Background/Purpose: 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 Papanicolaou (Pap) test uptake and identify factors influencing participation in cervical cancer screening among 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 National Health Insurance Service-National Health Information Database (NHIS-NHID). Data from 10,981 women with SLE and 54,905 controls eligible for national cervical cancer screening in 2018-2019 were analyzed. Pap test rates were calculated, and logistic regression was used to estimate odds ratios (ORs) for factors associated with Pap test uptake.

Results: The Pap test uptake 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 screening rates in both groups. The highest screening 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 screening 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: Cervical cancer screening is often underutilized by women of childbearing age with SLE, particularly those with comorbid conditions. Targeted interventions are needed to improve screening rates and address the unique challenges faced by this high-risk population.

National Health Insurance (NHIS) health screening and cervical cancer screening participation rates (2018-2019) among women of childbearing age with SLE compared to controls. *P value < .0001

SLE, systemic lupus erythematosus; Pap, Papanicolaou.

Factors associated with National Health Insurance (NHIS) cervical cancer screening participation rates (2018-2019) among women of childbearing age with SLE compared to controls. OR, odds ratio; CI, confidence interval.

Differences in baseline characteristics based on cervical cancer screening participation

Categorial values are provided as n (%).

Variables were obtained from the 2018 National Health Insurance-National Health Information (NHIS-NHID) database. The age was determined as of January 1, 2018.

*SLE and control groups were age- and sex-matched.

†Income levels were determined according to the decile method (8-10 refers to the low-income group)

‡Comorbidities were identified with the diagnostic code based on the International Classification of Diseases 10th revision (ICD-10) in the NHIS-NHID database 2016-2017.

SLE, systemic lupus erythematosus; DM, diabetes mellitus; Pap, Papanicolaou.

§ Having at least one of the comorbidities, including hypertension, DM, hyperlipidemia, cancer

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/cervical-cancer-screening-rates-in-korean-women-of-childbearing-age-with-systemic-lupus-erythematosus/