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FRI0061 Cervical Dysplasia and Cervical Cancer in Women with Rheumatoid Arthritis
  1. H. Wadström,
  2. T. Frisell,
  3. J. Askling
  1. Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden

Abstract

Background Immunosuppression is a key factor in the progression from HPV-infection to invasive cervical cancer. Cervical screening programmes aim to detect cervical lesions before they develop into malignancies, non-adherence to these programmes is a major risk factor for cervical cancer. Some reports have found a higher risk of cervical neoplasia in patients with rheumatoid arthritis (RA) compared to the general population.

Objectives The objective was to examine screening patterns and the risk of cervical neoplasia in women with RA as compared to the general population.

Methods Through register-linkages, we assembled a cohort of female biologics-naïve patients with RA (n=36,883), and a general population comparator cohort (matched 1:10). Patients with two non-primary care outpatient visits with an RA ICD code were included, at least one of the visits had to be at a rheumatology or internal medicine department. The second visit served as the index date. Incidences for these outcomes 1999 through 2012 were compared using Cox regression, adjusted for age, level of education, previous cervical screening, co-morbidities, marital status, and total days spent in hospital during last 5 yrs. Outcomes were first cytology screening with a normal outcome, first ever Cervical Intraepithelial Neoplasia (CIN) grade I-II, first ever CIN III, and first ever invasive cervical cancer during follow-up.

Results Cox regression yielded higher rates of cytology screening, CIN I-II, and CIN III in the RA cohort than in the general population cohort. There was no difference in invasive cervical cancer between the groups (Table 1). Hazard ratios were not significantly altered by adjusting for age, level of education, previous cervical screening, co-morbidities, marital status, and total days spent in hospital during last 5 yrs.

Table 1.

Hazard ratios (HRs) and 95% confidence intervals comparing each outcome between cohorts

Conclusions This study demonstrated that screening patterns were largely similar between the cohorts, although there was a statistically significant 10% higher rate of screening among RA patients in the fully adjusted model. We further found a moderate (30-50%) increase in the observed risk of CIN I-II and of CIN III in biologics-naïve patients with RA compared to the general population, but no difference in risk of invasive cervical cancer.

Disclosure of Interest None declared

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