Min Kyung Chung

Cervical cancer screening rates in Korean women of childbearing age with systemic lupus erythematosus

Objective Cervical cancer remains a leading cause of death among women of childbearing age despite the proven efficacy of screening in reducing mortality rates. Women with systemic lupus erythematosus (SLE) are at a higher risk for cervical cancer but tend to have lower screening rates. This study aimed to assess cervical cancer screening (CCS) rates and identify factors influencing screening uptake among Korean women of childbearing age with SLE. Methods Women aged 20-49 with SLE and age matched controls, randomly selected at a 1:5 ratio, were identified from the 2016-2017 Korean National Health Insurance Service-National Health Information Database (NHIS-NHID). Data from 10,981 women with SLE and 54,905 controls eligible for National Health Screening Program (NHSP) in 2018-2019 were analyzed. The CCS rate was determined based on participation in Papanicolaou test among eligible individuals for NHSP. Logistic regression was used to estimate odds ratios (ORs) for factors associated with CCS uptake. Results The CCS rate was significantly lower in women with SLE compared to controls (49.6% vs 52.1%, P < .0001). Logistic regression revealed that younger age, lower income, self-employment or medical aid insurance, and rural residence were associated with reduced CCS uptake in both groups. The highest CCS uptake occurred in the 40-44 age group for both women with SLE (OR 5.09, 95% CI 4.17-6.22) and controls (OR 4.65, 95% CI 4.26-5.07). Comorbidities increased CCS uptake among controls (OR 1.18, 95% CI 1.13-1.23), but were associated with mild non-significant decrease in uptake among women with SLE (OR 0.96, 95% CI 0.87-1.04). Conclusion National CCS program is often underutilized by Korean women of childbearing age with SLE, particularly among those with lower income and those of rural residency. Targeted interventions are needed to improve screening rates and address the unique challenges faced by this high-risk population.

Risk for Human Papillomavirus-Associated Gynecologic Cancers Among Women of Childbearing Age With Rheumatic Diseases: A Population-Based Cohort Study

This study evaluated the risk of human papillomavirus (HPV)-associated gynecologic cancers in women with rheumatic diseases (RD) during their childbearing years. Using the Korean National Health Insurance Service-National Health Information Database (2011-2021), we conducted a cohort study of 40,514 women with RD and 199,366 women without RD aged 20-49 years. The RD cohort included 9,932 women with systemic lupus erythematosus (SLE), 23,731 with seropositive rheumatoid arthritis (SPRA), and 6,851 with ankylosing spondylitis (AS). Incidence rates and hazard ratios (HRs) for HPV-associated gynecologic cancers, including cervical intraepithelial neoplasia grade 3, and cervical, vaginal, and vulva cancers, were estimated using Cox regression. Over the mean (standard deviation) follow-up period of 67.5 (37.7) months, the incidence rate of HPV-associated gynecologic cancers was 111.5/100,000 person-years in the RD cohort and 73.2/100,000 person-years in the non-RD cohort. The incidence rate/100,000 person-years of HPV-associated gynecologic cancers in the RD subcohorts was higher in SLE (223.6) and SPRA (83.1) and lower in AS (69.1) than in the non-RD cohort. The fully adjusted HR for HPV-associated gynecologic cancers was higher in the RD cohort (HR, 2.95; 95% confidence interval [CI], 2.44-3.57) and all the RD subcohorts (SLE: HR, 1.85; 95% CI, 1.33-2.57, SPRA: HR, 4.10; 95% CI, 3.03-5.55, and AS: HR, 1.91; 95% CI, 1.06-3.43). After adjusting for comorbidities and medication use, hazard ratios increased in SPRA and AS but decreased in SLE. Korean women of childbearing age with RD have a threefold increased risk for HPV-associated gynecologic cancers compared with those without RD. Comorbidities and medication use in SLE may influence the risk. Improved screening strategies are needed for these women.