Cervical Cancer Screening in Women With Systemic Lupus Erythematosus

Objective: To determine rates of cervical cancer screening and associated abnormal results in women with systemic lupus erythematosus (SLE). Methods: We identified women with an initial diagnosis of SLE in the MarketScan Commercial Claims and Encounters Database from 2001 to 2014. Cervical cancer screening rates and associated diagnostic claims within 3 years of the initial claim were determined. Multivariable logistic regression was performed to evaluate the association of screening with lupus treatment. A matched logistic regression analysis was conducted to compare screening rates to those in age-matched women without connective tissue disease. Results: We included 4,316 women with SLE. Screening rates were higher in women with SLE than in general controls (73.4% versus 58.5%; P < 0.001). Factors associated with decreased screening included recent time (odds ratio [OR] 0.70 [95% confidence interval (95% CI)] 0.55–0.89) (2012–2014 compared to 2001–2005), age ≥61 years (OR 0.27 [95% CI 0.18–0.39]), comorbidity score ≥2 (OR 0.71 [95% CI 0.6–0.83]), corticosteroid use (OR 0.77 [95% CI 0.61–0.97]), and use of immunosuppressants (OR 0.80 [95% CI 0.69–0.94]). Abnormal pathology result claims were more common in women with SLE than in general controls (12.3% versus 9.8%; P < 0.001). Conclusion: Though with higher rates than the general cohort, over 25% of the patients with SLE were not screened, and screening rates seem to be decreasing over time. Patients with SLE are at higher risk of abnormal cervical screening test results than controls, supporting the need for regular screening.