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


LoS One. 2020 Jun 18;15(6):e0234813. doi: 10.1371/journal.pone.0234813. eCollection 2020.

Emma Foster 1 2 3, Michael J Malloy 4 5, Vilija G Jokubaitis 1 2, C David H Wrede 6 7, Helmut Butzkueven 1 2, Joe Sasadeusz 8, Sharon Van Doornum 9 10, Finlay Macrae 11, Gary Unglik 12, Julia M L Brotherton 4 5, Anneke van der Walt 1 2 3

Author Information

1 Department of Neurology, MS and Neuroimmunology Service, Alfred Health, Melbourne, Australia.

2 Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia.

3 Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia.

4 Victorian Cervical Screening Registry, VCS Population Health, VCS Foundation, Melbourne, Australia.

5 Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.

6 Department of Oncology and Dysplasia, Royal Women's Hospital, Melbourne, Australia.

7 Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia.

8 Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Melbourne, Australia.

9 Rheumatology Department, The Royal Melbourne Hospital, Melbourne, Australia.

10 Department of Medicine, The University of Melbourne, Melbourne, Australia.

11 Colorectal Medicine and Genetics, The Royal Melbourne Hospital, Melbourne, Australia.

12 Department of Clinical Immunology and Allergy, The Royal Melbourne Hospital, Melbourne, Australia.

Free PMC article


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 erythematosus and/or mixed connective tissue disease (SLE/MCTD) (702), HIV (44), and 985,383 immunocompetent controls were included. SLE/MCTD and HIV groups had greater rates of high-grade histological and cytological abnormalities compared to controls. Increased rates of low-grade cytological abnormalities were detected in all females with AICs, with the exception of the MS group.

Conclusions: Females with SLE/MCTD or HIV have increased rates of high-grade cervical abnormalities. The increased low-grade dysplasia rate seen in most females with AICs is consistent with increased HPV infection. These findings support expansion of cervical cancer preventative programs to include these at-risk females.