Increased risk of cervical dysplasia in females with autoimmune conditions—Results from an Australia database linkage study

Abstract

Background Autoimmune conditions (AICs) and/or their treatment may alter risk of human papilloma virus (HPV) infection and females with AICs are therefore at an increased risk of cervical dysplasia. However, inclusion of these at-risk populations in cervical cancer screening and HPV-vaccination guidelines, are mostly lacking. This study aimed to determine the prevalence of cervical dysplasia in a wide range of AICs and compare that to HIV and immunocompetent controls to support the optimisation of cervical cancer preventive health measures. Methods Data linkage was used to match cervical screening episodes to emergency department records of females with AICs or HIV to immunocompetent controls over a 14-year period. The primary outcome was histologically confirmed high-grade cervical disease. Results, measured as rates by cytology and histology classification per 1,000 females screened, were analysed per disease group, and intergroup comparisons were performed. Results Females with inflammatory bowel disease (2,683), psoriatic and enteropathic arthropathies (1,848), multiple sclerosis (MS) (1,426), rheumatoid arthritis (1,246), systemic lupus

Age, margin status, high‑risk human papillomavirus and cytology independently predict recurrent high‑grade cervical intraepithelial neoplasia up to 6 years after treatment

“…Although the present results did not show significantly increased comorbid conditions among the patients with detected recurrence, further inspection of Table I , Table II , Table III suggests that in individual cases these disorders, especially autoimmune conditions, may have been contributory. Notably, in a long-term large-scale Australian study ( 65 ), autoimmune conditions were found to be associated with increased cervical dysplasia, supporting the need for ‘expansion of cervical cancer preventative programs to include these at-risk females’.…”

GWAS meta-analysis and gene expression data link reproductive tract development, immune response and cellular proliferation/apoptosis with cervical cancer and clarify overlap with other cervical phenotypes

“…It has been suggested that persistent HPV infection and cervical cancer are more common in women with autoimmune disease 65, 66 , partly because of systemic immunosupressive drugs prescribed to these women 65 . However, our results suggest shared genetic predisposition may also play a role, as the combination of HLA alleles associated with risk of cervical dysplasia has also been associated with autoimmune diseases.…”

Temporal and area-level variation in prevalence of high-grade histologically confirmed cervical abnormalities among Indigenous and non-Indigenous women, Queensland, Australia, 2008–2017

“…Persistent oncogenic HPV infection is considered a necessary but not sufficient cause for precancerous cervical lesions. 5,22 One possible reason for the observed differentials in hHGA prevalence may be population-level differences in the prevalence of recognised co-factors for progression to HGA among women with persistent oncogenic HPV infections, such as sexual and reproductive behaviours including earlier and higher parity, 22 hormonal factors, 23 smoking, 24 human immunodeficiency viral (HIV) infections, 25 chronic inflammation, 22 and lower SES. 26 Although we lacked the necessary data to explore these issues further, Indigenous women are, on average, more likely to live in lower SES areas, have higher smoking rates, and earlier and higher parity.…”

“…Lack of information on HPV vaccination status and known co-factors (e.g. smoking) for increased risk of cervical HGA 5,22,25 also limited insights into reasons for the observed patterns.…”