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Cancer Screening in Patients with Systemic Lupus Erythematosus
SASHA R. BERNATSKY, GLINDA S. COOPER, CHRIS MILL, ROSALIND RAMSEY-GOLDMAN, ANN E. CLARKE, and CHRISTIAN A. PINEAU
ABSTRACT. Methods. We conducted a patient survey of cancer screening practices within the Montreal General Hospital lupus cohort. We compared self-reported frequency of cancer screening to guidelines suggested for the general population, and to figures for cancer screening reported in the general population. We also developed logistic regression models to establish potential predictors of screening for patients with SLE, with cervical cancer screening being the outcome of interest in our primary analyses. Results. Of 48 women aged 50-69, 53% (95% confidence interval, CI: 38-68) had had a mammogram in the past 12 months, compared to 74% (95% CI: 73-75) for similarly aged Quebec women. Of 51 subjects aged 50 and older, only 18% (95% CI: 8-34) reported screening (fecal occult blood check with or without endoscopy) within the recommended time frame, compared to 48% (95% CI: 45-51) for colorectal screening for persons > 50 in the general population. Only 9 of 27 patients with SLE aged less than 30 had Pap tests in the past 12 months (33%, 95% CI: 19-52), compared with a general population rate of 56% (95% CI: 53-59) for similarly aged Quebec women. Our logistic regression model suggested that, among the SLE patients, non-whites, those with lower education, and those with higher disease damage scores were less likely to undergo cervical Pap testing. Conclusion. These data suggest that appropriate cancer screening may be overlooked in patients with SLE. (J Rheumatol 2006; 33:45-9; First Release Dec 1, 2005) Key Indexing Terms:
SYSTEMIC LUPUS ERYTHEMATOSUS
From the Montreal General Hospital Research Institute, the Department of Rheumatology and the Divisions of Clinical Immunology and Allergy and Clinical Epidemiology, Montreal General Hospital, McGill University Health Centre, Montreal, Canada; the National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Resources, Durham, North Carolina; and the Division of Rheumatology, Department of Medicine, Northwestern University Department of Medicine, Chicago, Illinois, USA. Supported by the Singer Family Fund for Lupus Research. Dr. Bernatsky has received fellowship support from the Canadian Arthritis Network, Lupus Canada, and the Canadian Institutes for Health Research (CIHR). Dr. Cooper is supported by the Intramural Research Program of the National Institute of Environmental Health Sciences, National Institutes of Health (NIH), Department of Health and Human Resources. Dr. Ramsey-Goldman has received support from the Arthritis Foundation, Clinical Science Grant, Arthritis Foundation Greater Chicago Chapter, NIH # AR 02138, # AR 48098, and Lupus Foundation of Illinois Chapter Grant. Dr. Clarke is a CIHR Investigator. Dr. Pineau is supported by the McGill University Health Center Research Institute. S.R. Bernatsky, MD, FRCPC, MSc, Research Fellow, Montreal General Hospital Research Institute; G.S. Cooper, PhD, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Resources; C. Mill, Research Assistant, Montreal General Hospital Research Institute; R. Ramsey-Goldman, MD, DrPh, Professor of Medicine, Division of Rheumatology, Department of Medicine, Northwestern University Department of Medicine; A.E. Clarke, MD, MSc, FRCPC, Associate Professor, Divisions of Clinical Immunology/Allergy and Clinical Epidemiology; C.A. Pineau, MD, FRCPC, Department of Rheumatology, Montreal General Hospital, McGill University Health Centre. Address reprint requests to Dr. S. Bernatsky, 1650 Cedar Ave., Room L10-520, Montreal, PQ, H3G 1A4. Accepted for publication August 15, 2005. |
