Guidelines for Cervical Cancer Screening in Immunosuppressed Women Without HIV Infection

Area of Science:

• Gynecology
• Oncology
• Immunology

Background:

• Immunosuppressant therapy improves outcomes but increases long-term risks for cervical neoplasia and cancer.
• Cervical cancer (CC) screening guidelines for non-HIV immunocompromised women lack robust evidence.
• HIV-infected women have established CC screening guidelines due to improved treatments and life expectancy.

Purpose of the Study:

• To summarize knowledge on CC, squamous intraepithelial lesions, and HPV infection in non-HIV immunocompromised women.
• To determine best practices for CC surveillance in this population.
• To provide evidence-based recommendations for CC screening.

Main Methods:

• Panel of healthcare professionals reviewed existing literature.
• Literature searches focused on CC, cervical dysplasia, HPV, and immunosuppression types.
• Articles published within 10 years were prioritized; expert opinion guided recommendations.

Main Results:

• Solid organ transplant recipients show a consistent increase in cervical neoplasia and CC risk.
• Hematopoietic stem cell transplant patients may have an increased CC risk, though data is conflicting.
• Inflammatory bowel disease patients on immunosuppressants, and those with systemic lupus erythematosus or rheumatoid arthritis on immunosuppressants, have increased CC risk.

Conclusions:

• Solid organ transplant and hematopoietic stem cell transplant recipients should follow CC screening guidelines for HIV-infected women.
• Women with inflammatory bowel disease on immunosuppressants, systemic lupus erythematosus, or rheumatoid arthritis on immunosuppressants require intensified screening.
• Women with type 1 diabetes mellitus should follow general population CC screening guidelines due to lack of evidence for increased risk.