Physicians have long been sounding a warning to avoid sun exposure to decrease the risk of getting skin cancer, and if you have rheumatoid arthritis, you should pay special attention to their advice.
Compared with the general population, people with RA have an increased chance of developing squamous cell carcinoma and basal cell carcinoma. These two forms of skin cancer are not as threatening as the most lethal kind, melanoma, and they are very treatable if caught early. But when left untreated, they can spread to other tissues and even kill. According to the American Cancer Society, about 2,000 people die each year in the U.S. from basal cell and squamous cell cancer that has metastasized. The incidence of skin cancer been on the rise for decades, and the ACS lists skin cancer as the most common form of the disease.
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According to the Skin Cancer Foundation, more than 5.4 million cases of nonmelanoma skin cancer are treated annually in more than 3.3 million people in the U.S. In fact, more new cases of skin cancer are diagnosed than breast, prostate, lung and colon cancer combined.
This means that 1 in 5 Americans will develop skin cancer over their lifetimes, and between 40 and 50 percent of Americans who reach age 65 will get a least one case of either basal cell carcinoma, the most common form of the disease, or squamous cell carcinoma.
According to the Arthritis Foundation, people with RA have a modestly increased risk of developing skin cancer. The reasons for this are unclear. “This is not really well understood,” says Dr. Evan Leibovitz, a rheumatologist in Midland Park, New Jersey. “The theory is that [the increased risk] is related to [having] an abnormal immune system.”
RA is an autoimmune disorder. The immune system is the body’s police force, and it’s always on patrol, seeking foreign viruses and bacteria that threaten our health. When it finds them, it marshals its forces to surround the invaders and destroy them.
When the body develops an autoimmune disease like RA, the immune system mistakenly begins to view its own healthy tissue as a dangerous invader and goes on the attack. When this happens, people develop autoimmune disorders that manifest themselves in a variety of different symptoms, depending on the type of disease that develops.
In RA, the immune system attacks multiple organ systems, including the lining of the joints, the heart, lungs, eyes, bones and skin. Although nodules, or bumps, on the skin are the most common skin manifestation of RA, skin cancer can also develop.
In the past 20 years, new treatments for RA have greatly decreased the potentially devastating consequences of the disease, like joint damage and heart disease. Many of these medications work by targeting and subduing the errant immune response, meaning that they suppress the immune system.
[See: 10 Seemingly Innocent Symptoms You Shouldn’t Ignore.]
Because RA is a chronic, incurable disease, these medications typically have to be taken over an entire lifetime. In the process, the “chronic exposure to immunosuppressive medications” may increase the chance of getting skin cancer, Leibowitz says. This may be especially true for methotrexate and the biologics like Enbrel, Remicade and Humira, he says.
A 2016 Swedish study published in the British Medical Journal supports this theory. The researchers found that taking a biologic raises the risk for squamous cell cancer by 30 percent, which seems like a lot, but it actually translates to a very small number of cases. “Treating 1,600 patients with biologic medications for one year would lead to just one additional case of squamous cell carcinoma of the skin than would otherwise be expected,” Leibowitz says. “Although we are not completely sure whether certain medications like methotrexate and the biologics contribute slightly to that increased risk of skin cancer, the consequences of not treating the RA, [which include] disability, the need for joint replacements, early cardiovascular events like heart attacks and strokes and early death, far outweigh any tiny possible increased risk from the medications.”
Dr. Eric Matteson, a rheumatologist and professor of medicine at the Mayo Clinic in Rochester, Minnesota, agrees. “The benefits of controlling rheumatoid arthritis [are much greater than] the risks of cancer, ” he says.
[See: 7 Ways to Prevent Skin Cancer.]
Although the increased risk of developing skin cancer is small if you have RA, it’s very real, so it’s important to take measures to minimize the chances that you develop skin cancer.
Leibowitz advises his RA patients to get yearly skin checks by a dermatologist, avoid the sun and wear sunscreen.
It’s also important to follow the guidelines developed by the Skin Cancer Foundation:
— Seek the shade, especially between 10 a.m. and 4 p.m.
— Do not burn.
— Avoid tanning and UV tanning beds.
— Cover up with clothing, including a broad-brimmed hat and UV-blocking sunglasses.
— Use a broad-spectrum (UVA/UVB) sunscreen with an SPF of 15 or higher every day. For extended outdoor activity, use a water-resistant, broad-spectrum (UVA/UVB) sunscreen with an SPF of 30 or higher.
— Apply 1 ounce (2 tablespoons) of sunscreen to your entire body 30 minutes before going outside. Reapply every two hours or immediately after swimming or excessive sweating.
— Examine your skin head-to-toe every month.
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Got Rheumatoid Arthritis? You May Face An Increased Risk of Skin Cancer originally appeared on usnews.com
