Review

. 2023 Dec;19(12):805-817.

doi: 10.1038/s41584-023-01045-w. Epub 2023 Nov 9.

International Guideline for Idiopathic Inflammatory Myopathy-Associated Cancer Screening: an International Myositis Assessment and Clinical Studies Group (IMACS) initiative

Alexander G S Oldroyd^{1

2

3

4}, Jeffrey P Callen⁵, Hector Chinoy^{1

2

3}, Lorinda Chung^{6

7}, David Fiorentino⁸, Patrick Gordon⁹, Pedro M Machado^{10

11

12

13}, Neil McHugh¹⁴, Albert Selva-O'Callaghan¹⁵, Jens Schmidt^{16

17

18}, Sarah L Tansley^{14

19}, Ruth Ann Vleugels²⁰, Victoria P Werth^{21

22}; International Myositis Assessment and Clinical Studies Group Cancer Screening Expert Group; Rohit Aggarwal²³

Collaborators, Affiliations

Collaborators

International Myositis Assessment and Clinical Studies Group Cancer Screening Expert Group:
Anthony A Amato, Helena Andersson, Lilia Andrade-Ortega, Dana Ascherman, Olivier Benveniste, Lorenzo Cavagna, Christina Charles-Shoeman, Benjamin F Chong, Lisa Christopher-Stine, Jennie T Clarke, Emma J Crosbie, Philip A J Crosbie, Sonye Danoff, Maryam Dastmalchi, Marianne De Visser, Paul F Dellaripa, Louise Pyndt Diederichsen, Mazen M Dimachkie, Erik Ensrud, Floranne Ernste, D Gareth R Evans, Manabu Fujimoto, Ignacio Garcia-De La Torre, Abraham Garcia-Kutzbach, Zoltan Griger, Latika Gupta, Marie Hudson, Florenzo Iannone, David Isenberg, Joseph Jorizzo, Helen Kurtz, Masataka Kuwana, Vidya Limaye, Ingrid E Lundberg, Andrew L Mammen, Herman Mann, Frank Mastaglia, Lorna McWilliams, Christopher A Mecoli, Federica Meloni, Frederick W Miller, Siamak Moghadam-Kia, Sergey Moiseev, Yoshinao Muro, Melinda Nagy-Vincze, Clive Nayler, Merrilee Needham, Ichizo Nishino, Chester V Oddis, Julie J Paik, Joost Raaphorst, Lisa G Rider, Jorge Rojas-Serrano, Lesley Ann Saketkoo, Adam Schiffenbauer, Samuel Katsuyuki Shinjo, Vineeta Shobha, Yeong-Wook Song, Tania Tillett, Yves Troyanov, Anneke J van der Kooi, Mónica Vázquez-Del Mercado, Jiri Vencovsky, Qian Wang, Steven Ytterberg

Affiliations

¹ National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, University of Manchester, Manchester, UK.
² Department of Rheumatology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK.
³ Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
⁴ Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK.
⁵ Division of Dermatology, Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA.
⁶ Division of Immunology and Rheumatology, Department of Medicine and Dermatology, Stanford University, Stanford, CA, USA.
⁷ Palo Alto Health Care System, Palo Alto, CA, USA.
⁸ Department of Dermatology, Stanford University School of Medicine, Redwood City, CA, USA.
⁹ Department of Rheumatology, King's College Hospital NHS Foundation Trust, London, UK.
¹⁰ Centre for Rheumatology, Division of Medicine, University College London, London, UK.
¹¹ Department of Neuromuscular Diseases, Division of Medicine, University College London, London, UK.
¹² National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London Hospitals National Health Service Trust, London, UK.
¹³ Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK.
¹⁴ Department of Life Sciences, University of Bath, Bath, UK.
¹⁵ Systemic Autoimmune Diseases Unit, Vall D'Hebron General Hospital, Medicine Department, Universitat Autonoma de Barcelona, Barcelona, Spain.
¹⁶ Department of Neurology and Pain Treatment, Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, Germany.
¹⁷ Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, Germany.
¹⁸ Department of Neurology, Neuromuscular Centre, University Medical Centre Göttingen, Göttingen, Germany.
¹⁹ Royal National Hospital for Rheumatic Diseases, Royal United Hospitals NHS Foundation Trust Bath, Bath, UK.
²⁰ Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
²¹ Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA.
²² Division of Dermatology, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA.
²³ Myositis Center and Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. aggarwalr@upmc.edu.

PMID: 37945774
PMCID: PMC10834225
DOI: 10.1038/s41584-023-01045-w

Review

International Guideline for Idiopathic Inflammatory Myopathy-Associated Cancer Screening: an International Myositis Assessment and Clinical Studies Group (IMACS) initiative

Alexander G S Oldroyd et al. Nat Rev Rheumatol. 2023 Dec.

. 2023 Dec;19(12):805-817.

doi: 10.1038/s41584-023-01045-w. Epub 2023 Nov 9.

Authors

Collaborators

International Myositis Assessment and Clinical Studies Group Cancer Screening Expert Group:
Anthony A Amato, Helena Andersson, Lilia Andrade-Ortega, Dana Ascherman, Olivier Benveniste, Lorenzo Cavagna, Christina Charles-Shoeman, Benjamin F Chong, Lisa Christopher-Stine, Jennie T Clarke, Emma J Crosbie, Philip A J Crosbie, Sonye Danoff, Maryam Dastmalchi, Marianne De Visser, Paul F Dellaripa, Louise Pyndt Diederichsen, Mazen M Dimachkie, Erik Ensrud, Floranne Ernste, D Gareth R Evans, Manabu Fujimoto, Ignacio Garcia-De La Torre, Abraham Garcia-Kutzbach, Zoltan Griger, Latika Gupta, Marie Hudson, Florenzo Iannone, David Isenberg, Joseph Jorizzo, Helen Kurtz, Masataka Kuwana, Vidya Limaye, Ingrid E Lundberg, Andrew L Mammen, Herman Mann, Frank Mastaglia, Lorna McWilliams, Christopher A Mecoli, Federica Meloni, Frederick W Miller, Siamak Moghadam-Kia, Sergey Moiseev, Yoshinao Muro, Melinda Nagy-Vincze, Clive Nayler, Merrilee Needham, Ichizo Nishino, Chester V Oddis, Julie J Paik, Joost Raaphorst, Lisa G Rider, Jorge Rojas-Serrano, Lesley Ann Saketkoo, Adam Schiffenbauer, Samuel Katsuyuki Shinjo, Vineeta Shobha, Yeong-Wook Song, Tania Tillett, Yves Troyanov, Anneke J van der Kooi, Mónica Vázquez-Del Mercado, Jiri Vencovsky, Qian Wang, Steven Ytterberg

Affiliations

¹ National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, University of Manchester, Manchester, UK.
² Department of Rheumatology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK.
³ Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
⁴ Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK.
⁵ Division of Dermatology, Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA.
⁶ Division of Immunology and Rheumatology, Department of Medicine and Dermatology, Stanford University, Stanford, CA, USA.
⁷ Palo Alto Health Care System, Palo Alto, CA, USA.
⁸ Department of Dermatology, Stanford University School of Medicine, Redwood City, CA, USA.
⁹ Department of Rheumatology, King's College Hospital NHS Foundation Trust, London, UK.
¹⁰ Centre for Rheumatology, Division of Medicine, University College London, London, UK.
¹¹ Department of Neuromuscular Diseases, Division of Medicine, University College London, London, UK.
¹² National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London Hospitals National Health Service Trust, London, UK.
¹³ Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK.
¹⁴ Department of Life Sciences, University of Bath, Bath, UK.
¹⁵ Systemic Autoimmune Diseases Unit, Vall D'Hebron General Hospital, Medicine Department, Universitat Autonoma de Barcelona, Barcelona, Spain.
¹⁶ Department of Neurology and Pain Treatment, Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, Germany.
¹⁷ Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, Germany.
¹⁸ Department of Neurology, Neuromuscular Centre, University Medical Centre Göttingen, Göttingen, Germany.
¹⁹ Royal National Hospital for Rheumatic Diseases, Royal United Hospitals NHS Foundation Trust Bath, Bath, UK.
²⁰ Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
²¹ Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA.
²² Division of Dermatology, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA.
²³ Myositis Center and Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. aggarwalr@upmc.edu.

PMID: 37945774
PMCID: PMC10834225
DOI: 10.1038/s41584-023-01045-w

Erratum in

Author Correction: International Guideline for Idiopathic Inflammatory Myopathy-Associated Cancer Screening: an International Myositis Assessment and Clinical Studies Group (IMACS) initiative.
Oldroyd AGS, Callen JP, Chinoy H, Chung L, Fiorentino D, Gordon P, Machado PM, McHugh N, Selva-O'Callaghan A, Schmidt J, Tansley SL, Vleugels RA, Werth VP; International Myositis Assessment and Clinical Studies Group Cancer Screening Expert Group; Aggarwal R. Oldroyd AGS, et al. Nat Rev Rheumatol. 2024 May;20(5):315. doi: 10.1038/s41584-024-01111-x. Nat Rev Rheumatol. 2024. PMID: 38548933 No abstract available.

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.

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Figures

**Figure 1 –. Flowchart of cancer risk stratification and frequency of screening**
Abbreviations: DM = dermatomyositis PM = polymyositis IMNM = immune-mediated necrotising myopathy CADM = clinically amyopathic dermatomyositis NXP2 = nuclear matrix protein 2 TIF1-gamma = transcriptional intermediary factor 1 SAE1 = small ubiquitin-like modifier-1 activating enzyme HMGCR = 3-hydroxy 3-methylutaryl coenzyme A reductase MDA5 = melanoma differentiation-associated gene 5 IIM = idiopathic inflammatory myopathy SRP = signal recognition particle ASSD = anti-synthetase syndrome RNP = ribonucleoprotein CT = computed tomography USS = ultrasound scan ¹⁸F-FDG PET/CT = [18F]-fluoro-deoxy-glucose positron emission tomography/computed tomography

See this image and copyright information in PMC

References

1. Oldroyd A, Lilleker J & Chinoy H Idiopathic inflammatory myopathies - a guide to subtypes, diagnostic approach and treatment. Clin. Med. (Northfield. Il) 17, (2017). - PMC - PubMed
1. Chinoy H & Cooper RG Polymyositis and dermatomyositis. in Oxford Textbook of Rheumatology 1009–1020 (Oxford University Press, 2013). doi:10.1093/med/9780199642489.003.0124_update_001 - DOI
1. Qiang JK, Kim WB, Baibergenova A & Alhusayen R Risk of malignancy in dermatomyositis and polymyositis: A systematic review and meta-analysis. J. Cutan. Med. Surg 21, 131–136 (2017). - PubMed
1. Dobloug GC, Garen T, Brunborg C, Gran JT & Molberg Ø Survival and cancer risk in an unselected and complete Norwegian idiopathic inflammatory myopathy cohort. Semin. Arthritis Rheum 45, 301–308 (2015). - PubMed
1. Kang EH et al. Temporal relationship between cancer and myositis identifies two distinctive subgroups of cancers: impact on cancer risk and survival in patients with myositis. Rheumatology (Oxford). 55, 1631–41 (2016). - PubMed

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International Guideline for Idiopathic Inflammatory Myopathy-Associated Cancer Screening: an International Myositis Assessment and Clinical Studies Group (IMACS) initiative

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International Guideline for Idiopathic Inflammatory Myopathy-Associated Cancer Screening: an International Myositis Assessment and Clinical Studies Group (IMACS) initiative

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