Background/Purpose: Patients with Systemic Lupus Erythematosus (SLE) are at increased risk of cervical dysplasia and persistent Human Papilloma Virus (HPV) infection. There are few prior studies looking at cervical cancer screening in SLE, and these have relied upon self-report to document if screening was done appropriately. These studies have also not included uninsured and non-English speaking subjects. We examined performance of cervical cancer screening in patients with SLE at Denver Health (DH) as well as sociodemographic and other predictors of screening.

Methods: Using data from the DH electronic health record (EHR), we identified rheumatology clinic patients with initial encounters between July 2006 and August 2011 who had SLE, were female, and were between the ages of 21-50 years. We queried data from the EHR including age, race/ethnicity, primary language, use of interpreter services and primary payer. We also queried the EHR regarding the rates of cervical cancer screening in this cohort and at DH overall. Manual record review was conducted to review medication use and possible history of hysterectomy. A chi-square test was used to test differences in the proportion of SLE patients with cervical cancer screening documented within one year pre or post index encounter and within three years pre or post index encounter by patient demographics. We looked at screening rates at both 1 and 3 year intervals depending on age, as 2003 American College of Obstetrics and Gynecology guidelines had  recommended annual screening in women younger than 30. 

Results: One hundred twenty eight patients with SLE were identified. Six of these patients were status post hysterectomy unrelated to cervical cancer. Data was analyzed for the remaining 122 patients. Eighty percent were non-White and half did not have health insurance. Overall, rates of cervical cancer screening within 3 years were 75% in DH primary care clinics and 66% in SLE patients. In our SLE cohort, only 60% of women age 30-50 underwent cervical cancer screening in 3 years, in contrast to 81% of patients age 21-29 (p = 0.0235). In unadjusted analyses, White women were less likely to have screening in 3 years compared to non-White women in the 21-29 age group  (p=0.0147). Women in the 21-29 age group with a history of gynecologic care were had a higher likelihood of screening at 3 years (p=0.0378). In the 30-50 age group, having seen a primary care physician was associated with a higher likelihood of screening at 1 and 3 years (p=0.0013 and 0.0040 respectively) and history of gynecology care was associated with increased likelihood of having a screening test at 1 and 3 years (p=0.0013 and 0.0003 respectively). Patients receiving immunosuppressive medications were no more likely to receive cervical cancer screening than other SLE patients.

Conclusion: We identified a gap in care in large subsets of the SLE patients at DH. White women age 21-29 and patients age 30-50 were less likely than the general primary care DH population to have appropriate cervical cancer screening. Rheumatologists need to help connect female SLE patients of all races and ethnicities with primary or gynecology care services as patients who limit physician visits to rheumatology are at risk of not being screened for cervical cancer.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/non-white-race-younger-age-and-use-of-primary-and-gynecologic-care-are-associated-with-higher-rates-of-cervical-cancer-screening-in-systemic-lupus-erythematosus-patients-at-a-public-hospital/