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IBD showed link with cervical neoplasia
A reciprocal association existed between inflammatory bowel disease, particularly Crohn’s disease, and cervical neoplasia in a recent study.
In the population-based, nationwide cohort study, researchers evaluated women diagnosed with ulcerative colitis (UC; n=18,691) or Crohn’s disease (CD; n=8,717) between 1979 and 2011. A matched control group of 1,508,334 women also was enrolled in the study.
Researchers determined that while women with CD underwent smear-test screening for cervical cancer as frequently as controls (IRR=0.99; 95% CI, 0.96-1.02), women with UC were screened slightly more often than the general population (IRR=1.06; 95% CI, 1.04-1.08).
During a median follow-up of 7.8 years, 561 patients with UC were diagnosed with cervical dysplasia; 28 developed cervical cancer compared with 1,918 controls (IRR=0.78; 95% CI, 0.53-1.13). Among UC patients, there was an increased risk for low-grade squamous intraepithelial lesions (SILs; IRR=1.15; 95% CI, 1-1.32) and high-grade SILs (IRR=1.12; 95% CI, 1.01-1.25).
In the CD cohort, 407 patients were diagnosed with dysplasia (median follow-up, 8.3 years), and 26 patients developed cervical cancer vs. 940 controls. Women with CD had increased risk for low-grade SILs (IRR=1.26, 95% CI, 1.07-1.48), high-grade SILs (IRR=1.28; 95% CI, 1.13-1.45) and cervical cancer as opposed to controls (IRR=1.53; 95% CI, 1.04-1.27).
Between 1 and 9 years before UC diagnosis, the OR for cervical cancer increased compared with women without UC (OR=2.78; 95% CI, 2.12-3.64) or CD (OR=1.85; 95% CI, 1.08-3.15).
“Women with a diagnosis of CD had increased risk of cervical dysplasia and cancer despite similar screening intensity as in the general population,” the researchers concluded. “Patients with UC only had increased risk of dysplasia along with a slightly increased screening frequency compared to controls.
“Patients with IBD should be encouraged to follow the screening program for cervical neoplasia and clinicians should be aware of the slightly increased risk of HPV-related cervical lesions in IBD patients.”
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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“Crohn’s disease” begs for etiologic insights. Might the near-absolute (probably causal) relationship of cervical neoplasia with papilloma virus infection suggest a role for HPV in Crohn’s? If so, the increasing HPV vaccination rate may reduce inflammatory bowel disease in the future. Stay tuned.