Is higher prevalence of cervical intraepithelial neoplasia in women with lupus due to immunosuppression?

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). OBJECTIVES: 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.