Patients with RA Have Greater Risk of Delayed Cervical, Prostate Cancer Screening

Rebecca Brooks, MD

Credit: Mayo Clinic

Findings from a recent study are calling attention to delays in certain cancer screening tests among patients with rheumatoid arthritis (RA), providing important insight into cancers potentially driving mortality in this patient population.¹

Results showed RA was associated with a 16% increased risk of delay in cervical cancer screening and patients with RA and a history of smoking had a significant decrease in prostate cancer screening. However, obesity was a protective factor in the completion of breast cancer screening among patients with RA.¹

According to the World Health Organization, in 2019, 18 million people worldwide were living with RA.² People with RA and other related inflammatory diseases may face a slightly increased risk of developing certain cancers, underscoring the importance of understanding screening practices in patients with RA.³

“Despite the increased mortality in RA due to cancer, a study has not yet investigated the completion of age-appropriate cancer screening tests in RA patients,” Rebecca Brooks, MD, a resident in the department of internal medicine at Mayo Clinic in Rochester, and colleagues wrote.¹

To determine the cumulative incidence of breast, cervical, prostate, and colorectal cancer screening in RA patients compared to matched non-RA comparators and evaluate the impact of various demographics and health behaviors on the completion of age-appropriate cancer screenings, investigators performed a retrospective matched cohort study of patients in an 8-county region of southeastern Minnesota with prevalent RA on January 1, 2015.¹

Patients were identified through manual review of medical records and fulfillment of either the 1987 ACR or 2010 EULAR classification criteria. For patients who moved to the region with pre-existing RA where criteria could not be assessed, a physician diagnosis of RA with the use of disease-modifying anti-rheumatic drugs was required for inclusion.¹

Patients were matched 1:1 to randomly selected individuals based on sex, age, and county of residence. Patients without medical history prior to January 1, 2015, were excluded from both cohorts.¹

Investigators determined age-appropriate cancer screening guidelines for breast, cervical, prostate, and colorectal cancer based on recommendations from the United States Preventative Services Task Force. Patients with a prior diagnosis of the cancer of interest were excluded from the respective screening analysis.¹

The cumulative incidence of completion of the recommended cancer screening tests was estimated, accounting for the competing risk of death, and Cox proportional hazard models adjusted for age and race assessed the risk for delay in cancer screening.¹

In total, the study included 1614 patients with RA and 1597 patients without RA, with a mean age of 63 years and 71% being female. After adjusting for age and race, RA was associated with decreased cervical cancer screening (adjusted hazard ratio [aHR], 0.84; 95% CI, 0.73-0.97). However, investigators noted RA was not significantly associated with a delay in breast, prostate, or colorectal cancer screening.¹

At 8.5 years of follow-up, the non-RA comparators had a greater cumulative incidence of cervical cancer screening compared to RA patients (64.7%; 95% CI, 60.7-68.9 vs 58.7%; 95% CI, 54.9-62.9). Analyses accounting for the associations between RA and various health behaviors found obesity was a protective factor in the completion of breast cancer screening (aHR, 1.37; 95%CI, 1.07-1.75) and smoking was associated with a decrease in prostate cancer screening (aHR, 0.48; 95% CI, 0.26-0.90). Investigators noted sensitivity analyses restricted to the years of the COVID-19 pandemic did not find any significant influence on the incidence of cancer screening.¹

“Importantly, our study suggests that increased attention to cervical cancer screening by both primary care providers and rheumatologists could help to address the excess mortality and morbidity seen in RA patients due to cancer,” investigators concluded.¹

References:

1. ^{Brooks RT, Hulshizer CA, Hanson AC, et al. RATES OF CANCER SCREENING AND INVESTIGATION OF RISK FACTORS FOR SUB-OPTIMAL SCREENING IN A POPULATION-BASED COHORT OF PATIENTS WITH RHEUMATOID ARTHRITIS. EULAR. doi:10.1136/annrheumdis-2024-eular.1806}
2. ^{World Health Organization. Rheumatoid Arthritis. Newsroom. June 28, 2023. Accessed June 25, 2024. https://www.who.int/news-room/fact-sheets/detail/rheumatoid-arthritis}
3. ^{Gower, T. Rheumatoid Arthritis and Cancer Risk. Arthritis Foundation. Accessed June 25, 2024. https://www.arthritis.org/health-wellness/about-arthritis/related-conditions/other-diseases/arthritis-and-cancer-risk}