Risk of cervical pre-cancer and cancer in women with multiple sclerosis exposed to high efficacy disease modifying therapies

Francesca Bridge; Julia M L Brotherton; Yi Foong; Helmut Butzkueven; Vilija G Jokubaitis; Anneke Van der Walt

doi:10.3389/fneur.2023.1119660

Risk of cervical pre-cancer and cancer in women with multiple sclerosis exposed to high efficacy disease modifying therapies

Front Neurol. 2023 Feb 10:14:1119660. doi: 10.3389/fneur.2023.1119660. eCollection 2023.

Authors

Francesca Bridge^{1

2}, Julia M L Brotherton^{3

4}, Yi Foong^{1

2

5}, Helmut Butzkueven^{1

2}, Vilija G Jokubaitis^{1

2}, Anneke Van der Walt^{1

2}

Affiliations

¹ Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia.
² Department of Neurology, Alfred Health, Melbourne, VIC, Australia.
³ Australian Centre for the Prevention of Cervical Cancer (Formerly Victorian Cytology Service), Carlton South, VIC, Australia.
⁴ Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
⁵ Department of Neurosciences, Eastern Health, Melbourne, VIC, Australia.

Abstract

There is a growing need to better understand the risk of malignancy in the multiple sclerosis (MS) population, particularly given the relatively recent and widespread introduction of immunomodulating disease modifying therapies (DMTs). Multiple sclerosis disproportionately affects women, and the risk of gynecological malignancies, specifically cervical pre-cancer and cancer, are of particular concern. The causal relationship between persistent human papillomavirus (HPV) infection and cervical cancer has been definitively established. To date, there is limited data on the effect of MS DMTs on the risk of persistent HPV infection and subsequent progression to cervical pre-cancer and cancer. This review evaluates the risk of cervical pre-cancer and cancer in women with MS, including the risk conferred by DMTs. We examine additional factors, specific to the MS population, that alter the risk of developing cervical cancer including participation in HPV vaccination and cervical screening programs.

Keywords: autoimmune disease (AID); cervical cancer; disease modifying therapy (DMT); human papilloma virus (HPV); multiple sclerosis (MS).

Publication types

Review