Increased risk of high-grade cervical neoplasia in women with inflammatory bowel disease: a case-controlled cohort study

Goetgebuer, R.L.; Kreijne, J.E.; Aitken, C.A.; Dijkstra, G.; Hoentjen, F.; Boer, N.K. de; ... ; Dutch Initiative Crohn Colitis ICC (2021)

Article / Letter to editor

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 frequencymatched 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.

• Inflammatory bowel disease
• cervical intraepithelial neoplasia
• human papillomavirus

• All authors: Goetgebuer, R.L.; Kreijne, J.E.; Aitken, C.A.; Dijkstra, G.; Hoentjen, F.; Boer, N.K. de; Oldenburg, B.; Meulen, A.E. van der; Ponsioen, C.I.J.; Pierik, M.J.; Kemenade, F.J. van; Kok, I.M.C.M. de; Siebers, A.G.; Mannien, J.; Woude, C.J. van der; Vries, A.C. de; Dutch Initiative Crohn Colitis ICC
• Date: 2021-09-01
• Journal: Journal of Crohn's and Colitis
• Volume: 15
• Issue: 9
• Pages: 1464 - 1473
• DOI: doi:10.1093/ecco-jcc/jjab036
• Link: https://academic.oup.com/ecco-jcc/article/15/9/1464/6145789