Routine cancer screening in young dermatomyositis patients risks missing most occult malignancies
Keywords:dermatomyositis, malignancy, screening
Purpose: This study was conducted to determine the incidence and types of malignancies in dermatomyositis (DM) patients, focusing on young patients, and to estimate the percentage of cancers missed if only age-appropriate screening is utilized.
Methods: The MarketScan® (MS) Commercial Claims and Encounters database, a collection of private insurance claims data from 53 million Americans, was queried for patients with at least two separate diagnoses of DM by ICD9 code (710.3), separated by at least six months. The MS database was also queried for age-and-gender matched controls without a diagnosis of DM. The types of cancer in the DM and control groups were determined using ICD-9 codes and compared to malignancies screened for by USPSTF and ACS guidelines. Malignancies routinely screened vs those not routinely screened in the DM and control groups were compared using an odds ratio.
Results: 632 DM cases were identified across all age groups. 302 DM patients were over 50 years old with 89 malignancies identified. 55% of these cancers occurred in organs not routinely screened. 330 patients were under 50 years old with 28 malignancies identified. 100% of these cancers occurred in organs not routinely screened for. In both groups, there was a statistically significant increase in malignancies in organs not routinely screened for by ACS/USPSTF guidelines when compared to age-and-gender matched controls.
Conclusions: Our results agree with the well-defined risk for neoplasia with DM and highlight that younger patients with DM have a considerably higher risk of developing a cancer than matched controls, especially in organs not routinely screened. Development of evidence-based guidelines to optimize malignancy screening in adult DM patients of all ages is needed. Broad malignancy screening should include modalities for identifying cancers poorly visualized on traditional imaging, such as ovarian and prostate. Special attention should be given to young DM patients as guidelines undergo development. Overall, our research supports the need for future studies aimed at optimizing malignancy screening in all patients with DM.
Authors retain copyright, simultaneously licensing their works under a Creative Commons Attribution 4.0 International License (CC BY 4.0). That license allows others to share and adapt the work so long as they provide reasonable attribution. This license applies to the submitted version of the work (preprint), the accepted version of the work (postprint), and the final published version.
Ideal attribution for a work published in this journal consists of the work’s title, the title of the journal, the name(s) of the author(s), the DOI (digital object identifier), and a link to the CC BY 4.0 license deed. The journal encourages those relying on the CC BY 4.0 license to consult the Best Practices for Attribution on the Creative Commons wiki.
As they retain copyright, authors are entitled to distribute any version of the article and to grant other licenses to use the work, subject to the CC BY 4.0 license. The journal encourages authors to include the ideal attribution described above when they distribute their works after acceptance by the journal.
Authors are encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and after publication, as it can lead to productive exchanges, as well as earlier and greater citation of published work (see SPARC's "Open Access" article).