0939: Pilot Study: A Novel Method for Cervical Health Monitoring in African American Women with Systemic Lupus Erythematosus (SLE) Using a Self- Sampling Brush to Assess Cervical HPV Infection and Cervical Cytology

J. Patricia Dhar¹, Heather Walline², Lamia Fathallah³, Susanna Szpunar⁴, Louis Saravolatz⁵, Gil Mor⁶ and Thomas Carey⁷, ¹Ascension St. John Hospital and Wayne State University School of Medicine, Bloomfield Hills, MI, ²University of Michigan, Ann Arbor, MI, ³Ascension St.John Hospital, Detroit, MI, ⁴Ascension St. John Hospital, Grosse Pointe Woods, MI, ⁵Ascension St John Hospital and Medical Center, Wayne State University School of Medicine (affiliate), Grosse Pointe Woods, MI, ⁶Wayne State University and C.S. Mott Center for Human Growth and Development., Detroit, MI, ⁷University of Michigan School of Medicine, Ann Arbor, MI

Background/Purpose: A health disparity exists for AA women with SLE who have increased morbidity & mortality from both cervical cancer & SLE. Current cervical cancer screening guidelines are inadequate for these women who need frequent monitoring. We pilot tested a self-sampling brush to obtain cervical cytology & study HPV genetics to develop a less expensive & more convenient way to make cervical cancer screening more accessible for these high risk women

Methods: 30 AA women with SLE recruited from the Rheumatology clinics consented to participate in the study (IRB approved by Ascension St. John Hospital IRB). Inclusion criteria: AA women with SLE, ages 18-50 years, able to consent and obtain vaginal self sampling. Exclusion criteria: current pregnancy, & not meeting inclusion criteria. Clinical information was obtained by records review & interviewing the patient, & surveys administered to assess cervical health information, knowledge of HPV, and satisfaction with using the self sampling brush. Vaginal self sampling by the participant was performed after instruction & the brush immersed in an RNA-stable ThinPrep vial. Hologic ThinPrep automated processor was used for slide preparation & cytology read by a board-certified cytopathologist. HPV DNA &RNA were extracted, & samples were frozen at -80 ⁰C for further analysis.

Results: All patients met established criteria for SLE: mean age =36.9 yrs., 40% had lupus nephritis, & all treated with chronic immunosuppressives [Table 1]. Two thirds had a history of abnormal pap smear ranging from atypical squamous sells of undermined significance (ASCUS) to high grade squamous intra-epithelial lesion (HSIL)/cervical intra-epithelial lesion 3 (CIN 3); 7 had a cervical biopsy & 6 underwent a surgical procedure for abnormal cytology or genital warts. HPV test results were available in 43% of which 8 were positive.Most participants had sexually transmitted diseases other than HPV, were not vaccinated for HPV, had multiple lifetime sex partners, did not smoke, & did not use condoms. The average time to last pap smear was 3.2 yrs.[Table 2] Most had knowledge that HPV can cause cervical cancer, but were unaware of HPV causing oral & genital cancers & warts. Most felt the device was easy to use, comfortable, & preferred it for over traditional pap smear. [Table 3].Cytology samples obtained from the brush showed preservation of morphology, but quality indicators were generally absent with abnormal findings in 4/30 : 3=low grade squamous intra-epithelial lesion (LSIL) and 1=ASCUS. Participants were notified of abnormal results & advised to see a gynecologist.

Conclusion: Our high risk cohort had histories of adverse cervical health, yet lacked knowledge about the spectrum of HPV related genital & oral disease & were not following health prevention strategies to reduce their risk with HPV vaccination and condoms. Cervical cytology can be performed using a brush self sampling method of collection. This study highlights the need for cervical health education, increased monitoring & intervention in these high risk women.
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Disclosures: J. Dhar, None; H. Walline, None; L. Fathallah, None; S. Szpunar, None; L. Saravolatz, None; G. Mor, None; T. Carey, None.