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Abstract
Background Compared with the general population, women with systemic lupus erythematosus (SLE) tend to have higher rates of cervical neoplasia and pre-malignant lesions and in particular, SLE women treated with immunosuppressant therapies such as methotrexate, azathioprine and mycophenolate mofetil may be at even higher risk when compared to SLE women treated with antimalarials alone. Previous studies have suggested suboptimal cervical cancer screening among SLE patients and racial disparity studies have also shown that black SLE patients endure delayed SLE diagnosis and higher morbidity and mortality from SLE related disease compared to non-black SLE patients.
Methods This was a cross-sectional study using electronic health records to identify women aged 21–65 years old with ICD code of SLE M32.9, positive ANA and who have prescription for hydroxychloroquine on their medication list. We compared this to controls (women 21–65 years of age with a ICD code of asthma ICD J45*, negative ANA and excluded patients with SLE diagnosis). For both groups we excluded patients who underwent hysterectomy with removal of the cervix. We used statistical calculator to ‘N-1’ Chi-squared test
Results Much higher proportion of SLE women are overdue for pap smears compared to non SLE women (60.09% vs 51.21% p=0.0022). Non-SLE women are more likely to be up to date on pap screening compared to SLE women (48.59% vs 39.90% p=0.0117). SLE women who are up to date on pap screening and who have had previous positive HPV pap testing had a similar rate of HPV positivity compared to non-SLE patients (28.70% vs 20.60% p=0.163). There was a significant difference when we compared black SLE patients to white SLE patients with regards to overdue status ( 56.60% vs 43.49% p=0.0197), overdue status with prior HPV positivity in black SLE versus white SLE patients (70% vs 30% p=0.0455) and also higher rate of HPV positivity in black SLE versus white SLE patients (66.02% vs 33.97% p≤0.0001).When we compared pap overdue black SLE vs black non-SLE we found higher number of black SLE patients were overdue versus black non-SLE (56% vs 46.36% p=0.0144) however the inverse was noted for white SLE and white non-SLE (43.39% vs 53.63% p=0.0263).
Pap screening in SLE & non SLE patients
(1) SLE women and pap smear screening rates as well as average age; (2) SLE women and HPV screening rates as well as HPV positivity
Non-SLE women and HPV sreening rates as well as HPV positivity
(1) Comparing SLE vs non-SLE using ‘N-1’ Chi-squared test; (2) Comparing black SLE patients to while SLE patients using ‘N-1’ chi-squared test
Conclusions This study suggests that women with SLE are at a significantly higher risk of falling behind on PAP smears when compared to women without SLE. Significant racial disparities between black SLE women and white SLE exist at our institution. Black SLE patients have a significant higher rate of HPV positivity compared to white SLE patients. Increased rate of HPV positivity and lower rates of screening in black SLE patients in conjunction with the known increased risk of cervical neoplasia due to SLE disease itself and due to immunomodulators used to treat SLE signifies that treating physicians should be mindful of the importance of preventative measures, such as cervical screening and HPV vaccination in the SLE population in particular black SLE patients.
Funding Source(s): This abstract is not funded