title: Risk of high-grade cervical dysplasia and cervical cancer in women with systemic inflammatory diseases: a population-based cohort study.
abstract: BACKGROUND
  Previous studies have suggested a potential risk of cervical cancer in patients with systemic inflammatory diseases (SID) such as inflammatory bowel disease (IBD) and systemic lupus erythematosus (SLE).
  
  
  OBJECTIVE
  To assess the risk of high-grade cervical dysplasia, a surrogate endpoint for cervical cancer and cervical cancer, in women with SID, including IBD, psoriasis, rheumatoid arthritis (RA) or SLE, compared with the risk in women without SID.
  
  
  METHODS
  Using US insurance data (2001-2012), we conducted a cohort study of 133,333 women with SID, based on two or more diagnoses and one or more dispensed prescription for disease-specific treatment, and 533,332 women without SID. High-grade cervical dysplasia and cervical cancer was defined by a validated algorithm with a positive predictive value of ≥81%.
  
  
  RESULTS
  Over the mean follow-up of 2.1 years, the crude incidence rate of high-grade cervical dysplasia and cervical cancer per 100,000 person-years was the highest at 141.1 in SLE and the lowest at 82.2 in psoriasis among women with SID, and 73.4 in women without SID. The multivariable HR adjusted for potential confounders was 1.07 (95% CI 0.79 to 1.45) in IBD, 0.96 (95% CI 0.73 to 1.27) in psoriasis, 1.49 (95% CI 1.11 to 2.00) in RA and 1.53 (95% CI 1.07 to 2.19) in SLE. Multivariable HRs were increased, but not statistically significant, in IBD, RA and SLE with baseline use of systemic immunosuppressive drugs or steroids.
  
  
  CONCLUSIONS
  The risk of high-grade cervical dysplasia and cervical cancer was 1.5 times higher in women with RA and SLE than in those without SID. The risk may be increased in IBD with use of systemic immunosuppressive drugs or steroids.
authors.affiliation: Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, Massachusetts, USA Division of Rheumatology, Allergy and Immunology, Brigham and Women's Hospital, Boston, Massachusetts, USA Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA.
authors.forename: Seoyoung C
authors.initials: SC
authors.lastname: Kim
authors.affiliation: Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Glynn
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA.
authors.forename: Edward
authors.initials: E
authors.lastname: Giovannucci
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA.
authors.forename: Sonia
authors.initials: S
authors.lastname: Hernández-Díaz
authors.affiliation: Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Jun
authors.initials: J
authors.lastname: Liu
authors.affiliation: Department of Obstetrics Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Feldman
authors.affiliation: Division of Rheumatology, Allergy and Immunology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Elizabeth W
authors.initials: EW
authors.lastname: Karlson
authors.affiliation: Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Schneeweiss
authors.affiliation: Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, Massachusetts, USA Division of Rheumatology, Allergy and Immunology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Solomon
mesh_terms: D000328:Adult; D000465:Algorithms; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D015212:Inflammatory Bowel Diseases / Q000150:complications*; D008180:Lupus Erythematosus, Systemic / Q000150:complications*; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology*; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology*
keywords: Autoimmune Diseases; Epidemiology; Rheumatoid Arthritis; Systemic Lupus Erythematosus