Rheumatology Advance Access originally published online on December 15, 2008
Rheumatology 2009 48(2):149-151; doi:10.1093/rheumatology/ken442
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Reports of abnormal cervical cancer screening tests in systemic sclerosis
1Divisions of Rheumatology and Clinical Epidemiology, McGill University, Health Centre, 2Division of Rheumatology, Sir Mortimer B. Davis Jewish General Hospital, Montreal, Quebec, 3Division of Rheumatology, University of Western Ontario, London, Ontario, 4Division of Rheumatology, University of Saskatchewan, Saskatoon, Saskatchewan, 5Division of Rheumatology, University of Manitoba, Winnipeg, Manitoba, 6Division of Rheumatology, University of Alberta, Edmonton, Alberta, 7Division of Rheumatology, Moncton Hospital, Moncton, New Brunswick, 8University of Calgary, Calgary, Alberta, 9Division of Rheumatology, University of British Columbia, Vancouver, British Columbia, 10Division of Rheumatology, University of Ottawa, Ottawa, Ontario, 11Division of Rheumatology, Dalhousie University, Halifax, Nova Scotia, 12Division of Rheumatology, McMaster University, Hamilton, Ontario, 13Division of Rheumatology, University of Montreal, Montreal and 14Division of Rheumatology, University of Sherbrooke, Sherbrooke, Quebec, Canada.
Correspondence to: S. Bernatsky, Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, 687 Pine Avenue West, V-Building, Montreal, Quebec H3A 1A1, Canada. E-mail: sasha.bernatsky{at}mail.mcgill.ca
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Abstract |
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Objective. To assess the prevalence of abnormal cervical cancer screening (Pap tests) reported by women with SSc onset before the age of 50 yrs.
Methods. Female members of a Canadian multi-centre SSc cohort completed standardized assessments and were questioned regarding a history of an abnormal Pap test. Potential correlates examined included demographics, reproductive history, smoking, diffuse vs limited SSc type, immunosuppressant exposure and SSc duration.
Results. In the 320 women with SSc onset before the age of 50 yrs, the life-time prevalence of an abnormal Pap test (according to self-report) was 25.4% (95% CI CI 20.9, 30.4%). By comparison, self-reported prevalence of abnormal Pap tests among general population Canadian females was recently reported at 13.8% (95% CI 11.6, 16.4%). Women with diffuse SSc (n = 142), tended to have a higher prevalence of self-reported cervical dysplasia (31.7%) compared with those with limited disease (20.7%), but the CIs overlapped. A multivariate logistic regression found a significant positive association between self-reported abnormal Pap test and diffuse disease [odds ratio (OR) 1.87; 95% CI 1.01, 3.47]. An independent association of an abnormal Pap test with smoking (OR 2.43; 95% CI 1.23, 4.78) and with younger age at disease onset was also noted.
Conclusions. We noted a high prevalence of abnormal Pap tests self-reported in our sample. Increased risk was seen among those with diffuse SSc, and also among smokers and those with a younger age at disease onset. Thus, it seems prudent to ensure that adequate attention is paid to cervical cancer screening for women with SSc.
KEY WORDS: Cervical dysplasia, Pap test, Malignancy, Systemic sclerosis, Scleroderma
Submitted 18 July 2008;
revised version accepted 22 October 2008.
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