Abstract
BACKGROUND AND AIMS: Women with inflammatory bowel disease [IBD] may be at higher risk for cervical intraepithelial neoplasia [CIN]. However, data are conflicting. The aim of this study was to assess the risk of high-grade dysplasia and cancer [CIN2+] in IBD women and identify risk factors.
METHODS: Clinical data from adult IBD women in a multicentre Dutch IBD prospective cohort [PSI] from 2007 onwards were linked to cervical cytology and histology records from the Dutch nationwide cytology and pathology database [PALGA], from 2000 to 2016. Patients were frequency-matched 1:4 to a general population cohort. Standardised detection rates [SDR] were calculated for CIN2+. Longitudinal data were assessed to calculate CIN2+ risk during follow-up using incidence rate ratios [IRR] and risk factors were identified in multivariable analysis.
RESULTS: Cervical records were available from 2098 IBD women [77%] and 8379 in the matched cohort; median follow-up was 13 years. CIN2+ detection rate was higher in the IBD cohort than in the matched cohort (SDR 1.27, 95% confidence interval [CI] 1.05-1.52). Women with IBD had an increased risk of CIN2+ [IRR 1.66, 95% CI 1.21-2.25] and persistent or recurrent CIN during follow-up (odds ratio [OR] 1.89, 95% CI 1.06-3.38). Risk factors for CIN2+ in IBD women were smoking and disease location (ileocolonic [L3] or upper gastrointestinal [GI] [L4]). CIN2+ risk was not associated with exposure to immunosuppressants.
CONCLUSIONS: Women with IBD are at increased risk for CIN2+ lesions. These results underline the importance of human papillomavirus [HPV] vaccination and adherence to cervical cancer screening guidelines in IBD women, regardless of exposure to immunosuppressants.
Original language | English |
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Pages (from-to) | 1464-1473 |
Number of pages | 10 |
Journal | Journal of Crohn's & Colitis |
Volume | 15 |
Issue number | 9 |
DOIs | |
Publication status | Published - 25 Sept 2021 |
Keywords
- Adult
- Aged
- Case-Control Studies
- Cervical Intraepithelial Neoplasia/diagnosis
- Cohort Studies
- Early Detection of Cancer
- Female
- Humans
- Immunosuppressive Agents/therapeutic use
- Incidence
- Inflammatory Bowel Diseases/complications
- Middle Aged
- Neoplasm Grading
- Netherlands
- Papanicolaou Test
- Patient Compliance
- Risk Factors
- Uterine Cervical Neoplasms/diagnosis
- ABNORMALITIES
- GUIDELINES
- DYSPLASIA
- CONSENSUS
- HUMAN-PAPILLOMAVIRUS
- PREVALENCE
- CANCER
- INFECTION
- MANAGEMENT
- cervical intraepithelial neoplasia
- Inflammatory bowel disease
- RESPONSES
- human papillomavirus