Background The association between cancer and autoimmune myositis is well established and has lead to the common practice of malignancy screening in asymptomatic individuals. The international literature advocates widely for cancer screening in autoimmune myositis however no consensus or guideline has been published to set forth a process for screening standardisation (1). Malignancy screening is a complicated topic and recommendations in favour of screening should in principle be based on a judicious assessment of the evidence in terms of the benefits, risks and costs. In inflammatory myositis there is currently insufficient evidence to support any recommendation with respect to cancer screening. In the absence of clinical guideline and quality evidence, our study aimed to establish the current trends in malignancy screening amongst Australian Rheumatologists.
Objectives To explore the current trends in malignancy screening in autoimmune myositis amongst Australian Rheumatologists using an online questionnaire.
Methods Research approval was granted by The Townsville Hospital. An invitation email containing the survey weblink was sent twice to 386 Australian Rheumatologists between August 2015 and August 2016. Voluntary participation and anonymity were guaranteed. The questionnaire contained a fixed set of multiple choice questions that requested data on respondent demographics, practice setting and screening preference, practice and concerns. Open entry comment was an option throughout the questionnaire. Fifty-eight Rheumatologists, 1 Immunologist and 1 Paediatric Rheumatologist responded (16% response rate). There were 3 survey dropouts. The data was pooled, coded and analysed using statistical software. All data was included in the analysis.
Results Most respondents (N=58) were in private (67%) and/or public practice (68%), in practice for >10 years (70%), conducted cancer screening (93%) and were “very” or “somewhat” confident in their screening practice (90%). The majority (72%) performed cancer screening independent of patient characteristics. Determinants that triggered screening (in descending order of popularity) were: tobacco use (N=11), history of cancer (N=10), age >40 (N=7), cancer family history (N=7), age >50 (N=3) and age >60 (N=1). Most respondents indicated preference to order screening tests (in descending order of popularity): mammogram (81%); CT chest & abdomen (78%); myeloma screen (70%); chest x-ray (69%), serum PSA (67%), PAP smear (54%), colonoscope (44%), LDH (41%), pelvic USS (33%), gastroscope (33%), FOBT (33%), tumour markers (28%), CT neck (17%), nuclear bone scan (15%), PET CT (4%) & testicular USS (2%). Respondents (N=57) indicated that cancer screening was problematic due to a lack of clinical practice consensus & guideline (77%), test selection knowledge (37%) and knowledge regarding repeated screening (53%). The potential for harm in conducting screening was identified to be a problem by most respondents (62%).
Conclusions The practice of malignancy screening in autoimmune myositis amongst Australian Rheumatologists is highly variable. Practice is driven by patient factors and clinician preferences. The cancer screening process is felt on several fronts to have inherent problems. Guideline, consensus and further research is needed in this area to address the challenges and evidence gap.
Masiak, A et al. (2016). Clinical characteristics of patients with anti-TIF1-y Abs. Reumatologia. 54(1): 14–18.
Disclosure of Interest None declared