Cumulative Incidence of Cancer Screening for Breast, Cervical, Prostate, and Colorectal Cancer in Patients With Rheumatoid Arthritis.

Abstract

To determine the incidence of breast, cervical, prostate, and colorectal cancer screening in patients with rheumatoid arthritis (RA) vs matched non-RA comparators. We performed a retrospective, matched cohort study of patients with and without RA living in an 8-county region of southern Minnesota on January 1, 2015. Through review of medical records, patients who fulfilled either the 1987 American College of Rheumatology (ACR) or 2010 ACR/European Alliance of Associations for Rheumatology classification criteria for RA were identified. Patients with RA were matched 1:1 to non-RA comparators on age, sex, and county of residence. Cancer screening was determined from review of the US Preventative Task Force recommendations. Cumulative incidence of cancer screening was estimated accounting for the competing risk of death, and Cox proportional hazard models adjusted for age, smoking, and race assessed for the risk of delay. The study included 1614 patients with RA and 1597 comparators without RA (mean age 63 years, 71% female). At 5-years of follow-up, 51.6% (95% CI 47.9-55.6) of the RA cohort had cervical cancer screening compared to 58.2% (95% CI 54.5-62.2) in the non-RA cohort. After adjusting for age, smoking, and race, RA was associated with decreased cervical cancer screening (adjusted hazard ratio [aHR] 0.83, 95% CI 0.72-0.96). RA was not significantly associated with a decrease in breast (aHR 0.98, 95% CI 0.87-1.10), prostate (aHR 0.99, 95% CI 0.74-1.34), or colorectal (aHR 1.04, 95% CI 0.93-1.16) cancer screening. Women with RA were more likely to experience delayed cervical cancer screening. Increased diligence by healthcare providers to ensure cervical cancer screening in patients with RA is important to reduce the morbidity and mortality seen in these patients.