Investigator
The University Of Texas Md Anderson Cancer Center
Cervical Cancer Screening in Women With Systemic Lupus Erythematosus
ObjectiveTo determine rates of cervical cancer screening and associated abnormal results in women with systemic lupus erythematosus (SLE).MethodsWe identified women with an initial diagnosis of SLE in the MarketScan Commercial Claims and Encounters Database from 2001 to 2014. Cervical cancer screening rates and associated diagnostic claims within 3 years of the initial claim were determined. Multivariable logistic regression was performed to evaluate the association of screening with lupus treatment. A matched logistic regression analysis was conducted to compare screening rates to those in age‐matched women without connective tissue disease.ResultsWe included 4,316 women with SLE. Screening rates were higher in women with SLE than in general controls (73.4% versus 58.5%; P < 0.001). Factors associated with decreased screening included recent time (odds ratio [OR] 0.70 [95% confidence interval (95% CI)] 0.55–0.89) (2012–2014 compared to 2001–2005), age ≥61 years (OR 0.27 [95% CI 0.18–0.39]), comorbidity score ≥2 (OR 0.71 [95% CI 0.6–0.83]), corticosteroid use (OR 0.77 [95% CI 0.61–0.97]), and use of immunosuppressants (OR 0.80 [95% CI 0.69–0.94]). Abnormal pathology result claims were more common in women with SLE than in general controls (12.3% versus 9.8%; P < 0.001).ConclusionThough with higher rates than the general cohort, over 25% of the patients with SLE were not screened, and screening rates seem to be decreasing over time. Patients with SLE are at higher risk of abnormal cervical screening test results than controls, supporting the need for regular screening.
Content and quality of consumer websites providing information about human papillomavirus infection in patients with systemic lupus erythematosus: An environmental scan
We aimed to evaluate the content and quality of websites for consumers providing information about human papillomavirus (HPV) risks in patients with systemic lupus erythematosus (SLE). We conducted an environmental scan of websites for patients and the general public with information about HPV and SLE. We searched Google from inception to June 2023, using the terms "HPV" and "lupus". We included websites with information about HPV and SLE. Two reviewers appraised the websites and collected website characteristics, and rated various attributes: completeness and comprehensiveness, accuracy, technical elements, design and aesthetics, usability, readability, and accessibility. We identified 16 websites for analysis. Ten (62.5 %) were commercial websites One website provided complete and comprehensive information about HPV risk, screening, and vaccination in patients with SLE; 7 (44 %) websites provided only information about the HPV vaccine. Eight websites included risk of HPV infection, cervical cancer screening, and cervical cancer risk in patients with SLE. Seventy-five percent provided information based on clinical guidelines, textbooks, peer-reviewed papers or scientific publications while the remaining were based on expert opinions. All websites were considered to have adequate design and aesthetics and were easy to navigate. Only 1 (6 %) website had a 6th-grade reading level and the other had reading levels higher than that (not appropriate for consumer websites). The overall quality scores ranged from 32 to 51 (maximum 69). Our findings showed that most websites for patients and the general public with information about HPV and SLE did not provide complete and comprehensive information about HPV.
Factors Associated With Adherence of Cervical Cancer Screening in Women With Systemic Lupus Erythematosus
ObjectiveThe objective is to determine cervical cancer screening rates and factors associated with decreased cervical cancer screening in women with systemic lupus erythematosus (SLE).MethodsWe conducted a cross‐sectional study that enrolled consecutive women (age 21–64 years) with SLE. We collected demographics, clinical characteristics, constructs of the Health Beliefs Model (HBM) (ie, susceptibility, severity, barriers, benefits, cues to action, and self‐efficacy), and self‐reported cervical cancer screening (confirmed with the electronic medical record). The primary outcome was adherence to cervical cancer screening according to current guidelines. Multivariable logistic regression models were used to examine the association between SLE disease activity and cervical cancer screening and explore mediation effects from HBM constructs.ResultsWe enrolled 130 women with SLE. The median age was 42 years (interquartile range 32–52 years). The cervical cancer screening adherence rate was 61.5%. Women with high SLE disease activity were less likely to have cervical cancer screening versus those with low disease activity (odds ratio 0.59, 95% confidence interval [CI] 0.39–0.89; P = 0.01), which remained statistically significant after adjusting for baseline demographics and drug therapy in a multivariable model (odds ratio 0.25, 95% CI 0.08–0.79; P = 0.02). Regarding the HBM constructs, increased perceived barriers to cervical cancer screening (r = −0.30, P < 0.01) and decreased self‐efficacy (r = −0.21, P = 0.02) correlated with decreased cervical cancer screening.ConclusionPatients with SLE with high disease activity undergo cervical cancer screening less frequently than those with low disease activity. Perceived barriers to cervical cancer screening are moderately correlated with decreased screening. These data highlight the need to develop strategies to increase cervical cancer screening in this high‐risk patient population.
