RA Patients Get Cancer Screens, May Need More

• Arthritis • • Cancer • • Rheumatic Diseases • Jul 10, 12

Patients with rheumatoid arthritis (RA) are receiving the recommended cancer screening tests, but the recommendations may not be adequate for these patients, researchers reported.

Compared with controls, women with RA were more likely to have had a Pap smear (HR 1.21, 95% CI 1.17 to 1.24), a mammogram (HR 1.49, 95% CI 1.45 to 1.53), and a colonoscopy (HR 1.69, 95% CI 1.61 to 1.77), according to Seoyoung C. Kim, MD, and colleagues from Brigham and Women’s Hospital in Boston.

However, “given the increased risk of some cancers in RA and concerns in the association between various types of RA treatment and malignancy, it may be worth investigating the effectiveness of current cancer screening guidelines in patients with RA and in subgroups on specific treatments,” Kim and colleagues wrote online in Arthritis & Rheumatism.

Some previous studies have suggested that patients with chronic conditions, including RA, receive less-than-adequate preventive care, while at least one study found similar rates of cancer screening.

To clarify this—particularly in light of the recognized fact that RA patients have a shortened life expectancy—the researchers conducted an analysis of administrative claims data from a commercial health plan and a Medicare cohort during the years 2001 through 2008.

Patients were classified as having RA if they had two visits coded for the disease and had at least one prescription for a disease-modifying anti-rheumatic drug.

Two comparator groups were also included. One consisted simply of adults who had never had a diagnosis of RA, while the second included patients with hypertension, to compare rates of screening for patients with another chronic disease.

Variables included age and sex, comorbidities such as myocardial infarction, diabetes, and renal disease, as well as utilization of healthcare resources.

The cohort included 13,314 RA patients, 131,989 non-RA controls, and 80,335 hypertensive controls.

The mean ages of the three groups were 52, 48, and 61 years, respectively. Mean follow-up was slightly over 2 years.

A greater proportion of the RA group were women, and they had more comorbidities and physician visits than the non-RA controls, while the hypertensive group had the most comorbidities and inpatient stays.

The researchers calculated that if screening rates stayed the same, 70% to 80% of women in all three groups would have a Pap test once every 3 years.

Among women 40 and older, 70% of those with RA would have a mammogram every other year, as would 60% of the non-RA and hypertension groups.

Among individuals 50 and older, 70% of the RA and non-RA groups and 61% of the hypertension group would have a colonoscopy once during a 10-year period.

Men with RA were more likely to have undergone a colonoscopy compared with non-RA men (HR 1.52, 95% CI 1.40 to 1.64).

However, when patients with RA were compared with hypertensive patients, no differences were seen in screening:

Pap smear, HR 1.04 (95% CI 1 to 1.07)
Mammography, HR 0.98 (95% CI 0.95 to 1.01)
Colonoscopy for men, HR 0.97 (95% CI 0.89 to 1.05)
Colonoscopy for women, HR 0.87 (95% CI 0.82 to 0.92)

The results of these analyses suggest that patients with RA are receiving the screening tests recommended for the general population, and at similar rates compared with those having a different chronic disease.

Further work is needed to determine the optimal screening approaches for patients with RA, the researchers concluded.

“Continuous efforts should be made to improve and maintain both patients’ and physicians’ awareness of the importance of preventive health services in patients with chronic disease such as RA,” they stated.

Limitations of the study included its reliance on claims data, which means the results may differ among patients lacking health insurance, and the possibility of diagnostic misclassification.

The lead author has received support from the National Institutes of Health as well as from Pfizer and Takeda Pharmaceuticals.

Co-authors disclosed receiving support from the Agency for Healthcare Research and Quality, FDA, WHISCON, Booz & Company, Novartis, Boehringer Ingelheim, Abbott, Amgen, Lilly, and Bristol-Myers Squibb.

Primary source: Arthritis & Rheumatism
Source reference: Kim S, et al “Cancer screening rates in patients with rheumatoid arthritis: no different than the general population” Arthritis Rheum 2012; DOI:10.1002/art.34542.