{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T13:04:36Z","timestamp":1784120676198,"version":"3.55.0"},"reference-count":19,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T00:00:00Z","timestamp":1784073600000},"content-version":"unspecified","delay-in-days":14,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["RMD Open"],"accepted":{"date-parts":[[2026,6,22]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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 (TIF1\u03b3) positivity (OR 4.64, 95% CI 2.35 to 9.16, p&lt;0.001), smoking (OR 3.00, 95% CI 1.64 to 5.50, p&lt;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&lt;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-TIF1\u03b3 positivity (6.8% vs 31.4%, p&lt;0.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Observed cancer distribution across IMACS risk categories was consistent with the framework\u2019s 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/rmdopen-2025-006373","type":"journal-article","created":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T12:10:15Z","timestamp":1784117415000},"page":"e006373","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Multicentre international audit of IMACS malignancy screening guidelines in idiopathic inflammatory myopathies: insights from the myositis audit and research collaborative group"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8528-4361","authenticated-orcid":false,"given":"Jessica","family":"Day","sequence":"first","affiliation":[{"name":"Department of Rheumatology, Royal Melbourne Hospital, Parkville, Victoria, Australia"},{"name":"Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia"},{"name":"University of Melbourne, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-5921-3684","authenticated-orcid":false,"given":"Lekshmi","family":"Minikumari Rahulan","sequence":"additional","affiliation":[{"name":"Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel Katsuyuki","family":"Shinjo","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Faculdade de Medicina FMUSP, Universidade de S\u00e3o Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernanda Oliveira","family":"de Andrade Lopes","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Faculdade de Medicina FMUSP, Universidade de S\u00e3o Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3590-1637","authenticated-orcid":false,"given":"Akira","family":"Yoshida","sequence":"additional","affiliation":[{"name":"Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6172-9116","authenticated-orcid":false,"given":"Shintaro","family":"Yamamoto","sequence":"additional","affiliation":[{"name":"Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Rosa","family":"Pellico","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy"},{"name":"Department of Rheumatology and Medical Sciences, ASST Gaetano Pini, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shereen","family":"Oon","sequence":"additional","affiliation":[{"name":"Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia"},{"name":"University of Melbourne, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian","family":"Teh","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Royal Melbourne Hospital, Parkville, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pallavi","family":"Vij","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Royal Wolverhampton NHS Trust, West Midlands, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iris","family":"Tang","sequence":"additional","affiliation":[{"name":"Division of Rheumatology and Clinical Immunology, Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edmund","family":"Wong","sequence":"additional","affiliation":[{"name":"Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong, Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aman","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Royal Wolverhampton NHS Trust, West Midlands, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1549-8852","authenticated-orcid":false,"given":"Nicoletta","family":"Del Papa","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy"},{"name":"Department of Rheumatology and Medical Sciences, ASST Gaetano Pini, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9300-6169","authenticated-orcid":false,"given":"Roberto","family":"Caporali","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy"},{"name":"Department of Rheumatology and Medical Sciences, ASST Gaetano Pini, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ho","family":"So","sequence":"additional","affiliation":[{"name":"Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vahed","family":"Maroufy","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston School of Public 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