AB0502 IMPROVING RATES OF CERVICAL CANCER SCREENING AND PREVENTION IN PATIENTS WITH LUPUS
Authors: Nancy Desai, Michael York, Hanni Menn-Josephy, Ramon Bonegio, Christina Lam, Anna Kancharla
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Recent studies suggest that patients with lupus have higher rates of cervical dysplasia and pre-malignant lesions. We have a large population of lupus patients at our institution that may be at increased risk of dysplastic lesions due to suboptimal rates of HPV vaccination and cervical cancer screening. The aim of this study was to determine the rate of HPV vaccination completion and cervical cancer screening compliance among the lupus patients seen in our institution. In addition, we developed a process to increase patient education and improve both HPV and cervical cancer screening rates at the level of the outpatient renal, dermatology and rheumatology clinics. <h3>Objectives:</h3> To improve rates of cervical cancer screening and HPV vaccination among patients with Lupus <h3>Methods:</h3> A comprehensive list was compiled of all patients with a diagnosis of lupus seen in the clinics over a 3 year period. A chart review of 332 patients was subsequently performed to determine the rate of HPV vaccination completion and the rate of compliance with cervical cancer screening. Methods were developed to improve these rates by streamlining access to HPV vaccination sites or facilitating referral for screening exams. Patients were also provided education through brochures about their increased risk. <h3>Results:</h3> Our results revealed that rates of HPV vaccination among lupus patients at our institution were lower than national averages by 11%. Rates of cervical cancer screening were also 21% lower compared to national average for this group of patients. In creating a system to flag providers and increase patient education, we were able to improve these rates. In the first two months, 73.7% of all patients seen in the clinics were provided education and 61.5% of eligible patients that were seen in clinic were appropriately referred to either their PCP or to gynecology to complete cervical cancer screening and prevention. <h3>Conclusion:</h3> Initial review of the lupus population at our institution highlighted a strong need to develop an intervention to improve vaccination and screening compliance in this population. By raising awareness amongst providers, we were able to significantly increase the number of at risk patients referred for cervical cancer screening and prevention. Given that the United States Food and Drug Administration has recently approved to expand the use of the HPV vaccine to women and men up to age 45, future efforts will be made to expand our eligble population to reflect these recommendations. <h3>References</h3> [1] "FDA Approves Expanded Use of Gardasil 9 to Include Individuals 27 through 45 Years Old." FDA News Release, 5 Oct. 2018, www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm622715.htm. [2] "Gynecologic Cancers." Centers for Disease Control and Prevention, 27 June 2018, www.cdc.gov/cancer/cervical/basic_info/test-results.htm. [3] "Practice Bulletin No. 140." Obstetrics &amp; Gynecology, vol. 122, no. 6, 2013, pp. 1338–1366., doi:10.1097/01.aog.0000438960.31355.9e. [4] "Vaccines &amp; Immunizations." Centers for Disease Control and Prevention, 4 Sept. 2018, www.cdc.gov/vaccines/index.html. [5] Feldman, C H, et al. "Risk of High-Grade Cervical Dysplasia and Cervical Cancer in Women with Systemic Lupus Erythematosus Receiving Immunosuppressive Drugs." Lupus, vol. 26, no. 7, 2016, pp. 682–689., doi:10.1177/0961203316672928. [6] Grein, Ingrid Herta Rotstein, et al. "HPV Infection and Vaccination in Systemic Lupus Erythematosus Patients: What We Really Should Know." Pediatric Rheumatology, vol. 14, no. 1, 2016, doi:10.1186/s12969-016-0072-x. [7] Santana, I U, et al. "Systemic Lupus Erythematosus, Human Papillomavirus Infection, Cervical Pre-Malignant and Malignant Lesions: a Systematic Review." Clinical Rheumatology., May 2011 <h3>Disclosure of Interests:</h3> Nancy Desai: None declared, Michael York: None declared, Hanni Menn-Josephy: None declared, Ramon Bonegio Grant/research support from: Merck, Chugai Pharmaceuticals, Astra Zeneca, Aurinia Pharmacueticals, Consultant for: Merck, Chugai Pharmaceuticals, Christina Lam: None declared, Anna Kancharla: None declared