Low Rate of Cervical Cancer Screening among Women with Hematologic Malignancies after Stem Cell Transplant

Abstract

Annual cervical cancer screening with Papanicolaou (Pap) and human papillomavirus (HPV) testing after stem cell transplant (SCT) is recommended, but the uptake is unknown. We aimed to determine the prevalence and predictors of cervical cancer screening in patients with hematologic malignancies. We searched MarketScan Commercial Claims database for women who underwent allogeneic or autologous SCT. The primary outcome was cervical cancer screening, defined as procedures or abnormal results for HPV and/or Pap testing according administrative codes within 2 years after SCT. A multivariable logistic regression model was fitted with cancer type, SCT year, age, geographic area, insurance plan, comorbidity, and presence of graft-versus-host disease (GVHD).The study included 1484 patients; 1048 patients (70.6%) had autologous and 436 (29.4%) allogeneic SCT. Mean age was 52.5 years. Overall, 660 patients (44.5%) had screening within 2 years after SCT, 214 (49.1%) with allogeneic SCT and 446 (42.6%) with autologous SCT (P = .02). In the allogeneic SCT group, patients with GVHD had a lower rate of screening than patients without GVHD (42.5% versus 55.4%, P < .01), and GVHD was associated with lower odds of screening (odds ratio, .50; 95% confidence interval, .32 to .79). In the autologous SCT group, patients with comorbid medical conditions had a lower rate of screening than patients without comorbidity (36.0% versus 45.7%, P < .01). In both allogeneic and autologous SCT groups older patients had lower odds of screening. Cervical cancer screening rates after SCT are low, particularly in patients with GVHD, who are at significant risk of second malignancies. Future work is needed to develop strategies to increase uptake.

The disease stage-associated imbalance of Th1/Th2 and Th17/Treg in uterine cervical cancer patients and their recovery with the reduction of tumor burden

“…The balance between Treg and Th17 cells reportedly controls the immune response and is an instrumental factor in regulating helper T cell function associated with the Th1/Th2 shift in autoimmune diseases and graft versus host disease [15]. In our previous studies [16], we found imbalances of Th1/Th2 and Th17/Treg cells in patients with UCC or CIN.…”

The disease stage-associated imbalance of Th1/Th2 and Th17/Treg in uterine cervical cancer patients and their recovery with the reduction of tumor burden

“…The balance between Treg and Th17 cells reportedly controls the immune response and is an instrumental factor in regulating helper T cell function associated with the Th1⁄Th2 shift in autoimmune diseases and graft versus host disease [15]. In our previous studies, we found imbalances of Th1/Th2 and Th17/Treg cells in patients with UCC or CIN.…”

“…An imbalance among these T cells will either lead to an immune response or its suppression [14]. Women with hematologic malignancies after stem cell transplant have a low rate of cervical cancer screening for the fresh normal T cells [15].…”

The disease stage-associated imbalance of Th1/Th2 and Th17/Treg in uterine cervical cancer patients and their recovery with the reduction of tumor burden

“…The levels of Treg cells are reportedly increased in cancer patients, and their high numbers are associated with poor survival [19,21]. The balance between Treg cell-and Th17 cell-controlled immune response was a key factor in regulating T helper cell function associated with the Th1⁄Th2 shift in autoimmune disease and graft versus host disease [15]. In our pervious study [16], we systematically determined that the proportion of Th2, Th17, and Treg cells in PBMCs and of their related cytokines IL-4, IL-10, IL-17, IL-23, and TGF-βI in the serum were markedly increased in UCC and CIN patients.…”