November 25, 2020

Pilot study will explore why Black women with lupus are more prone to HPV-led progression into cervical cancer

Dr. Patricia Dhar
J. Patricia Dhar, M.D.

Black women with lupus have a higher risk of cervical cancer, and are more likely die from the disease than women of other races. However, a new pilot project by Wayne State University School of Medicine Professor J. Patricia Dhar, M.D., and her co-investigators from WSU’s C.S. Mott Center for Human Growth and Development, Ascension St. John Hospital and the University of Michigan, could change those odds for the better.

Dr. Dhar and her collaborators were awarded the Physician Investigator Research Award grant from BCBSM Foundation, worth up to $10,000 in support of a novel pilot study to look at human papilloma virus infection and cervical cancer in Black women with systemic lupus erythematosus, or SLE.

Lupus an autoimmune disease in which the body's immune system mistakenly attacks healthy tissue in the body.

Black women bear significant disease burdens with increased morbidity and mortality for both SLE and cervical cancer, which is caused by HPV. Little is known about the biology and genetics of HPV infection and subsequent development of HPV-related cervical disease in women with SLE. The project will pilot a systematic approach and methodology to study the biology and genetics of HPV infection using a self-inserted vaginal brush to obtain cell samples that will be tested for HPV genetic information, gene activation of local inflammatory factors, or cytokines, in the vagina, and cervical cytopathology.

The researchers believe the system will be a more efficient, less invasive and more patient-friendly method of obtaining cells from the cervix for cancer screening and HPV testing compared to the traditional gynecologic exam and Pap smear. “In addition, more broadly, this self-sampling method could improve monitoring for cervical neoplasia and HPV infection in high-risk and underserved populations by making testing more accessible and convenient for patients,” Dr. Dhar said. “The study will pave the way for developing an effective cervical health monitoring program for African American women with SLE.”

Dr. Dhar and her co-investigators previously showed that cervical neoplasia is increased in women with SLE, and that HPV infection is both increased and latent in the same group.

The pilot study may help determine the reasons why Black women with SLE are more prone to HPV infection and progression to cervical cancer.

“I am ecstatic to be funded after working toward this goal for years. But this is hopefully just the beginning to developing a large program for cervical health in African American women with SLE in the Detroit area,” Dr. Dhar said.

Dr. Dhar directs the Rheumatology Fellowship Program at Ascension St. John Hospital.

“Women with SLE have a weak immune system, which makes them more susceptible to infection and makes it more difficult to get rid of any HPV infection of the cervix. This study will help us understand the biology, genetics and immunology of HPV infection of the cervix in African American women with SLE,” she added.

Her work focuses on cervical health in women with SLE and studying the biology of HPV infection and progression to cervical cancer in these high-risk women. There are no specific clinical recommendations for women with SLE, despite an increased risk for cervical neoplasia. And, Pap smear testing requires an invasive examination by a trained health care professional in an office setting. “This becomes an issue for underserved populations that have social barriers and other circumstances that prevent compliance with this type of preventive health care,” Dr. Dhar said. “A self-sampling brush would definitely make HPV and cervical cancer screening more accessible and more convenient for patients, and allow for frequent monitoring. In addition, since cervical cancer and HPV-related diseases are preventable through vaccination, women who are at high risk for these diseases should consider getting the HPV vaccine as part of their health prevention.”

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