Abstract
Adult-onset idiopathic inflammatory myopathy (IIM) is associated with an increased cancer risk within the 3 years preceding and following IIM onset. Evidence- and consensus-based recommendations for IIM-associated cancer screening can potentially improve outcomes. This International Guideline for IIM-Associated Cancer Screening provides recommendations addressing IIM-associated cancer risk stratification, cancer screening modalities and screening frequency. The international Expert Group formed a total of 18 recommendations via a modified Delphi approach using a series of online surveys. First, the recommendations enable an individual patient's IIM-associated cancer risk to be stratified into standard, moderate or high risk according to the IIM subtype, autoantibody status and clinical features. Second, the recommendations outline a 'basic' screening panel (including chest radiography and preliminary laboratory tests) and an 'enhanced' screening panel (including CT and tumour markers). Third, the recommendations advise on the timing and frequency of screening via basic and enhanced panels, according to risk status. The recommendations also advise consideration of upper or lower gastrointestinal endoscopy, nasoendoscopy and 18F-FDG PET-CT scanning in specific patient populations. These recommendations are aimed at facilitating earlier IIM-associated cancer detection, especially in those who are at a high risk, thus potentially improving outcomes, including survival.
| Original language | English |
|---|---|
| Pages (from-to) | 805-817 |
| Number of pages | 13 |
| Journal | Nature reviews. Rheumatology |
| Volume | 19 |
| Issue number | 12 |
| Early online date | 9 Nov 2023 |
| DOIs | |
| Publication status | Published - 31 Dec 2023 |
Bibliographical note
Funding Information:This Evidence-Based Guideline was developed and conducted under the auspices of the International Myositis Assessment and Clinical Studies Group (IMACS). R.A. conceived the guideline development process. A.G.S.O. carried out survey question design, distribution and response collation. A.G.S.O and R.A. led the preparation of the manuscript, which was critically appraised and amended by all co-authors. All co-authors completed the surveys that led to the formation of the recommendations. The authors would like to acknowledge A.B. Allard, M.D. George, K. Kolstad, D.J.B. Kurtzman and A. Postolova, who provided input on the systematic literature review and meta-analysis, which formed key evidence for the development of the recommendations. The authors would like to acknowledge the invaluable input from three patient partners (two of whom are listed as authors, one of whom opted to remain anonymous) during the guideline planning, development and manuscript writing. The authors thank members of the IMACS Scientific Committee for critical reading of the manuscript. The authors thank H. Kim and I. Pinal Fernández for critical reading of the manuscript and for providing helpful comments as part of the NIH internal review process. This report includes independent research supported by the National Institute for Health Research (NIHR) Biomedical Research Centre Funding Scheme. The views expressed in this publication are those of the authors and not necessarily those of the National Health Service, NIHR or the Department of Health and Social Care. A.G.S.O is supported by funding from the NIHR Clinical Lectureship Scheme. A.G.S.O, H.C., E.J.C., D.G.R.E., L.McW. and P.A.J.C are supported by the NIHR Manchester Biomedical Research Centre (NIHR203308). P.M.M is supported by funding from the NIHR University College London Hospitals Biomedical Research Centre. S.L.T. is supported by funding from the Bath Institute of Rheumatic Diseases. E.J.C. is supported by an NIHR Advanced Fellowship (NIHR300650). This research was supported in part by the Intramural Research Programs of the NIH, National Institute of Environmental Health Sciences (to L.G.R., F.W.M. and A.S.), and National Institute of Arthritis and Musculoskeletal and Skin Diseases (to A.L.M.). J.J.P. is supported by funding from the NIH (K23AR073927). M.V.-D.M. is supported by funding from Fondo de Desarrollo Cientifico (FODECIJAL) 2019 from Consejo Estatal de Ciencia y Tecnología de Jalisco (COECYTJAL, 1702512-8152). J.V. is supported by funding from the Czech Ministry of Health — Conceptual Development of Research Organization 00023728 (Institute of Rheumatology).
