title: Is higher prevalence of cervical intraepithelial neoplasia in women with lupus due to immunosuppression?
abstract: BACKGROUND
  Cervical cancer (CC) is still the second in prevalence and mortality among women. In spite of previously observed higher incidence of cervical dysplasia among systemic lupus erythematosus (SLE) patients, few studies have considered the influence of classic risk factors and the use of immunosuppressors (IM).
  
  
  OBJECTIVE
  To study cervical dysplasia prevalence among SLE patients submitted or not to immunosuppression and to evaluate its association with classic risk factors.
  
  
  METHODS
  A group of 171 SLE patients including 87 who were receiving IM continuously for at least 1 year was compared with 222 age- and sociocultural-paired women (control group) submitted to routine cervical cytopathology. Statistical methods included univariate and multivariate analysis, besides parametric and nonparametric tests.
  
  
  RESULTS
  The prevalence of atypical squamous cells of undetermined significance, low-grade and high-grade intraepithelial lesions were significantly increased in SLE patients (12.8%, 5.8%, and 3.5%, respectively) compared with controls (3.1%, 0.9%, and none, respectively, P = 0.0001), although they presented significantly fewer classic risk factors for CC. Multivariate analysis showed that SLE women had a 7-fold higher prevalence of cervical dysplasia (OR: 7.23, 95% IC: 3.40-15.38) and an 11-fold higher prevalence of premalignant cervical dysplasia (OR: 11.36, 95% IC: 2.57-50.10) compared with controls. SLE patients with long-term use of IM presented even higher prevalence of low-grade and high-grade intraepithelial lesions in comparison with those without long-term use of these agents (68.7% vs. 31.1%, P = 0.03).
  
  
  CONCLUSIONS
  This study provides evidence that even though not presenting the classic risk factors for CC, SLE patients, especially those exposed to long-term immunosuppression, have increased chances of presenting more premalignant lesions than the general population and they probably need to follow a more stringent CC prevention program.
authors.affiliation: Department of Rheumatology, State University of Rio de Janeiro, UERJ, Blvd Vinte e Oito de Setembro 77, RJ-RJ, CEP: 20551-030, Brazil. klumb@uol.com.br
authors.forename: Evandro M
authors.initials: EM
authors.lastname: Klumb
authors.forename: Mario L
authors.initials: ML
authors.lastname: Araújo
authors.forename: Guilherme R
authors.initials: GR
authors.lastname: Jesus
authors.forename: Denise B
authors.initials: DB
authors.lastname: Santos
authors.forename: Albanita V
authors.initials: AV
authors.lastname: Oliveira
authors.forename: Elisa M N
authors.initials: EM
authors.lastname: Albuquerque
authors.forename: Jacyara M B
authors.initials: JM
authors.lastname: Macedo
mesh_terms: D000328:Adult; D001938:Brazil / Q000453:epidemiology; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000188:drug therapy* / Q000453:epidemiology; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D013997:Time Factors; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology / Q000276:immunology* / Q000473:pathology; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology / Q000276:immunology* / Q000473:pathology
chemical_list: D007166:Immunosuppressive Agents