Female IBD patients: Stay up-to-date on your cervical cancer screening

Women with inflammatory bowel disease (IBD) may be at increased risk of cervical dysplasia and cancer, according to a new study¹ published in Clinical Gastroenterology and Hepatology, the official clinical practice journal of the American Gastroenterological Association.

"Our research shows that patients with IBD, specifically Crohn's disease, are at increased risk for developing cervical cancer, even when undergoing the recommended screening," said study author Professor Tine Jess, MD, from Statens Serum Institut in Denmark. "These findings provide an important reminder for IBD patients, and their physicians, to follow the recommended screening guidelines for cervical cancer."

Researchers conducted a population-based, case-controlled study of 27,408 women with IBD in Denmark, followed during a 35-year period. They found a two-way association between IBD, notably Crohn's disease, and neoplastic lesions, or abnormal tissue growth, of the uterine cervix. This observation is not explained by differences in screening activity.

Although patients with both ulcerative colitis and Crohn's disease - the two most common forms of IBD - had higher odds of being diagnosed with cervical cancer before IBD, only patients with Crohn's disease were at an increased risk of developing cervical cancer after the IBD diagnosis.

For patients with Crohn's disease, researchers found a significantly higher risk of cervical neoplasia in patients diagnosed at a young age and in patients treated with azathioprine. Treatment with TNF-α antagonists and hormonal contraceptive devices may also influence risk of cervical neoplasia in Crohn's disease.

Inflammatory bowel diseases (IBDs) commonly affect women in their childbearing years. Women identify unique psychologic issues compared with men related to body image and their ability to bear children. The menstrual cycle can be disrupted because of disease activity, medications and/or malnutrition. Oral contraceptives can be used; however, monitoring for thromboembolic events should be performed. Women with IBD are potentially at risk of higher rates of cervical dysplasia and should be screened as are other immunocompromised women. Fertility rates are comparable to those of women without IBD. The risk of disease activity during pregnancy depends on the disease activity at the time of conception. Pregnancy for the majority of women is uncomplicated, although women with Crohn's disease do tend to deliver children of lower birthweights than do healthy women. The majority of medications used in the treatment of IBD are not harmful to the fetus and should be continued throughout pregnancy in order to maintain maternal health. Breastfeeding should not be discouraged and the majority of medications are safe for nursing. Menopause tends to occur earlier in women with IBD; the cause of this is unclear.

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¹ Rungoe, Christine, et al. Inflammatory Bowel Disease and Cervical Neoplasia: A Population-Based Nationwide Cohort Study, Clinical Gastroenterology and Hepatology, Volume 13(4): 693-700.e1 http://www.cghjournal.org/article/S1542-3565(14)01081-7/abstract