Abstract
BACKGROUND: This study evaluated the risk of human papillomavirus (HPV)-associated gynecologic cancers in women with rheumatic diseases (RD) during their childbearing years. METHODS: Using the Korean National Health Insurance Service-National Health Information Database (2011-2021), we conducted a cohort study of 40,514 women with RD and 199,366 women without RD aged 20-49 years. The RD cohort included 9,932 women with systemic lupus erythematosus (SLE), 23,731 with seropositive rheumatoid arthritis (SPRA), and 6,851 with ankylosing spondylitis (AS). Incidence rates and hazard ratios (HRs) for HPV-associated gynecologic cancers, including cervical intraepithelial neoplasia grade 3, and cervical, vaginal, and vulva cancers, were estimated using Cox regression. RESULTS: Over the mean (standard deviation) follow-up period of 67.5 (37.7) months, the incidence rate of HPV-associated gynecologic cancers was 111.5/100,000 person-years in the RD cohort and 73.2/100,000 person-years in the non-RD cohort. The incidence rate/100,000 person-years of HPV-associated gynecologic cancers in the RD subcohorts was higher in SLE (223.6) and SPRA (83.1) and lower in AS (69.1) than in the non-RD cohort. The fully adjusted HR for HPV-associated gynecologic cancers was higher in the RD cohort (HR, 2.95; 95% confidence interval [CI], 2.44-3.57) and all the RD subcohorts (SLE: HR, 1.85; 95% CI, 1.33-2.57, SPRA: HR, 4.10; 95% CI, 3.03-5.55, and AS: HR, 1.91; 95% CI, 1.06-3.43). After adjusting for comorbidities and medication use, hazard ratios increased in SPRA and AS but decreased in SLE. CONCLUSION: Korean women of childbearing age with RD have a threefold increased risk for HPV-associated gynecologic cancers compared with those without RD. Comorbidities and medication use in SLE may influence the risk. Improved screening strategies are needed for these women.