Abnormal Cervicovaginal Cytology in Women with Lupus: A Retrospective Cohort Study

Dhar, J. Patricia; Kmak, David; Bhan, Raj; Pishorodi, Latha; Ager, Joel W.; Sokol, Robert J.

doi:10.1006/gyno.2001.6207

Cited by 64 publications

(52 citation statements)

References 6 publications

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“…1,2 Further, in studies with systemic lupus erythematosus, a disorder in which immunosuppressive medications are commonly used long-term, there is evidence suggesting that exposure to immunosuppressants increases the risk of an abnormal Papanicolaou (Pap) test. [3][4][5] Similar results have been found in immunosuppressed transplant and cancer patients. 6 -10 Current recommendations published by the American College of Obstetricians and Gynecologists (ACOG) suggest yearly cytological screening for women younger than 30, and screenings every 2-3 years for older women who have 3 consecutive negative Pap smears.…”

supporting

confidence: 88%

Abnormal Pap smears in inflammatory bowel disease

Kane

2008

Inflammatory Bowel Diseases

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Inflammatory bowel disease (IBD) is a chronic inflammatory condition that is frequently treated with immunomodulators. Previous work has demonstrated an increased risk for abnormal cervical cytology in women treated with chronic immunosuppression, due mainly to human papillomavirus. This review summarizes the data known for this relationship in women with IBD, and management strategies for patients found to have abnormal cervical cytology.

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supporting

confidence: 88%

Abnormal Pap smears in inflammatory bowel disease

Kane

2008

Inflammatory Bowel Diseases

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“…Previous studies have suggested that women with SLE are at greater risk for cervical dysplasia than women in the general population; however, the factors associated with abnormal Pap test results in SLE have not been well studied [20][21][22][23][24]. In the early National Institute of Health (NIH) trial of methylprednisolone and cyclophosphamide in patients with lupus nephritis, an association of cyclophosphamide with cervical dysplasia was suggested, since this complication was seen in 11% of the cyclophosphamide group, 7.1% of the combination methylprednisolone/cyclophosphamide therapy group, and in none of the group who were unexposed to cyclophosphamide [25].…”

Section: Cervical Dysplasia In Slementioning

confidence: 96%

Revisiting the issue of malignancy risk in systemic lupus erythematosus

2005

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Certain cancers occur more frequently in systemic lupus erythematosus (SLE) as compared with the general population, as recent data substantiates. The risk appears to be most heightened for lymphoma. Several pathogenic mechanisms may explain these observations, although little is definitively known. One particular concern relates to whether cancer risk in SLE is increased by medication exposures. Cooperative efforts to evaluate this have been undertaken by the Systemic Lupus International Collaborating Clinics and the Canadian Network for Improved Outcomes in Systemic Lupus research groups. This and other works in progress will, it is hoped, considerably advance the knowledge regarding the association between autoimmune diseases and malignancy.

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“…Hence, screening for pre-cancerous lesions of the cervix is vital for these patients. Previous studies by our group and others [1][2][3][4] have demonstrated an increased frequency of cervical dysplasia in women with lupus. Data on the effect of immunosuppressive therapy suggest a correlation with abnormal pap smears, [4] as well.…”

mentioning

confidence: 88%

Ominous cervical cytopathology in women with lupus

Dhar

Essenmacher

Ager

et al. 2005

Intl J Gynecology & Obste

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Recent studies have demonstrated cervical cancer as among the most common malignancies in lupus [1]. Hence, screening for pre-cancerous lesions of the cervix is vital for these patients. Previous studies by our group and others [1][2][3][4] have demonstrated an increased frequency of cervical dysplasia in women with lupus. Data on the effect of immunosuppressive therapy suggest a correlation with abnormal pap smears, [4] as well. To extend the results of our previous study to assess the risk for cervical dysplasia/cervical cancer in a larger cohort of lupus patients, the Wayne State University Lupus Registry was linked to our medical center's pathology database. To insure statistical independence, only the first Pap smear per patient over the 18 months studied was used. The Control Group consisted of 747 non-lupus patients seen consecutively over a 1-year period by the same team of gynecologists. Aggregate data were used for controls as the expected compared with observed for the study group.Demographics and pap smear results are shown in Table 1. There was an increase in abnormal cervical cytology in the lupus group vs. controls ( P b 0.0008). Furthermore, this increase in abnormal cytopathology was accounted for by an excess of HGSIL and cancer (OR = 3.46; P b 0.0003); women with lupus were 3.5 times more likely to develop high grade cervical dysplasia or cervical cancer than women in our control group. This was partially accounted for by greater age of controls 0020-7292/$ -see front matter D (P b 0.001). We drew a sub-sample of lupus patients who were comparable in age to controls; all effects were smaller, but still significant and in the same direction.The key finding from this large series is that lupus patients are at increased risk for more severe abnormal cytopathology (HSGIL, cancer), and hence, deserve careful surveillance. Further studies are needed to look at histology for tissue diagnosed as cancer and at risk of progression from HGSIL to carcinoma in situ and invasive carcinoma which is possibly more likely to progress more rapidly in lupus patients.

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Abnormal Cervicovaginal Cytology in Women with Lupus: A Retrospective Cohort Study

Cited by 64 publications

References 6 publications

Abnormal Pap smears in inflammatory bowel disease

Abnormal Pap smears in inflammatory bowel disease

Revisiting the issue of malignancy risk in systemic lupus erythematosus

Ominous cervical cytopathology in women with lupus

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