番茄社区

WASHINGTON -- Women with systemic lupus erythematosus (SLE) do not appear undergo timely cervical cancer screening despite being at an increased risk for cervical dysplasia and persistent human papillomavirus (HPV) infection, researchers reported here.

Based on an analysis of healthcare database information, rates of cervical cancer screening within 3 years were 75% among all eligible women versus 66% among SLE patients, according to Jennifer Stichman, MD, from the Denver Health Medical Center and the University of Colorado, and colleagues.

"Women who have lupus are at a higher risk of at least cervical dysplasia and they have a harder time getting rid of the HPV than women without lupus," Stichman told 番茄社区 at her poster presentation at the annual meeting of the American College of Rheumatology.

"In our study, we think we have identified a gap in care for a large subset of women with lupus," Stichman said.

For this research, they identified rheumatology clinic patients with initial encounters between July 2006 and August 2011 who had lupus, were female, and were between the ages of 21-50 years.

They looked at screening rates at both 1-year and 3-year intervals depending on age, pointing out that the 2003 American College of Obstetrics and Gynecology guidelines recommend annual screening in women younger than 30.

Data was analyzed for 122 patients and 80% were nonwhite. Half of the women did not have health insurance.

In the SLE cohort, 60% of women, ages 30-50, underwent cervical cancer screening in 3 years compared with 81% of those ages 21-29 (P=0.0235). Women in the latter age group with a history of gynecologic care were had a higher likelihood of screening at 3 years (P=0.0378).

Also in that same age group, white women were less likely to have screening in 3 years compared to nonwhite women (P=0.0147), based on an unadjusted analyses.

In the 30-50 age group, seeing a primary care physician was associated with a higher likelihood of screening at 1 year (P=0.0013) and 3 years (P=0.0040). Again, a history of gynecology care was associated with increased likelihood of having a screening test at 1 year (P=0.0013) and 3 years (P=0.0003).

Finally, patients receiving immunosuppressive medications were no more likely to receive cervical cancer screening than other lupus patients.

Stichman suggested that rheumatologists should encourage their female SLE patients see a primary care physician or gynecologist for nonrheumatology care.

Christopher Morris, MD, a private practice rheumatologist in Kingsport, Tenn., told 番茄社区, that often women with lupus and other rheumatologic diseases tend to look at their rheumatologists as a primary care physician.

"I think a lot of older women tend to think, 'oh I'm seeing a doctor for my lupus, I guess don't need to see anyone else.' We try to make sure that they have a primary care physician," Morris said.