Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.
Frequency of PAP Smears among Lupus PatientsA Patient Report Survey.
Lydon, Eileen J., Belmont, H. Michael
In our practice 2 patients (pts) with systemic lupus erythematosus (SLE) who received intravenous (IV) cyclophosphamide (CYC) for lupus nephritis developed anal cancer (ca). Both had a history of human papilloma virus (HPV) & presented with bright red blood per rectum (BRBPR). HPV is responsible for almost all cervical & 90% of anal ca. Studies suggest that women with SLE are at greater risk of developing cervical dysplasia & ca than the general population. It is unknown whether this is attributable to immunosuppressive exposure or baseline defective immunity to HPV. Furthermore, immunocompromised pts & women with a history of cervical ca (or high-grade cervical lesions) are among high risk groups for the development of anal ca. Appropriate screening and knowledge of cervical & anal ca is imperative for SLE pts.
We developed a patient report survey (PRS) to assess knowledge & educate our pts regarding cervical & anal ca. From May-June 2010 we surveyed pts at Bellevue & NYUHJD lupus clinics as well as private practice. Both genders were included & questions consisted of HPV awareness, HPV/SLE/ca risk, frequency of cervical & anal pap smears, & HPV vaccine. Education and recommendations were also provided.
75 pts participated; 69 F, 6 M; Age mean = 48; AA 24, H 32, C 6, A 11; Sexually active 39/75(52%); Unaware of HPV 40/75(53%); Ever told had HPV 11/75(15%); Smoked cigarettes 7/75(9%); Unaware of SLE/HPV/ca risk 67/75(89%); Unaware of utility for cervical PAP 20/69(29%); No GYN 15/69(22%); Greater than 1 year since last cervical PAP 19/69(28%) & 6/19(32%) never had; Abnormal cervical PAP 14/63(22%); Unaware of anal ca risk 64/75 (85%); Had anal pap smear 0/75(0%); Unaware of HPV vaccine 41/75(55%); Had vaccine 3/75(4%). Almost half the cohort were unaware of HPV & a strikingly high number unaware of SLE, HPV & ca risk. The few smokers were encouraged to quit. Many needed to be counseled about the importance of yearly cervical screening & more frequently if abnormal. A few never had cervical PAP smears & were encouraged to make an appointment. The majority of pts lacked knowledge regarding risks of anal ca & screening tools such as anal pap smears. Finally, most were unaware of the HPV vaccine & only a few eligible pts had yet to receive it.
The RPS allowed for assessment of knowledge and the ability to provide education to help decrease the development of cervical and anal ca. Our immunocompromised pts should undergo appropriate screening. Yearly PAP smears with HPV testing can help identify high risk (HR) types of HPV early in the disease. The SLE pts exposed to immunosuppressants also need to receive annual screenings. In addition, eligible pts should be educated about the HPV vaccine which prevents up to 70% of HR HPV. Also, as we experienced, pts exposed to CYC with HPV who develop BRBPR need prompt evaluation. Furthermore, anal ca screening should be considered for our high risk pts even though there are currently no standardized guidelines. Finally, education about these malignancies will help ensure that our pts are screened appropriately & increase awareness to report associated symptoms.
To cite this abstract, please use the following information:
Lydon, Eileen J., Belmont, H. Michael; Frequency of PAP Smears among Lupus PatientsA Patient Report Survey. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :996