No differences in cancer screening rates in patients with rheumatoid arthritis compared to the general population

Authors

  • Seoyoung C. Kim,

    Corresponding author
    1. Brigham and Women's Hospital, Boston, Massachussetts
    • Brigham and Women's Hospital, 1620 Tremont Street, Suite 3030, Boston, MA 02120
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    • Dr. Kim has received research support from Takeda Pharmaceuticals North America and Pfizer.

  • Sebastian Schneeweiss,

    1. Brigham and Women's Hospital, Boston, Massachussetts
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    • Dr. Schneeweiss has received consulting fees from Booz & Company (less than $10,000) and WHISCON, LLC (more than $10,000); he has received research grants from Pfizer, Novartis, and Boehringer Ingelheim.

  • Jessica A. Myers,

    1. Brigham and Women's Hospital, Boston, Massachussetts
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  • Jun Liu,

    1. Brigham and Women's Hospital, Boston, Massachussetts
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  • Daniel H. Solomon

    1. Brigham and Women's Hospital, Boston, Massachussetts
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    • Dr. Solomon has received research support from Abbott Immunology, Amgen, Eli Lilly, and the Consortium of Rheumatology Researchers of North America (CORRONA) and an educational grant from Bristol-Myers Squibb; he serves as an unpaid member of an Executive Committee and a Data Safety Monitoring Board for two analgesic trials sponsored by Pfizer.


Abstract

Objective

Previous study findings have suggested that patients with chronic diseases such as rheumatoid arthritis (RA) do not receive optimal preventive medical services, including cancer screening tests. This study was undertaken to evaluate cancer screening rates in RA patients compared to non-RA control populations.

Methods

Using data from a large US commercial insurance plan, we examined rates of screening tests for cervical, breast, and colon cancer in patients with RA compared to control subjects without RA (non-RA controls) or control subjects with hypertension. Individuals were included in the RA cohort if they had at least 2 visits coded for a diagnosis of RA and had received at least 1 prescription for a disease-modifying antirheumatic drug during the study period. Multivariable Cox proportional hazards models were used to compare the rates of different cancer screening tests between RA patients and non-RA controls.

Results

RA patients (n = 13,314) and control subjects (non-RA and hypertension controls) (n = 212,324) were screened, on average, once every 3 years for cervical cancer and once every 2 years for breast cancer during the followup period (mean 2.3 years of followup). In the age-adjusted Cox regression model, women with RA were more likely to receive ≥1 Papanicolaou smear (hazard ratio [HR] 1.21, 95% confidence interval [95% CI] 1.17–1.24), ≥1 mammogram (HR 1.49, 95% CI 1.45–1.53), and ≥1 colonoscopy (HR 1.69, 95% CI 1.61–1.77) compared to female non-RA control subjects. Men with RA were also more likely to receive at least 1 colonoscopy (HR 1.52, 95% CI 1.40–1.64) than were male non-RA control subjects. These results were robust in multivariable analyses adjusted for age, number of physician visits, percentage of visits made to primary care physicians, and the Charlson Comorbidity Index.

Conclusion

Patients with RA did not appear to be at risk for receiving fewer cancer screening tests when compared to individuals without RA. The majority of both RA patients and non-RA control subjects were screened regularly for cervical, breast, and colon cancer, in accordance with current recommendations.

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