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P282. Cervical dysplasia and cancer in inflammatory bowel disease (IBD) women. Should we increase PAP test surveillance? A Spanish retrospective study

M. Piqueras1, A. Jauregu2, M. Barreiro3, M. Iborra4, I. Bermell5, D. Carpio6, M. Chaparro7, A. Villoria8, T. Lobaton9, M. Calvo10, A. Fernandez11, S. Garcia-Moran12, D. Monfort1, R. Mena1, Y. Zabana13, 1Consorci Sanitari de Terrassa (CST), Gastroenterology department, Terrassa (Barcelona), Spain, 2Hospital Clinic Barcelona, Spain, 3Hospital Santiago de Compostela, Spain, 4Hospital la Fe de Valencia, Spain, 5Hospital Dr Negrin, Spain, 6Compejo Hospitalario de Pontevedra, Spain, 7Hospital La Princesa, Spain, 8Corporacio Sanitaria Parc Tauli, Spain, 9Hospital de Bellvitge, Spain, 10Hospital Puerta del Hierro, Spain, 11Hospital Povisa de Vigo, Spain, 12Hospital General Yagüe, Spain, 13H. Germans Trias I Pujol, Spain

Background

There is a controversy regarding the increased risk of cervical abnormalities in IBD and whether or not it is related to disease itself or to immunosuppresant (IMS) therapy. Although cervical screening is recommended for women with IBD, especially if treated with immunomodulators, current guidelines recommend managing this subgroup of patients not differently from general population.

Methods

To describe cervical abnormalities (CA) in IBD women and to investigate if there is any association between these findings and IBD therapy.

All female patients that were diagnosed with cervical dysplasia or cervical cancer (considered as “cervical abnormalities”) after IBD diagnosis were identified from the IBD database of thirteen well distributed Spanish centres. Clinical (disease severity, immunosuppression) and epidemiological data (sexual behaviour, reproductive data) were obtained in a retrospective approach. For analysis purposes, CA was grouped into two categories taking into account the Bethesda classification: cervical intraepithelial neoplasia (CIN I) as low squamous intraepithelial lesion (L-SIL) and CIN II, III, in situ carcinoma and cervix carcinoma as high squamous intraepithelial lesion (H-SIL).

Results

46 patients were included. 31 had Crohn's disease (CD): 19 with inflammatory, 3 stricturing and 9 penetrant behaviour. A total of 13 had perianal disease. 14 patients had ulcerative colitis (UC): 4 proctitis, 4 distal and 6 extensive colitis. Within UC severity: 3 were in remission, 5 had mild course and 6 presented moderate-severe disease. Only 1 had indeterminate colitis. The median age at CA diagnosis was 37 years (IQR 27–42). The median time from IBD and CA diagnosis was 96 months (IQR 29–150). 33 patients (72%) received immunosuppressant drugs before CA diagnosis (12% systemic steroids, 85% azathioprine, 3% methotrexate, 39% anti-TNF). Concerning CA subtypes: 21 had L-SIL (CIN I) and 25 had H-SIL (9 had CIN II and 12 CIN III, 3 in situ carcinoma and 1 advanced cervix carcinoma). There were no differences in clinical baseline and sexual/reproductive characteristics when comparing L-SIL to H-SIL CA. Patients treated with IMS showed H-SIL (84%) more frequently than L-SIL (57%; p = 0.046).

Conclusion

Immunossuppressant therapy used in IBD seems to worsen cervical abnormalities. Thus, enhanced screening in IBD women on an annual basis is warranted, similar to transplant population.