction: people with RA having an increased risk of lung cancer. The lung cancer mortality rates painted the same picture (43.6 deaths per 10,000 patient years among those with RA compared with 27.7 deaths per 10,000 patients among those without the disease).

The comparison of patients with RA and interstitial lung disease with those without RA showed an even starker, threefold difference in the risk of incident lung cancer. Similarly, the lung cancer mortality rate was much higher among those RA and interstitial lung disease: 82.7 deaths per 10,000 patient year compared with 24.5 among those without RA.

England and his colleagues say the results of the CANTOS trial support the idea that inflammation is causative factor in lung cancer.CANTOS was designed to assess whether canakinumab, a monoclonal antibody targeting interleukin-1b, would reduce heart attacks and other cardiovascular events in people who had had heart attacks and had high levels of a biomarker of inflammation, high-sensitivity C-reactive protein. Results reported in The New England Journal of Medicine showed that it did, in fact, reduce recurrent cardiovascular events compared with a placebo. Some of the same researchers reported secondary results in The Lancet that showed canakinumab was also associated with lower risk of lung cancer and lung cancer mortality.Canakinumab is sold under the brand name Ilaris, which is approved as a treatment for gout flares, active Still’s disease and periodic fever syndromes.