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Rheumatoid arthritis receiving biologic and conventional immunosuppression — DFSRH MCQ

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EasyImmunosuppressionRheumatoid arthritis receiving biologic and conventional immunosuppressionDFSRH

A 38-year-old woman in England attends for a routine contraceptive review. She has rheumatoid arthritis treated with methotrexate 15 mg once weekly and adalimumab. Her cervical screening sample in September 2025 was negative for high-risk human papillomavirus, and she has never had an abnormal screening result or cervical intraepithelial neoplasia. She has no history of HIV or multifocal HPV-related disease and reports no postcoital bleeding, intermenstrual bleeding or abnormal vaginal discharge. Her next NHS Cervical Screening Programme invitation is scheduled for September 2030. She is concerned that immunosuppression places her at increased risk of cervical cancer and asks whether she requires additional screening. Which is the most appropriate management?

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Correct answer: A — Continue cervical screening at routine recall in September 2030 and reinforce the importance of attendance

The correct management is to continue routine programme recall. Although immunosuppressive drugs can increase susceptibility to acquisition or persistence of high-risk HPV, NHS Cervical Screening Programme guidance does not recommend intensified surveillance solely because a person receives cytotoxic treatment for rheumatological disease or a biologic agent. This patient is asymptomatic, has a complete screening history, was high-risk HPV-negative, and has no previous CIN, HIV or multifocal HPV-related disease. In England, people aged 25–64 with a routine primary high-risk HPV-negative result are generally recalled at 5 years; her September 2030 recall is therefore appropriate. Annual screening is used for people with HIV, not routinely for other forms of pharmacological immunosuppression. A 3-year recall may apply after a recent high-risk HPV-positive result, which she has not had. An additional unscheduled sample provides no established benefit and may be rejected by the screening laboratory when taken outside programme protocols. Colposcopy is not indicated without an abnormal screening result, a clinically suspicious cervix, relevant symptoms or specialist surveillance for multifocal disease. The key intervention is to reinforce attendance when invited rather than increasing screening frequency.

Reference: Screening and management of immunosuppressed individuals (9 July 2025) — https://www.gov.uk/government/publications/cervical-screening-programme-and-colposcopy-management/5-screening-and-management-of-immunosuppressed-individuals Introduction and programme policy (9 July 2025) — https://www.gov.uk/government/publications/cervical-screening-programme-and-colposcopy-management/1-introduction-and-programme-policy Guidance for acceptance of cervical screening samples in laboratories and pathways, roles and responsibilities (2025) — https://www.gov.uk/government/publications/cervical-screening-accepting-samples-in-laboratories/guidance-for-acceptance-of-cervical-screening-samples-in-laboratories-and-pathways-roles-and-responsibilities