Background/Purpose: Dermatomyositis (DM) is an immune-mediated myopathy characterized by muscle weakness and skin rash that carries an elevated risk of associated malignancy within 5 years of diagnosis [1]. While the link between DM and malignancy is well established, no consensus guidelines exist regarding advanced malignancy screening beyond standard age appropriate US Preventive service task force (USPSTF) and American Cancer Society recommendations. Given the variability of practices among providers, we sought to explore institutional trends and barriers to obtaining malignancy screenings for adult DM patients.

Methods: We conducted a retrospective review of patients enrolled from 2010-2020 in our previously established registry, the Penn State Registry of Inflammatory Myopathies (PRIMO). Inclusion criteria were diagnosed at age >18, DM diagnosis confirmed through ACR/EULAR criteria, and presentation within 3 years of diagnosis. Descriptive statistics were used to summarize results.

Results: A total of 65 patients met inclusion criteria. Patients were predominantly female (78.5%), with mean age at diagnosis of 55.3 years. In 69.8% of initial encounters, malignancy risk and/or need for screening was documented. CT thorax (72.3%) and CT abdomen/pelvis (66.2%) were the most commonly completed screenings with 42.8% undergoing PET CT. Regarding USPSTF screenings, 29% and 37.4% of eligible patients completed colonoscopy and mammogram respectively. All patients with high risk antibody profiles received advanced screening. Notably, 15.4% of patients had no advance testing completed or documented. Rheumatologists (25, 43.1%), dermatologists (29, 50.0%), and primary care physicians (19, 32.8%) were the most common ordering providers. Insurance approval and financial concerns were leading reasons why ordered tests were not completed. Malignancy was present in 18.8% of patients and included breast, lung, gastrointestinal, hematologic, and gynecologic cancers. The average time between first DM evaluation and malignancy diagnosis was 27.6 months.

Conclusion: Our data highlights the variability that exists among cancer screening practices in DM. While those with the highest risk disease subtypes were identified and screened, many others were not recommended for advanced screening and clinical decision making was not well documented. Furthermore, USPSTF screenings were not commonly ordered by specialists, drawing attention to the need for collaboration. Given the morbidity and mortality that accompanies malignancy, efforts should be made to overcome barriers to screening. Future efforts should focus on collaborations with other institutions to expand participant diversity, adopting insights from primary care screening practices, assessing patient and provider perspectives, and developing practical quality improvement initiatives to trial in the clinical environment.

Table 1 – Demographics and Antibody Panel

Malignancy Screenings: X-axis = Malignancy Screening Type, Y-axis = Number of tests ordered

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/malignancy-screening-of-dermatomyositis-patients-in-the-penn-state-registry-of-inflammatory-myopathies-primo/