Adherence to recommendations for cervical and breast cancer screening in systemic sclerosis

Abstract

In Italy, the current recommendations for the early diagnosis of the most frequent female cancers suggest screening women aged 25-64 years for cervical cancer with Papanicolaou (Pap) test at 3-year intervals and women aged 50-69 years at 2-year interval with mammography (1). The aim of cancer screening is to detect precancerous lesions or early neoplastic transformation, thereby resorting to earlier and potentially less invasive treatment than what is required for symptomatic and more advanced cancers. The benefit of cancer screening procedures in terms of lower incidence of the invasive disease and lower mortality has extensively been documented (2-5). There are discordant data regarding adherence to cancer screening programs in patients affected by systemic lupus erythematosus (SLE). A Canadian study showed that 53% of 48 SLE women aged 50-69 and 33% of 27 SLE women aged less than 30 years reported to have performed a mammogram and a Pap test, in the previous year. These figures compare with 74% and 56% of similarly aged control women, respectively. Moreover, among 51 SLE subjects aged 50 and older, only 18% reported screening for colorectal cancer compared to 48% in the general population. Non-white SLE patients, those with lower educational level, and with higher disease damage scores were less likely to undergo cervical Pap testing (6). It is not clear why SLE women are less careful in performing age-related cancer screening in agreement with recommendations. These results might be attributed to the tedious-SUMMARY The aim of the study was to evaluate the adherence of systemic sclerosis (SSc) female patients to cervix and breast cancer screening procedures, as suggested by local guidelines. A cohort of 84 SSc women was asked if they had undergone mammography and Pap test during the previous 2-and 3-year intervals, as indicated according to the Italian recommendations. The results were compared with those collected in patients affected by other chronic rheumatic disorders and in the general population. More than 85% of SSc women declared to comply with an age-related cervix and breast cancer screening schedule. The data were similar to those collected in patients affected by other chronic rheumatic disorders, whereas the subjects belonging to the general population reported to undergo breast cancer screening more frequently. Among SSc women, neither the educational level, nor the lung and skin involvement influenced their cancer screening program compliance. Only a positive history of ischemic digital ulcers seemed to interfere with mammography. Our study reported a very high percentage of SSc female patients who adhered to programs for the early detection of cervical and breast cancer. The significant adherence to guidelines may be due to the schedule adopted by the local health public service, which regularly invites eligible subjects by mail to undergo cancer screening at no charge.