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CERVICAL DYSPLASIA RISK IN MULTIPLE SCLEROSIS PATIENTS

Year 2023, Volume: 24 Issue: 4, 493 - 499, 09.10.2023
https://doi.org/10.18229/kocatepetip.1230125

Abstract

OBJECTIVE: In this study, we aimed to investigate the relationship between Multiple Sclerosis (MS) disease and the development of cervical dysplasia.
MATERIAL AND METHODS: This is a retrospective case-control study that included 262 patients, 62 patients aged 18-65 years and 200 control group, who were followed up in a tertiary health center for MS disease. For the study, the primary outcome measure was to determine the frequency of cervical dysplasia in MS patients and to determine whether MS disease had an effect on Pap smear results. The secondary outcome measure was to determine the relationship between immunomodulatory and immunosuppressive treatment, two different types of treatment used for MS disease, and disease duration, with Pap smear results.
RESULTS: The difference between Pap smear results between MS patients and control group was not significant (p=0.938). In MS patients and control group, the most common Pap smear test result was found as inflammation (MS group: 61.9%; control group: 63%). Difference between Pap smear results between patients using immunomodulator and immunosuppressor drugs for MS treatment was not significant (p=0.988). Age and drugs used did not predict the Pap smear result (p=0.316).
CONCLUSIONS: In MS patients, the most common Pap smear change is inflammation. More studies are needed to understand the relationship between the duration of the disease and the type of medication used in treatment and Pap smear results.

References

  • 1. Parkin DM, Bray F. Chapter 2: The burden of HPV-related cancers. Vaccine. 2006;24:11-25.
  • 2. Walboomers JM, Jacobs MV, Manos MM, et al. Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol. 1999;189(1):12-9.
  • 3. International Collaboration of Epidemiological Studies of Cervical Cancer. Comparison of risk factors for invasive squamous cell carcinoma and adenocarcinoma of the cervix: collaborative reanalysis of individual data on 8,097 women with squamous cell carcinoma and 1,374 women with adenocarcinoma from 12 epidemiological studies. Int J Cancer. 2007;120(4):885-91.
  • 4. Yim EK, Park JS. The role of HPV E6 and E7 oncoproteins in HPV-associated cervical carcinogenesis. Cancer Res Treat. 2005;37(6):319-24.
  • 5. Safaeian M, Solomon D, Castle PE. Cervical cancer prevention--cervical screening: science in evolution. Obstet Gynecol Clin North Am. 2007;34(4):739-60.
  • 6. Wallin MT, Culpepper WJ, Campbell JD, et al. The prevalence of MS in the United States: A population-based estimate using health claims data. Neurology. 2019;92(10):1029-40.
  • 7. Goodin DS. The epidemiology of multiple sclerosis: insights to disease pathogenesis. Handb Clin Neurol. 2014;122:231-66.
  • 8. Lublin FD, Reingold SC, Cohen JA, et al. Defining the clinical course of multiple sclerosis: the 2013 revisions. Neurology. 2014;83(3):278-86.
  • 9. Berkovich R. Treatment of acute relapses in multiple sclerosis. Neurotherapeutics. 2013;10(1):97-105.
  • 10. Uludüz D, Saip S, Siva A. Multipl skleroz’da uzun süreli koruyucu tedaviler. Nöropsikiyatri Arşivi. 2008;45:26-36.
  • 11. Vargas DL, Tyor WR. Update on disease-modifying therapies for multiple sclerosis. J Investig Med. 2017;65(5):883-91.
  • 12. Satmary W, Holschneider CH, Brunette LL, Natarajan S. Vulvar intraepithelial neoplasia: Risk factors for recurrence. Gynecol Oncol. 2018;148(1):126-31.
  • 13. Sager R, Frei P, Steiner UC, Fink D, Betschart C. Genital Dysplasia and Immunosuppression: Why Organ-Specific Therapy Is Important. Inflamm Intest Dis. 2019;4(4):154-60.
  • 14. Grulich AE, van Leeuwen MT, Falster MO, Vajdic CM. Incidence of cancers in people with HIV/AIDS compared with immunosuppressed transplant recipients: a meta-analysis. Lancet. 2007;370(9581):59-67.
  • 15. Reusser NM, Downing C, Guidry J, Tyring SK. HPV Carcinomas in Immunocompromised Patients. J Clin Med. 2015;4(2):260-81.
  • 16. Moscicki AB, Schiffman M, Kjaer S, Villa LL. Chapter 5: Updating the natural history of HPV and anogenital cancer. Vaccine. 2006;24:S3/42-51.
  • 17. Allegretti JR, Barnes EL, Cameron A. Are patients with inflammatory bowel disease on chronic immunosuppressive therapy at increased risk of cervical high-grade dysplasia/cancer? A meta-analysis. Inflamm Bowel Dis. 2015;21(5):1089-97.
  • 18. Zard E, Arnaud L, Mathian A, et al. Increased risk of high grade cervical squamous intraepithelial lesions in systemic lupus erythematosus: A meta-analysis of the literature. Autoimmun Rev. 2014;13(7):730-5.
  • 19. Wadström H, Frisell T, Sparén P, Askling J. Do RA or TNF inhibitors increase the risk of cervical neoplasia or of recurrence of previous neoplasia? A nationwide study from Sweden. Ann Rheum Dis. 2016;75(7):1272-8.
  • 20. Marrie RA, Reider N, Cohen J, et al. A systematic review of the incidence and prevalence of cancer in multiple sclerosis. Mult Scler. 2015;21(3):294-304.
  • 21. Dugué PA, Rebolj M, Hallas J, et al. Risk of cervical cancer in women with autoimmune diseases, in relation with their use of immunosuppressants and screening: population-based cohort study. Int J Cancer. 2015;136(6):711-9.
  • 22. Kim SC, Glynn RJ, Giovannucci E, et al. Risk of high-grade cervical dysplasia and cervical cancer in women with systemic inflammatory diseases: a population-based cohort study. Ann Rheum Dis. 2015;74(7):1360-7.
  • 23. Skare TL, da Rocha BV. [Breast and cervical cancer in patients with systemic lupus erythematosus]. Rev Bras Ginecol Obstet. 2014;36(8):367-71.
  • 24. Foster E, Malloy MJ, Jokubaitis VG, et al. Increased risk of cervical dysplasia in females with autoimmune conditions-Results from an Australia database linkage study. PLoS One. 2020;15(6):e0234813.
  • 25. Cirpan T, Guliyeva A, Onder G, et al. Comparison of human papillomavirus testing and cervical cytology with colposcopic examination and biopsy in cervical cancer screening in a cohort of patients with Sjogren's syndrome. Eur J Gynaecol Oncol. 2007;28(4):302-6.
  • 26. Schmidt RE, Grimbacher B, Witte T. Autoimmunity and primary immunodeficiency: two sides of the same coin? Nat Rev Rheumatol. 2017;14(1):7-18.
  • 27. Bernatsky S, Ramsey-Goldman R, Clarke AE. Malignancy in systemic lupus erythematosus: what have we learned? Best Pract Res Clin Rheumatol. 2009;23(4):539-47.
  • 28. Klumb EM, Araújo ML, Jr., Jesus GR, et al. Is higher prevalence of cervical intraepithelial neoplasia in women with lupus due to immunosuppression? J Clin Rheumatol. 2010;16(4):153-7.
  • 29. Nath R, Mant C, Luxton J, et al. High risk of human papillomavirus type 16 infections and of development of cervical squamous intraepithelial lesions in systemic lupus erythematosus patients. Arthritis Rheum. 2007;57(4):619-25.
  • 30. Kiss E, Kovacs L, Szodoray P. Malignancies in systemic lupus erythematosus. Autoimmun Rev. 2010;9(4):195-9.
  • 31. Nguyen ML, Flowers L. Cervical cancer screening in immunocompromised women. Obstet Gynecol Clin North Am. 2013;40(2):339-57.
  • 32. Hemmer B, Kerschensteiner M, Korn T. Role of the innate and adaptive immune responses in the course of multiple sclerosis. Lancet Neurol. 2015;14(4):406-19.
  • 33. Cools N, Ponsaerts P, Van Tendeloo VF, et al. Regulatory T cells and human disease. Clin Dev Immunol. 2007;2007:89195.
  • 34. Beyaert R, Beaugerie L, Van Assche G, et al. Cancer risk in immune-mediated inflammatory diseases (IMID). Mol Cancer. 2013;12(1):98.
  • 35. Jussila A, Virta LJ, Pukkala E, et al. Malignancies in patients with inflammatory bowel disease: a nationwide register study in Finland. Scand J Gastroenterol. 2013;48(12):1405-13.
  • 36. Schneider V, Kay S, Lee HM. Immunosuppression as a high-risk factor in the development of condyloma acuminatum and squamous neoplasia of the cervix. Acta Cytol. 1983;27(3):220-4.
  • 37. Welner SL. Screening issues in gynecologic malignancies for women with disabilities: critical considerations. J Womens Health. 1998;7(3):281-5.
  • 38. Bernatsky S, Ramsey-Goldman R, Gordon C, et al. Factors associated with abnormal Pap results in systemic lupus erythematosus. Rheumatology (Oxford). 2004;43(11):1386-9.
  • 39. Dreyer L, Faurschou M, Mogensen M, et al. High incidence of potentially virus-induced malignancies in systemic lupus erythematosus: a long-term followup study in a Danish cohort. Arthritis Rheum. 2011;63(10):3032-7.
  • 40. Schiffman M, Kjaer SK. Chapter 2: Natural history of anogenital human papillomavirus infection and neoplasia. J Natl Cancer Inst Monogr. 2003(31):14-9.
  • 41. Bartnik P, Wielgoś A, Kacperczyk-Bartnik J, et al. Evaluation of reproductive health in female patients with multiple sclerosis in Polish population. J Clin Neurosci. 2018;53:117-21.
  • 42. Garland SM, Brotherton JML, Moscicki AB, et al. HPV vaccination of immunocompromised hosts. Papillomavirus Res. 2017;4:35-8.

MULTİPL SKLEROZ HASTALARINDA SERVİKAL DİSPLAZİ RİSKİ

Year 2023, Volume: 24 Issue: 4, 493 - 499, 09.10.2023
https://doi.org/10.18229/kocatepetip.1230125

Abstract

AMAÇ: Bu çalışmada, Multipl Skleroz (MS) hastalığının servikal displazi gelişimi ile ilişkisini araştırmayı amaçladık.
GEREÇ VE YÖNTEM: Bu çalışma üçüncü basamak sağlık merkezinde MS hastalığı nedeniyle takip edilen 18- 65 yaş arası 62 hasta ve 200 kontrol grubu olmak üzere, toplam 262 hastayı içeren, retrospektif bir vaka kontrol çalışmasıdır. Çalışma için, birincil sonuç ölçütü, MS hastalarındaki servikal displazi sıklığının belirlenmesi ve MS hastalığının Pap- smear sonucuna etkisinin olup olmadığının saptanması iken, ikincil sonuç ölçütü, MS hastalığı için kullanılan iki farklı tedavi tipi olan, immunomodülatör ve immunsupresif tedavinin ve hastalık süresinin, Pap smear sonuçları ile ilişkisinin belirlenmesi idi.
BULGULAR: MS hastaları ile kontrol grubu arasında, Pap smear sonuçları arasındaki fark anlamlı değildi (p=0.938). MS hastaları ve kontrol grubunda, en sık tespit edilen Pap smear test sonucu, inflamasyon olarak bulundu (MS grubu: %61,9; kontrol grubu: %63) MS tedavisi için, immunomodülatör ve immunsupresör ilaç kullanan hastalar arasında, Pap smear sonuçları arasındaki fark anlamlı değildi (p=0.988). Yaş ve kullanılan ilaçlar Pap smear sonucunu predikte etmedi (p=0.316).
SONUÇ: MS hastalarında, en sık Pap smear değişikliği inflamasyondur. Hastalığın süresi ve tedavide kullanılan ilaç tipi ile, Pap smear sonuçları arasındaki ilişkiyi anlamak için daha fazla çalışma yapılması gerekir.

References

  • 1. Parkin DM, Bray F. Chapter 2: The burden of HPV-related cancers. Vaccine. 2006;24:11-25.
  • 2. Walboomers JM, Jacobs MV, Manos MM, et al. Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol. 1999;189(1):12-9.
  • 3. International Collaboration of Epidemiological Studies of Cervical Cancer. Comparison of risk factors for invasive squamous cell carcinoma and adenocarcinoma of the cervix: collaborative reanalysis of individual data on 8,097 women with squamous cell carcinoma and 1,374 women with adenocarcinoma from 12 epidemiological studies. Int J Cancer. 2007;120(4):885-91.
  • 4. Yim EK, Park JS. The role of HPV E6 and E7 oncoproteins in HPV-associated cervical carcinogenesis. Cancer Res Treat. 2005;37(6):319-24.
  • 5. Safaeian M, Solomon D, Castle PE. Cervical cancer prevention--cervical screening: science in evolution. Obstet Gynecol Clin North Am. 2007;34(4):739-60.
  • 6. Wallin MT, Culpepper WJ, Campbell JD, et al. The prevalence of MS in the United States: A population-based estimate using health claims data. Neurology. 2019;92(10):1029-40.
  • 7. Goodin DS. The epidemiology of multiple sclerosis: insights to disease pathogenesis. Handb Clin Neurol. 2014;122:231-66.
  • 8. Lublin FD, Reingold SC, Cohen JA, et al. Defining the clinical course of multiple sclerosis: the 2013 revisions. Neurology. 2014;83(3):278-86.
  • 9. Berkovich R. Treatment of acute relapses in multiple sclerosis. Neurotherapeutics. 2013;10(1):97-105.
  • 10. Uludüz D, Saip S, Siva A. Multipl skleroz’da uzun süreli koruyucu tedaviler. Nöropsikiyatri Arşivi. 2008;45:26-36.
  • 11. Vargas DL, Tyor WR. Update on disease-modifying therapies for multiple sclerosis. J Investig Med. 2017;65(5):883-91.
  • 12. Satmary W, Holschneider CH, Brunette LL, Natarajan S. Vulvar intraepithelial neoplasia: Risk factors for recurrence. Gynecol Oncol. 2018;148(1):126-31.
  • 13. Sager R, Frei P, Steiner UC, Fink D, Betschart C. Genital Dysplasia and Immunosuppression: Why Organ-Specific Therapy Is Important. Inflamm Intest Dis. 2019;4(4):154-60.
  • 14. Grulich AE, van Leeuwen MT, Falster MO, Vajdic CM. Incidence of cancers in people with HIV/AIDS compared with immunosuppressed transplant recipients: a meta-analysis. Lancet. 2007;370(9581):59-67.
  • 15. Reusser NM, Downing C, Guidry J, Tyring SK. HPV Carcinomas in Immunocompromised Patients. J Clin Med. 2015;4(2):260-81.
  • 16. Moscicki AB, Schiffman M, Kjaer S, Villa LL. Chapter 5: Updating the natural history of HPV and anogenital cancer. Vaccine. 2006;24:S3/42-51.
  • 17. Allegretti JR, Barnes EL, Cameron A. Are patients with inflammatory bowel disease on chronic immunosuppressive therapy at increased risk of cervical high-grade dysplasia/cancer? A meta-analysis. Inflamm Bowel Dis. 2015;21(5):1089-97.
  • 18. Zard E, Arnaud L, Mathian A, et al. Increased risk of high grade cervical squamous intraepithelial lesions in systemic lupus erythematosus: A meta-analysis of the literature. Autoimmun Rev. 2014;13(7):730-5.
  • 19. Wadström H, Frisell T, Sparén P, Askling J. Do RA or TNF inhibitors increase the risk of cervical neoplasia or of recurrence of previous neoplasia? A nationwide study from Sweden. Ann Rheum Dis. 2016;75(7):1272-8.
  • 20. Marrie RA, Reider N, Cohen J, et al. A systematic review of the incidence and prevalence of cancer in multiple sclerosis. Mult Scler. 2015;21(3):294-304.
  • 21. Dugué PA, Rebolj M, Hallas J, et al. Risk of cervical cancer in women with autoimmune diseases, in relation with their use of immunosuppressants and screening: population-based cohort study. Int J Cancer. 2015;136(6):711-9.
  • 22. Kim SC, Glynn RJ, Giovannucci E, et al. Risk of high-grade cervical dysplasia and cervical cancer in women with systemic inflammatory diseases: a population-based cohort study. Ann Rheum Dis. 2015;74(7):1360-7.
  • 23. Skare TL, da Rocha BV. [Breast and cervical cancer in patients with systemic lupus erythematosus]. Rev Bras Ginecol Obstet. 2014;36(8):367-71.
  • 24. Foster E, Malloy MJ, Jokubaitis VG, et al. Increased risk of cervical dysplasia in females with autoimmune conditions-Results from an Australia database linkage study. PLoS One. 2020;15(6):e0234813.
  • 25. Cirpan T, Guliyeva A, Onder G, et al. Comparison of human papillomavirus testing and cervical cytology with colposcopic examination and biopsy in cervical cancer screening in a cohort of patients with Sjogren's syndrome. Eur J Gynaecol Oncol. 2007;28(4):302-6.
  • 26. Schmidt RE, Grimbacher B, Witte T. Autoimmunity and primary immunodeficiency: two sides of the same coin? Nat Rev Rheumatol. 2017;14(1):7-18.
  • 27. Bernatsky S, Ramsey-Goldman R, Clarke AE. Malignancy in systemic lupus erythematosus: what have we learned? Best Pract Res Clin Rheumatol. 2009;23(4):539-47.
  • 28. Klumb EM, Araújo ML, Jr., Jesus GR, et al. Is higher prevalence of cervical intraepithelial neoplasia in women with lupus due to immunosuppression? J Clin Rheumatol. 2010;16(4):153-7.
  • 29. Nath R, Mant C, Luxton J, et al. High risk of human papillomavirus type 16 infections and of development of cervical squamous intraepithelial lesions in systemic lupus erythematosus patients. Arthritis Rheum. 2007;57(4):619-25.
  • 30. Kiss E, Kovacs L, Szodoray P. Malignancies in systemic lupus erythematosus. Autoimmun Rev. 2010;9(4):195-9.
  • 31. Nguyen ML, Flowers L. Cervical cancer screening in immunocompromised women. Obstet Gynecol Clin North Am. 2013;40(2):339-57.
  • 32. Hemmer B, Kerschensteiner M, Korn T. Role of the innate and adaptive immune responses in the course of multiple sclerosis. Lancet Neurol. 2015;14(4):406-19.
  • 33. Cools N, Ponsaerts P, Van Tendeloo VF, et al. Regulatory T cells and human disease. Clin Dev Immunol. 2007;2007:89195.
  • 34. Beyaert R, Beaugerie L, Van Assche G, et al. Cancer risk in immune-mediated inflammatory diseases (IMID). Mol Cancer. 2013;12(1):98.
  • 35. Jussila A, Virta LJ, Pukkala E, et al. Malignancies in patients with inflammatory bowel disease: a nationwide register study in Finland. Scand J Gastroenterol. 2013;48(12):1405-13.
  • 36. Schneider V, Kay S, Lee HM. Immunosuppression as a high-risk factor in the development of condyloma acuminatum and squamous neoplasia of the cervix. Acta Cytol. 1983;27(3):220-4.
  • 37. Welner SL. Screening issues in gynecologic malignancies for women with disabilities: critical considerations. J Womens Health. 1998;7(3):281-5.
  • 38. Bernatsky S, Ramsey-Goldman R, Gordon C, et al. Factors associated with abnormal Pap results in systemic lupus erythematosus. Rheumatology (Oxford). 2004;43(11):1386-9.
  • 39. Dreyer L, Faurschou M, Mogensen M, et al. High incidence of potentially virus-induced malignancies in systemic lupus erythematosus: a long-term followup study in a Danish cohort. Arthritis Rheum. 2011;63(10):3032-7.
  • 40. Schiffman M, Kjaer SK. Chapter 2: Natural history of anogenital human papillomavirus infection and neoplasia. J Natl Cancer Inst Monogr. 2003(31):14-9.
  • 41. Bartnik P, Wielgoś A, Kacperczyk-Bartnik J, et al. Evaluation of reproductive health in female patients with multiple sclerosis in Polish population. J Clin Neurosci. 2018;53:117-21.
  • 42. Garland SM, Brotherton JML, Moscicki AB, et al. HPV vaccination of immunocompromised hosts. Papillomavirus Res. 2017;4:35-8.
There are 42 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences
Journal Section Articles
Authors

Özlem Kayacık Günday 0000-0002-9249-679X

Gökçe Zeytin Demiral 0000-0002-9635-5804

Şerafettin Baysal 0000-0003-3647-020X

Tacettin Sevim 0000-0002-9778-0466

Selin Yoldaş 0000-0002-3229-802X

Berkay Çelebi 0000-0003-1154-4356

Ensar Çam 0000-0003-3360-660X

Publication Date October 9, 2023
Acceptance Date May 10, 2023
Published in Issue Year 2023 Volume: 24 Issue: 4

Cite

APA Kayacık Günday, Ö., Zeytin Demiral, G., Baysal, Ş., Sevim, T., et al. (2023). MULTİPL SKLEROZ HASTALARINDA SERVİKAL DİSPLAZİ RİSKİ. Kocatepe Tıp Dergisi, 24(4), 493-499. https://doi.org/10.18229/kocatepetip.1230125
AMA Kayacık Günday Ö, Zeytin Demiral G, Baysal Ş, Sevim T, Yoldaş S, Çelebi B, Çam E. MULTİPL SKLEROZ HASTALARINDA SERVİKAL DİSPLAZİ RİSKİ. KTD. October 2023;24(4):493-499. doi:10.18229/kocatepetip.1230125
Chicago Kayacık Günday, Özlem, Gökçe Zeytin Demiral, Şerafettin Baysal, Tacettin Sevim, Selin Yoldaş, Berkay Çelebi, and Ensar Çam. “MULTİPL SKLEROZ HASTALARINDA SERVİKAL DİSPLAZİ RİSKİ”. Kocatepe Tıp Dergisi 24, no. 4 (October 2023): 493-99. https://doi.org/10.18229/kocatepetip.1230125.
EndNote Kayacık Günday Ö, Zeytin Demiral G, Baysal Ş, Sevim T, Yoldaş S, Çelebi B, Çam E (October 1, 2023) MULTİPL SKLEROZ HASTALARINDA SERVİKAL DİSPLAZİ RİSKİ. Kocatepe Tıp Dergisi 24 4 493–499.
IEEE Ö. Kayacık Günday, G. Zeytin Demiral, Ş. Baysal, T. Sevim, S. Yoldaş, B. Çelebi, and E. Çam, “MULTİPL SKLEROZ HASTALARINDA SERVİKAL DİSPLAZİ RİSKİ”, KTD, vol. 24, no. 4, pp. 493–499, 2023, doi: 10.18229/kocatepetip.1230125.
ISNAD Kayacık Günday, Özlem et al. “MULTİPL SKLEROZ HASTALARINDA SERVİKAL DİSPLAZİ RİSKİ”. Kocatepe Tıp Dergisi 24/4 (October 2023), 493-499. https://doi.org/10.18229/kocatepetip.1230125.
JAMA Kayacık Günday Ö, Zeytin Demiral G, Baysal Ş, Sevim T, Yoldaş S, Çelebi B, Çam E. MULTİPL SKLEROZ HASTALARINDA SERVİKAL DİSPLAZİ RİSKİ. KTD. 2023;24:493–499.
MLA Kayacık Günday, Özlem et al. “MULTİPL SKLEROZ HASTALARINDA SERVİKAL DİSPLAZİ RİSKİ”. Kocatepe Tıp Dergisi, vol. 24, no. 4, 2023, pp. 493-9, doi:10.18229/kocatepetip.1230125.
Vancouver Kayacık Günday Ö, Zeytin Demiral G, Baysal Ş, Sevim T, Yoldaş S, Çelebi B, Çam E. MULTİPL SKLEROZ HASTALARINDA SERVİKAL DİSPLAZİ RİSKİ. KTD. 2023;24(4):493-9.

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