Ominous cervical cytopathology in women with lupus

Abstract

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.

Systemic lupus erythematosus, human papillomavirus infection, cervical pre-malignant and malignant lesions: a systematic review

“…Methodology used for review After the search for articles was made, the authors independently evaluated whether the articles analyzed could be included in the review. The full articles were assessed, with the exception of five studies that were in abstract form from international meetings [14][15][16][17][18]. The following data were extracted: study design, sample size, number of controls, diagnostic criteria, measures of frequency of HPV infection, cervical neoplasia, cervical cancer, and the association with immunosuppressive drugs.…”

Malignancies in systemic lupus erythematosus: an update

“…Several studies have shown that women with SLE were found to have an increased frequency of abnormal cervical Papanicolaou (Pap) smears compared with the general population [21]. A cohort analysis of lupus patients in the Wayne State University Lupus Registry indicated that women with lupus were 3.5-times more likely to develop high-grade cervical dysplasia or cervical cancer than the controls [22]. Published data have not emphasized an increase in invasive cervical cancers in SLE, compared with the general population [23], but it is not a common malignancy and single-center studies often cannot represent the risk of malignancy with precision.…”

Malignancies in systemic lupus erythematosus

“…A cohort analysis of lupus patients in the Wayne State University Lupus Registry indicated that women with lupus were 3.5-times more likely to develop high-grade cervical dysplasia or cervical cancer than the controls [22]. Published data have not emphasized an increase in invasive cervical cancers in SLE, compared with the general population [23], but it is not a common malignancy and single-center studies often cannot represent the risk of malignancy with precision.…”