Cervical cancer screening practices among patients with autoimmune and inflammatory rheumatic diseases: a descriptive cross-sectional observational study

Immunocompromised women with autoimmune and inflammatory rheumatic diseases (AIIRDs) are at increased risk of human papillomavirus (HPV) infection and cervical intraepithelial neoplasia, necessitating appropriate cervical cancer screening (CCS). However, there are still limited reports on CCS practices in patients with AIIRD. We assessed the proportion of women with AIIRDs undergoing CCS in accordance with current European guidelines, and factors associated with appropriate or inappropriate screening. We conducted a cross-sectional study at Bordeaux University Hospital (July 2023–July 2024). Women ≥ 18 years with confirmed AIIRDs (systemic lupus erythematosus, systemic sclerosis, Sjögren’s syndrome, Sharp’s syndrome, rheumatoid arthritis, or spondyloarthritis) completed a standardized self-administered questionnaire on rheumatologic and gynaecologic follow-up, CCS practices, and knowledge about HPV/CCS. Of the 309 participants included, 302 provided the date of their last CCS. Of these, 120 were classified as high risk for cervical pathology (receiving targeted therapies or immunosuppressive treatment), and 182 as lower risk. Overall, 188 of 302 women (62.3%) reported undergoing CCS in accordance with current guidelines. However, among high-risk patients, 45 of 120 (37.5%) had received a cervical smear within the past year. Inadequate screening was significantly associated with a low level of education, more frequent rheumatologic follow-up, and limited knowledge of cervical pathology. Notably, 16% of participants reported not knowing the purpose of the cervical smear. Women with AIIRDs may benefit from increased CCS awareness among rheumatologists and improved patient education by gynaecologist to promote screening. Further studies are needed to characterise disease- and treatment-specific risks more accurately, establish appropriate screening intervals, and optimise CCS practices for women with AIIRDs. The study was registered on ClinicalTrials.gov (NCT05961267, date of registration 2023-07-17).