Study Highlights Cancer Screening Gaps Among Patients With Rheumatoid Arthritis

A recent investigation presented at the American College of Rheumatology aimed to determine the completion rates for breast, cervical, prostate, and colorectal cancer screenings in patients with rheumatoid arthritis (RA) compared to individuals without RA. The study also examined the influence of demographics and health behaviors on screening rates.

The study, conducted in southeastern Minnesota, included 1614 patients with RA and 1597 matched non-RA individuals based on age, sex, and county of residence. Participants were identified using the 1987 ACR or 2010 ACR/EULAR classification criteria, with additional inclusion criteria for patients with pre-existing RA. Cancer screening adherence was evaluated using guidelines from the United States Preventive Services Task Force. Completion rates were analyzed using cumulative incidence estimates and adjusted Cox proportional hazard models to account for variables such as age, race, and competing risks of death.

The study revealed notable disparities in cancer screening rates among patients with RA: 

• Cervical Cancer Screening: patients with RA were 18% more likely to experience delays in cervical cancer screening compared to non-RA individuals (adjusted hazard ratio [aHR], 0.82; 95% CI, 0.71–0.95). After 5 years, only 51.6% of patients with RA had completed cervical cancer screening compared to 58.2% of those without RA. 
• Breast Cancer Screening:  Obesity emerged as a significant factor influencing breast cancer screening rates. Obese patients with RA had the highest screening rates compared to both nonobese patients with RA and their non-RA counterparts. A statistically significant interaction (p=0.009) was observed between obesity and RA status, suggesting that obesity may mitigate screening delays in patients with RA.
• Prostate and Colorectal Cancer Screening: No significant differences were found in completion rates for prostate and colorectal cancer screenings between RA and non-RA groups.
• Demographic and Behavioral Influences:  The study identified a greater disparity in cervical cancer screening rates among White and non-White individuals without RA compared to those with RA (interaction p=0.044). This suggests that RA may reduce some racial disparities in screening adherence.
• COVID-19 Impact: Analyses during the COVID-19 pandemic showed that patients with RA were not disproportionately affected in their cancer screening completion, despite overall disruptions to health care services.

The findings underscore the need for targeted efforts to improve cervical cancer screening in patients with RA, particularly given RA's association with increased cancer-related mortality. Primary care providers and rheumatologists should emphasize adherence to screening guidelines to address this gap. The high breast cancer screening rates in obese patients with RA may offer insights for improving overall adherence. 

This study highlights the critical role of cancer screening in mitigating excess mortality in patients with RA and calls for coordinated strategies to ensure equitable and timely preventive care.

Reference
Brooks R. Investigation of delays in cancer screening in RA. Presented at: American College of Rheumatology. November 14-19, 2024; Washington, DC.