Increased risk of cervical dysplasia in females with autoimmune conditions—Results from an Australia database linkage study

• Published in: PloS one Vol. 15; no. 6; p. e0234813
• Main Authors: Foster, Emma, Malloy, Michael J, Jokubaitis, Vilija G, Wrede, C. David H, Butzkueven, Helmut, Sasadeusz, Joe, Van Doornum, Sharon, Macrae, Finlay, Unglik, Gary, Brotherton, Julia M. L, van der Walt, Anneke
• Format: Journal Article
• Language: English
• Published: San Francisco Public Library of Science 18.06.2020; Public Library of Science (PLoS)
• Subjects: Abnormalities; Age; Arthritis; Autoimmune diseases; Biology and Life Sciences; Cancer; Cancer screening; Cellular biology; Cervical cancer; Cervix; Cervix dysplasia; Chronic conditions; Complications and side effects; Connective tissue diseases; Connective tissues; Cytology; Demographic aspects; Disease; Disease prevention; Drug dosages; Dysplasia; Emergency medical care; Emergency medical services; Ethics; Females; Foster, Michael; Health risks; Histology; HIV; Hospitals; Human immunodeficiency virus; Human papillomavirus; Hysterectomy; Infections; Inflammatory bowel disease; Inflammatory bowel diseases; Intestine; Measurement methods; Medical screening; Medicine and Health Sciences; Mixed connective tissue disease; Multiple sclerosis; Neurology; Neurosciences; Optimization; Population; Public health; Quality; Rheumatoid arthritis; Risk; Risk factors; Socioeconomic factors; Studies; Systemic lupus erythematosus; Vaccination; Vaccines; Viruses; Australia; Melbourne Victoria Australia
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0234813

Background Autoimmune conditions (AICs) and/or their treatment may alter risk of human papilloma virus (HPV) infection and females with AICs are therefore at an increased risk of cervical dysplasia. However, inclusion of these at-risk populations in cervical cancer screening and HPV-vaccination guidelines, are mostly lacking. This study aimed to determine the prevalence of cervical dysplasia in a wide range of AICs and compare that to HIV and immunocompetent controls to support the optimisation of cervical cancer preventive health measures. Methods Data linkage was used to match cervical screening episodes to emergency department records of females with AICs or HIV to immunocompetent controls over a 14-year period. The primary outcome was histologically confirmed high-grade cervical disease. Results, measured as rates by cytology and histology classification per 1,000 females screened, were analysed per disease group, and intergroup comparisons were performed. Results Females with inflammatory bowel disease (2,683), psoriatic and enteropathic arthropathies (1,848), multiple sclerosis (MS) (1,426), rheumatoid arthritis (1,246), systemic lupus erythematosus and/or mixed connective tissue disease (SLE/MCTD) (702), HIV (44), and 985,383 immunocompetent controls were included. SLE/MCTD and HIV groups had greater rates of high-grade histological and cytological abnormalities compared to controls. Increased rates of low-grade cytological abnormalities were detected in all females with AICs, with the exception of the MS group. Conclusions Females with SLE/MCTD or HIV have increased rates of high-grade cervical abnormalities. The increased low-grade dysplasia rate seen in most females with AICs is consistent with increased HPV infection. These findings support expansion of cervical cancer preventative programs to include these at-risk females.