title: Increased risk of high grade cervical squamous intraepithelial lesions in systemic lupus erythematosus: A meta-analysis of the literature.
abstract: Conflicting data have been published regarding the risk of cervical lesions among women with systemic lupus erythematosus (SLE). We systematically reviewed the evidence for an association of SLE with cervical precancerous lesions (high-grade squamous intraepithelial lesions, HSIL), and performed a meta-analysis to determine the risk of HSIL in SLE patients. Observational studies identified up to February 2013 from the Medline, Embase and Cochrane databases were selected if they assessed the prevalence of HSIL in female SLE patients versus healthy female controls and included in a meta-analysis with pooled effect estimates obtained using a random-effects model. Of 235 citations retrieved, 7 studies met inclusion criteria. The pooled odds ratio for the risk of HSIL in SLE patients (n=416) versus female controls (n=11,408) was 8.66 (95% CI: 3.75-20.00), without significant heterogeneity across studies. Cumulative meta-analysis according to year of study publication revealed a slight increase in the risk of HSIL in the 2001-2011 period and then a stabilization afterwards. This meta-analysis shows that the risk of HSIL is significantly increased in SLE patients, compared to healthy female controls. This suggests that women with SLE may benefit from HPV vaccines and specific cervical cancer screening.
authors.affiliation: AP-HP, Groupement Hospitalier Pitié-Salpêtrière, E3M Institute, Internal Medicine Department 2, National Reference Centre for Systemic Lupus Erythematosus, F-75013, Paris, France.
authors.forename: Emilie
authors.initials: E
authors.lastname: Zard
authors.affiliation: AP-HP, Groupement Hospitalier Pitié-Salpêtrière, E3M Institute, Internal Medicine Department 2, National Reference Centre for Systemic Lupus Erythematosus, F-75013, Paris, France; Inserm, U1135, CIMI, F-75013, Paris, France; Sorbonne Universités, UPMC Univ Paris 06, F-75013, Paris, France. Electronic address: Laurent.arnaud@psl.aphp.fr.
authors.forename: Laurent
authors.initials: L
authors.lastname: Arnaud
authors.affiliation: AP-HP, Groupement Hospitalier Pitié-Salpêtrière, E3M Institute, Internal Medicine Department 2, National Reference Centre for Systemic Lupus Erythematosus, F-75013, Paris, France; Inserm, U1135, CIMI, F-75013, Paris, France; Sorbonne Universités, UPMC Univ Paris 06, F-75013, Paris, France.
authors.forename: Alexis
authors.initials: A
authors.lastname: Mathian
authors.affiliation: Sorbonne Universités, UPMC Univ Paris 06, F-75013, Paris, France; Service d'endocrinologie et médecine de la reproduction, IE3M, Hôpitaux universitaires Pitié Salpêtrière Charles Foix, centre de référence des pathologies gynécologiques rares, F-75013, Paris, France; Inserm, U845, F-75014, Paris, France.
authors.forename: Zeina
authors.initials: Z
authors.lastname: Chakhtoura
authors.affiliation: AP-HP, Groupement Hospitalier Pitié-Salpêtrière, E3M Institute, Internal Medicine Department 2, National Reference Centre for Systemic Lupus Erythematosus, F-75013, Paris, France; Sorbonne Universités, UPMC Univ Paris 06, F-75013, Paris, France.
authors.forename: Miguel
authors.initials: M
authors.lastname: Hie
authors.affiliation: Sorbonne Universités, UPMC Univ Paris 06, F-75013, Paris, France; Service d'endocrinologie et médecine de la reproduction, IE3M, Hôpitaux universitaires Pitié Salpêtrière Charles Foix, centre de référence des pathologies gynécologiques rares, F-75013, Paris, France; Inserm, U845, F-75014, Paris, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Touraine
authors.affiliation: Service d'endocrinologie et médecine de la reproduction, IE3M, Hôpitaux universitaires Pitié Salpêtrière Charles Foix, centre de référence des pathologies gynécologiques rares, F-75013, Paris, France; Centre National de Référence des papillomavirus humains, Institut Pasteur, 75015 Paris, Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, F-75013, INSERM, UMR_S 1136, F-75013, Paris, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Heard
authors.affiliation: AP-HP, Groupement Hospitalier Pitié-Salpêtrière, E3M Institute, Internal Medicine Department 2, National Reference Centre for Systemic Lupus Erythematosus, F-75013, Paris, France; Inserm, U1135, CIMI, F-75013, Paris, France; Sorbonne Universités, UPMC Univ Paris 06, F-75013, Paris, France.
authors.forename: Zahir
authors.initials: Z
authors.lastname: Amoura
mesh_terms: D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000453:epidemiology; D060787:Neoplasm Grading; D015995:Prevalence; D012306:Risk; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology; D002578:Uterine Cervical Dysplasia / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*
keywords: Cervical cancer; Cervical intraepithelial neoplasia; High-grade cervical intraepithelial lesion; Human papillomavirus; Meta-analysis; Systemic lupus erythematosus