Risk of HPV-associated precancer and cancer in women with systemic lupus erythematosus

Objectives: We aimed to compare the occurrence of human papillomavirus (HPV)-associated precancer and cancer in a nationwide cohort of women with systemic lupus erythematosus (SLE) with general female population rates. Methods: In the nationwide Patient Registry, we identified all women in Denmark with a first diagnosis of SLE recorded during 1996-2021 (N = 5092). The cohort was followed up in nationwide registries for HPV-associated precancer and cancer until 2022. Standardised incidence ratios (SIRs) were computed with 95% CIs overall and stratified by age at SLE diagnosis and follow-up time. Results: Compared with general population rates, women with SLE had increased rates of cervical (SIR, 2.3; 95% CI, 2.0-2.7), vaginal (SIR, 4.3; 95% CI, 1.1-9.5), vulvar (SIR, 3.7; 95% CI, 2.3-5.5), and anal (SIR, 4.3; 95% CI, 1.7-8.1) precancers. Increased cancer rates were observed for cervix, anus, and oropharynx, but only the SIR for oropharyngeal cancer was near statistical significance (SIR, 2.5; 95% CI, 0.9-4.9). The increased SIRs for precancers and cancers sustained throughout follow-up and were higher in women diagnosed with SLE at age <50 years compared with ≥50 years, but CIs were overlapping. Conclusions: Women in this nationwide SLE cohort had twice the risk of cervical precancer (vs the general population) and up to 5-fold increased risk of the individual noncervical anogenital precancers. Rates of oropharyngeal cancer and the anogenital cancers were not statistically significantly increased; however, estimates were based on few cases.