Background/Purpose: Women living with systemic lupus erythematosus (SLE) are at an increased risk of infections from human papillomavirus (HPV), and cervical cancer, especially women with higher disease activity who require immunosuppression. The objective of this study was to determine cervical cancer screening rates in women with SLE, and to evaluate their attitudes and beliefs towards screening.

Methods: We conducted a cross-sectional study in which we enrolled consecutive women with a diagnosis of SLE by 2019 ACR criteria. Eligible women were ≥21 years old, without a prior hysterectomy or history of cervical cancer. We collected demographics, clinical characteristics, constructs of the Health Beliefs Model (HBM) (susceptibility, severity, perceived barriers, benefits, cues to action, and self-efficacy) and self-reported last cervical cancer screening (confirmed with the electronic medical record). Our primary outcome was adherence to cervical cancer screening according to the American Society for Colposcopy and Cervical Pathology (ASCCP) guidelines. Multivariable logistic regression models were used to examine the association between the SLE disease activity attributes and the cervical cancer screening and to explore the mediation effect of HBM constructs between disease activity and screening adherence.

Results: We enrolled 130 women with SLE to our study, the majority of whom were Black (35%) or Hispanic (52%), with a median age of 42. The cervical cancer screening adherence rate was 61.5%. Women with higher disease activity (SLEDAI < 6) underwent screening less frequently than those with low disease activity (76% vs 24%, p < 0.05). Multivariable logistic regression adjusting for demographics and clinical factors showed higher disease activity had a decreased odds of being screened than low disease activity (aOR 0.24, 95% CI 0.08-0.76, p < 0.02). HBM constructs, particularly perceived barriers (r=-0.30, p< 0.01) and self-efficacy (r=0.21, p< 0.05) were significantly correlated with the receipt of cervical cancer screening. Multivariable regression models adjusting for covariates and mediation effects of each HBM construct showed that SLE patients with high disease activity had decreased probability of cervical cancer screening (‘perceived susceptibility’: aOR 0.2548, p < 0.01; ‘perceived severity’: aOR 0.2552, p< 0.01; ‘perceived barriers’: aOR 0.2809, p< 0.01; ‘perceived benefits’: aOR 0.2491, p< 0.01; ‘self-efficacy’: aOR 0.2734, p< 0.01; ‘cues to action’: aOR 0.2602, p< 0.01).

Conclusion: Our results show that only 61.5% of women with SLE underwent screening according to ASCCP guidelines. Concerningly, only 24% of those with high disease activity, the highest risk population, had been screened. While some individual attitudes and beliefs partially explained these low rates, low odds for screening remained after adjustment. Our findings indicate the need for ascertainment of cervical cancer screening utilization in this high risk population as needed following ASCCP recommendations.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/factors-associated-with-adherence-to-cervical-cancer-screening-in-ethnically-diverse-women-with-systemic-lupus-erythematosus/