Women with inflammatory bowel disease are more likely to develop high-grade cervical neoplasia as well as persistent or recurrent cervical neoplasia, a Dutch study suggests. Researchers examined cervical cytology and histology data for 2,098 women with IBD and 8,379 women in a matched cohort from the general population in The Netherlands. After a median follow-up period of 13 years, women with IBD were significantly more likely to develop CIN2+ (incidence rate ratio 1.66) as well as persistent or recurrent CIN during follow-up (odds ratio 1.89). "In most cases, HPV infection and low grade CIN resolves spontaneously," said Dr. Seoyoung Kim, director of the program in rheumatologic, immunologic and musculoskeletal pharmacoepidemiology and an associate professor of medicine at Brigham and Women's Hospital and Harvard Medical School in Boston. "Patients with systemic inflammatory disease such as IBD may have a greater risk of persistent HPV infection due to their disease/inflammation and medications that they are taking," Dr. Kim, who wasn't involved in the study, said by email. In the study, however, exposure to biologics or immunomodulators did not appear to influence the risk of CIN2+ in women with IBD. Women with IBD did have an increased risk of CIN2+ when they smoked (adjusted OR 3.20) or had multiple cervical cancer screenings within a five-year period (aOR 2.0). Women with Crohn's disease had an increased risk of CIN2+ when they had ileocolonic or upper-GI disease location (aOR 1.84). One limitation of the study is that it only included patients from tertiary referral centers, who may have more severe disease, making the results not generalizable to all women with IBD, the study team notes in the Journal of Crohn's and Colitis. Senior study author A.C. de Vries of Erasmus University Medical Center in Rotterdam, didn't respond to emails seeking comment. The researchers also lacked data on some important potential confounders including sexual behavior and oral contraceptive use, the authors point out. And they didn't have enough data to pinpoint any specific risk factors for persistent or recurrent lesions. such as immunosuppressant medications. "Immunosuppressants are known to predispose to infections and cancer," said Dr. Tine Jess, director of the Center for Molecular Prediction of Inflammatory Bowel Disease (PREDICT), Aalborg University in Copenhagen, Denmark. "However, treatment with immunosuppressants also reflects the underlying disease severity," Dr. Jess, who wasn't involved in the study, said by email. "As a consequence, it is often difficult to conclude their independent impact on, for example, cancer risk." Even so, the results underscore the importance of promoting cervical cancer screening among women with IBD, Dr. Jess said. "Clinicians should be aware of the importance of HPV vaccination and screening among patients with IBD," Dr. Jess added. —Lisa Rapaport Source
