Research ArticleRheumatoid Arthritis
Open Access

Cumulative Incidence of Cancer Screening for Breast, Cervical, Prostate, and Colorectal Cancer in Patients With Rheumatoid Arthritis

Rebecca T. Brooks, Cassondra A. Hulshizer, Andrew C. Hanson, John M. Davis III, Vanessa L. Kronzer, Elena Myasoedova and Cynthia S. Crowson
The Journal of Rheumatology October 2025, 52 (10) 988-996; DOI: https://doi.org/10.3899/jrheum.2025-0190

Article Figures & Data

Figures

  • Figure 1.
    Figure 1.

    Five-year cumulative incidence of cancer screening in RA vs matched non-RA comparators for (A) breast cancer screening, (B) cervical cancer screening, and (C) prostate cancer screening. Non-RA comparators were matched on age, self-identified race, and county. HR: hazard ratio; RA: rheumatoid arthritis.

  • Figure 2.
    Figure 2.

    Adjusted cumulative incidence of completion of cancer screening by year after January 1, 2015, for patients with and without RA according to (A) obesity in breast cancer screening, (B) race in cervical cancer screening, and (C) smoking status in prostate cancer screening. RA: rheumatoid arthritis.

  • Figure 3.
    Figure 3.

    Cumulative incidence of cancer screening in RA vs matched non-RA comparators for colon cancer screening by (A) all methods, (B) imaging (ie, colonoscopy, flexible sigmoidoscopy, and CT colonography), (C) fecal DNA by DNA-FIT, and (D) fecal blood by FIT and gFOBT. Non-RA comparators were matched on age, self-identified race, and county. CT: computed tomography; FIT: fecal immunochemical test; gFOBT: guaiac fecal occult blood test; HR: hazard ratio; RA: rheumatoid arthritis.

Tables

  • Table 1.

    Baseline characteristics of RA and non-RA cohort.

     RA
    n = 1614    		Non-RA
    n = 1597
    Demographics and health indicators
          Age, yrs, mean (SD)63.2 (14.4)63.4 (14.4)
          Female sex, %1152 (71.38)1146 (71.76)
          Race and ethnicity, %
                Non-Hispanic White1485 (92.01)1448 (91.01)
                Hispanic58 (3.59)61 (3.83)
                Black21 (1.30)27 (1.70)
                Asian35 (2.17)32 (2.01)
                American Indian2 (0.12)6 (0.40)
                Hawaiian/Pacific Islander3 (0.19)1 (0.06)
                Other/mixed10 (0.62)16 (1.01)
                Unknown0 (0)6 (0.38)
          Education level, %
                8th grade or less34 (2.11)31 (2.24)
                Some high school56 (3.56)31 (2.24)
                High school/GED438 (27.81)331 (23.97)
                Some college or 2-year degree535 (33.97)438 (31.72)
                4-year college degree226 (14.35)223 (16.15)
                Postgraduate studies286 (18.16)327 (23.68)
                Unknown39 (2.42)216 (13.53)
          Ever smoker, %871 (53.97)746/1596 (46.74)
          BMIa, kg/m2, mean (SD)29.8 (7.2)29.9 (6.9)
          Area Deprivation Index, %  
                1st quartile (1-25)203 (12.62)197 (12.37)
                2nd quartile (26-50)671 (41.70)690 (43.34)
                3rd quartile (51-75)562 (34.93)562 (35.30)
                4th quartile (76-100)173 (10.75)143 (8.98)
                Unknown5 (0.31)5 (0.31)
          Charlson Comorbidity Index, median (IQR)1.0 (0.0-3.0)1.0 (0.0-2.0)
    RA-related factors
                RA durationa, yrs, median (IQR)6.5 (3.1-13.5)NA
                RF and/or anti-CCP positivity, %1028/1462 (70.31)NA
                Medicationsb, %  
                      cDMARDs1100 (68.15)NA
                      b/tsDMARDs302 (18.71)NA
    Cancer-related factors, %
                Breast cancer15/1152 (1.30)27/1146 (2.36)
                Cervical cancer2/1152 (0.17)2/1146 (0.17)
                Prostate cancer10/462 (2.16)18/451 (4)
                Colorectal cancer6/1614 (0.37)6/1597 (0.38)
                Bilateral mastectomy9/1152 (0.78)6/1146 (0.52)

    • Values are n (%) or n/N available (%) unless otherwise noted.

    • ↵a Available n: BMI (n = 1548 in RA, n = 1458 in non-RA); RA duration (n = 1098 in RA).

    • ↵b Prior to and within 5 years of index date. Anti-CCP: anticyclic citrullinated peptide antibody; b/tsDMARD: biologic/targeted synthetic DMARD; cDMARD: conventional DMARD; DMARD: disease-modifying antirheumatic drug; GED: general education development; NA: not applicable; RA: rheumatoid arthritis; RF: rheumatoid factor.

  • Table 2.

    Cumulative incidence of cancer screening in patients with and without RA.

    Cancer
    Screening    		Cumulative Incidence, % (95% CI)aHR (95% CI)a
    RANon-RA
    Breast  0.98 (0.87-1.10)
       1 year62.0 (58.4-65.9)62.9 (59.2-66.7) 
       2 years76.7 (73.5-80.1)76.9 (73.7-80.3) 
       5 years83.4 (80.6-86.4)85.2 (82.4-88.0) 
    Cervical  0.83 (0.72-0.96)
       3 years39.2 (35.6-43.1)43.4 (39.8-47.4) 
       5 years51.6 (47.9-55.6)58.2 (54.5-62.2) 
    Prostate  0.99 (0.74-1.34)
       1 year23.1 (17.6-30.3)24.4 (18.8-31.8) 
       2 years34.1 (27.7-42.0)37.4 (30.8-45.4) 
       5 years51.9 (44.9-60.0)55.6 (48.6-63.7) 
    Colorectal  1.04 (0.93-1.16)
       3 years35.3 (32.5-38.5)35.5 (32.6-38.7) 
       5 years48.9 (45.8-52.1)49.1 (46.1-52.4) 
       8.5 years65.5 (62.5-68.6)65.6 (62.6-68.8) 

    • ↵a aHRs are calculated from the maximum years of follow-up for each cancer screening. aHR: adjusted hazard ratio; RA: rheumatoid arthritis.

  • Table 3.

    Association between patient characteristics and cancer screening in patients with RA and non-RA.

     Cancer Screening
    Breast
    n = 1291    		Cervical
    n = 1326    		Prostate
    n = 346    		Colorectala
    n = 1968
    aHR (95% CI)
    Age (per 10 years)1.01
    (0.92-1.10)    		0.75
    (0.70-0.80)    		1.51
    (1.04-2.20)    		1.28
    (1.17-1.39)
    Male sex–––0.91
    (0.80-1.03)
    Non-White race0.84
    (0.67-1.05)    		0.82
    (0.64-1.04)    		0.65
    (0.33-1.27)    		0.88
    (0.71-1.09)
    Ever smoker0.86
    (0.77-0.97)    		0.81
    (0.69-0.94)    		0.60
    (0.44-0.80)    		0.97
    (0.87-1.09)
    BMI ≥ 30 kg/m21.02
    (0.90-1.15)    		0.97
    (0.83-1.12)    		0.97
    (0.72-1.30)    		1.02
    (0.93-1.17)
    Charlson Comorbidity Index (continuous)1.00
    (0.97-1.03)    		0.95
    (0.90-1.00)    		1.09
    (1.02-1.16)    		1.02
    (0.99-1.05)
    Charlson Comorbidity Index ≥ 21.00
    (0.88-1.15)    		0.77
    (0.63-0.94)    		1.39
    (1.01-1.91)    		0.98
    (0.87-1.11)
    ADI (per 10 points)0.92
    (0.89-0.95)    		0.94
    (0.90-0.97)    		0.93
    (0.86-1.00)    		0.96
    (0.94-0.99)
    ADI (1st quartile)b1.28
    (1.08-1.52)    		1.19
    (0.97-1.47)    		1.42
    (0.95-2.12)    		1.26
    (1.08-1.47)
    ADI (4th quartile)b0.84
    (0.68-1.04)    		0.76
    (0.59-0.99)    		0.73
    (0.42-1.25)    		1.08
    (0.89-1.31)
    Education > high school1.50
    (1.30-1.73)    		1.26
    (1.02-1.55)    		0.86
    (0.61-1.22)    		1.28
    (1.12-1.46)

    • Values in bold are statistically significant.

    • ↵a Includes data through 9/30/2023.

    • ↵b Reference: 2nd and 3rd quartiles combined. ADI: Area Deprivation Index; aHR: adjusted hazard ratio; RA: rheumatoid arthritis.

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Keywords

MORTALITY
PREVENTIVE MEDICINE
RHEUMATOID ARTHRITIS

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