{
  "abstract": "Background Consensus guidelines for malignancy screening in idiopathic inflammatory myopathy (IIM) were recently published by the International Myositis Assessment and Clinical Studies (IMACS) working group. This international multicentre study audited historical cancer screening practices against IMACS recommendations and examined the distribution of observed malignancies across IMACS-defined risk categories in a real-world cohort.Methods This retrospective study included patients with IIM from eight centres across seven countries/regions. Patients were stratified using IMACS-defined cancer risk categories. Historical screening was compared with the guideline recommendations. Multivariable logistic regression identified predictors of cancer and underscreening.Results Of the 795 patients (72.3% female), 51.7%, 37.9% and 10.4% were classified as high risk, moderate risk and standard risk, respectively. Across all sites, few high-risk (6.2%), moderate-risk (2.7%) and standard-risk (11.1%) patients underwent a full panel of IMACS-recommended tests. Within 3 years of diagnosis, 86 patients (10.8%) developed malignancy. Among observed cancers, 77.4% occurred in high-risk and 22.6% in moderate-risk patients, with none detected in the standard-risk group. Anti-transcription intermediary factor 1-gamma (TIF1γ) positivity (OR 4.64, 95% CI 2.35 to 9.16, p<0.001), smoking (OR 3.00, 95% CI 1.64 to 5.50, p<0.001), night sweats (OR 12.76, 95% CI 2.72 to 59.87, p=0.001) and increasing age (OR 1.05 95% CI 1.03 to 1.07 per year, p<0.001) were independently associated with cancer, whereas anti-Mi2 antibodies and non-dermatomyositis subtypes were protective. Cancer risk increased with each additional high-risk feature (OR 1.70) and decreased with each low-risk feature (OR 0.76). Underscreened individuals had lower rates of immune-mediated necrotising myopathy (5.6% vs 14.3%, p=0.005) and anti-TIF1γ positivity (6.8% vs 31.4%, p<0.001).Conclusion Observed cancer distribution across IMACS risk categories was consistent with the framework’s stratification logic, but differential screening intensity precludes formal assessment of predictive validity. Variation between historical practice and current recommendations underscores the need for continued education and prospective longitudinal studies to assess cumulative risk, age thresholds, screening uptake and outcomes in real-world clinical settings.",
  "authors": [
    {
      "affiliations": [
        "Department of Rheumatology, Royal Melbourne Hospital, Parkville, Victoria, Australia",
        "Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia",
        "University of Melbourne, Melbourne, Victoria, Australia"
      ],
      "name": "Jessica Day"
    },
    {
      "affiliations": [
        "Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India"
      ],
      "name": "Lekshmi Minikumari Rahulan"
    },
    {
      "affiliations": [
        "Division of Rheumatology, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil"
      ],
      "name": "Samuel Katsuyuki Shinjo"
    },
    {
      "affiliations": [
        "Division of Rheumatology, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil"
      ],
      "name": "Fernanda Oliveira de Andrade Lopes"
    },
    {
      "affiliations": [
        "Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan"
      ],
      "name": "Akira Yoshida"
    },
    {
      "affiliations": [
        "Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan"
      ],
      "name": "Shintaro Yamamoto"
    },
    {
      "affiliations": [
        "Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy",
        "Department of Rheumatology and Medical Sciences, ASST Gaetano Pini, Milan, Italy"
      ],
      "name": "Maria Rosa Pellico"
    },
    {
      "affiliations": [
        "Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia",
        "University of Melbourne, Melbourne, Victoria, Australia"
      ],
      "name": "Shereen Oon"
    },
    {
      "affiliations": [
        "Department of Rheumatology, Royal Melbourne Hospital, Parkville, Victoria, Australia"
      ],
      "name": "Ian Teh"
    },
    {
      "affiliations": [
        "Department of Rheumatology, Royal Wolverhampton NHS Trust, West Midlands, UK"
      ],
      "name": "Pallavi Vij"
    },
    {
      "affiliations": [
        "Division of Rheumatology and Clinical Immunology, Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong"
      ],
      "name": "Iris Tang"
    },
    {
      "affiliations": [
        "Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong, Hong Kong"
      ],
      "name": "Edmund Wong"
    },
    {
      "affiliations": [
        "Department of Rheumatology, Royal Wolverhampton NHS Trust, West Midlands, UK"
      ],
      "name": "Aman Kumar"
    },
    {
      "affiliations": [
        "Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy",
        "Department of Rheumatology and Medical Sciences, ASST Gaetano Pini, Milan, Italy"
      ],
      "name": "Nicoletta Del Papa"
    },
    {
      "affiliations": [
        "Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy",
        "Department of Rheumatology and Medical Sciences, ASST Gaetano Pini, Milan, Italy"
      ],
      "name": "Roberto Caporali"
    },
    {
      "affiliations": [
        "Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong"
      ],
      "name": "Ho So"
    },
    {
      "affiliations": [
        "Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA"
      ],
      "name": "Vahed Maroufy"
    },
    {
      "affiliations": [
        "Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan"
      ],
      "name": "Masataka Kuwana"
    },
    {
      "affiliations": [
        "Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India"
      ],
      "name": "Vikas Agarwal"
    },
    {
      "affiliations": [
        "Department of Rheumatology, Royal Wolverhampton NHS Trust, West Midlands, UK",
        "School of Infection, Inflammation and Immunology, College of Medicine and Health, University of Birmingham, Birmingham, UK",
        "Francis Crick Institute, London, UK"
      ],
      "name": "Latika Gupta"
    }
  ],
  "title": "Multicentre international audit of IMACS malignancy screening guidelines in idiopathic inflammatory myopathies: insights from the myositis audit and research collaborative group",
  "uid": "f46831a1-603f-51ea-9cd8-4459926f5466"
}