Background: There is an increased risk of high-grade uterine cervical dysplasia and cervical cancer among patients with inflammatory bowel disease (IBD) who are on immunosuppressive medications compared with the general population. Other risk factors have also been identified such as smoking, prolonged use of oral contraceptives and many pregnancies to term. ECCO guidelines recommend regular gynecologic screening for uterine cervical cancer in women with IBD, especially if they were treated with immunosuppressant. Young women with immunosuppressive treatment should obtain a Papanicolau test twice in the first year after diagnosis and annually thereafter if the results are normal. Our aim was to evaluate the performance of the regular gynecologic screening for uterine cervical cancer among patients with IBD who are on immunosuppressive therapy.
Methods: We performed a cross-sectional study in 101 patients with IBD who are on immunosuppressive therapy. An interviewer-administered questionnaire was used to collet information on demographics, immunosuppressive therapy, risk factors and last screening for uterine cervical cancer.
Results: In total, 101 patients with IBD (69 crohn's disease, 32 ulcerative colitis), and immunosupresive therapy (58% antiTNF, 37% tiopurinas, 3 MTX and 2% CTC) were included in the study. Up to 28% of patient underwent combined immunosuppressive therapy. 47.5% of patient was smokers and 15% therapy with oral contraceptives. 55.5% of patients had at least two risk factors and 7% had three or more factors. Only 28% of patients had screening for uterine cervical cancer in the last year, 36% for 2–5 years and 36% more than 5 years. Some degree of dysplasia was observed in 10% of patients with screening uterine cervical cancer in the last year. Only 17% of patients with two o more risk factors had performed screening for uterine cervical cancer in the last year. No patient knew that immunosuppressive therapy is a risk factor for uterine cervical cancer.
Conclusions: Most IBD patients with immunosuppressive therapy are not successfully screening for cervical cancer. The low rate of correct follow-up in patients with two or more risk factors is really alarming. Although the incidence of dysplasia is low, patients with IBD should be informed about cervical cancer risk factors and the benefit of early detection of dysplasia.