1916: Adherence to Cervical Cancer Screening Programs in Women with Systemic Lupus Erythematosus

Background/Purpose: Women with Systemic Lupus Erythematosus (SLE) are at a higher risk of persistent HPV infection and developing premalignant cervical lesions and cervical cancer. High-risk oncogenic HPV genotypes, particularly types 16 and 18, are the primary causal agents in most cases. Cervical cancer screening using HPV testing and cytology enables early detection of precursive lesions, preventing their progression to invasive cancer. The study aimed to evaluate adherence to the cervical cancer screening program in women with Systemic Lupus Erythematosus of reproductive age. Additionally, it sought to identify the most prevalent high-risk HPV genotypes within this population.

Methods: A retrospective observational study was carried out in a cohort of 128 women with SLE aged 20-50 years, followed in the outpatient rheumatology clinic of a tertiary care hospital in northern Spain.

Results: A total of 128 women were included, with a mean age of 39.11 ± 7.91 years and a mean disease duration of 11.16 ± 7.53 years (Table 1). Among them, 19.53% had never undergone cytology or HPV testing. Among the 80.46% who participated in screening, only 34.37% adhered to the recommended intervals (every three years or less), while the remainder were screened sporadically or outside the established periodicity. A total of 22.65% underwent screening at least once, and 23.43% were screened two or more times without following the recommended intervals. Regarding HPV infections, 18.75% tested positive, predominantly for high-risk genotypes (17.18%), with 8.59% showing coinfection with low-risk genotypes. Genotype 16 was the most frequently identified among high-risk infections (Figure 1). Cervical lesions related to HPV were detected in 14.06% of the women, with 9.37% presenting high-grade lesions (HSIL) and 4.68% presenting low-grade lesions (LSIL). Cervical cancer was diagnosed in 7.03% of the cases, with two patients presenting associated intraepithelial neoplasia of the vagina and vulva. Regarding smoking habits, 21.09% of the women were active smokers, 26.56% were former smokers, and 52.34% had never smoked. No statistically significant association was found between tobacco use and cervical cancer in this cohort (p = 0.0735).

Conclusion: The findings reveal a high prevalence of high-risk HPV infections in women with SLE, associated with a considerable risk of progression to premalignant lesions and cervical cancer. However, low adherence to the screening program was observed, highlighting the need for strategies to promote greater participation in such programs.