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P784 Prevalence of cervical dysplasia in women with inflammatory bowel disease: data from the Parelsnoer Institute (PSI) and PALGA database (PAP-IBD study)

R. Goetgebuer*1, J. Kreijne1, C. Aitken2, M. Pierik3, F. Hoentjen4, N. de Boer5, B. Oldenburg6, A. van der Meulen7, C. Ponsioen8, G. Dijkstra9, F. van Kemenade10, G. Nieuwenhuyzen – de Boer11, A. Siebers12, C. J. van der Woude1, A. de Vries1

1Erasmus MC, University Medical Center, Gastroenterology and hepatology, Rotterdam, The Netherlands, 2Erasmus MC, University Medical Center, Public Health, Rotterdam, The Netherlands, 3Maastricht University Medical Center, Gastroenterology and Hepatology, Maastricht, The Netherlands, 4Radboud University Medical Center, Gastroenterology and Hepatology, Nijmegen, The Netherlands, 5VU University Medical Center, Gastroenterology and Hepatology, Amsterdam, The Netherlands, 6University Medical Center Utrecht, Gastroenterology and Hepatology, Utrecht, The Netherlands, 7Leiden University Medical Center, Gastroenterology and Hepatology, Leiden, The Netherlands, 8Academic Medical Center, Gastroenterology and Hepatology, Amsterdam, The Netherlands, 9University Medical Center Groningen, Gastroenterology and Hepatology, Groningen, The Netherlands, 10Erasmus MC, University Medical Center, Pathology, Rotterdam, The Netherlands, 11Erasmus MC, University Medical Center, Gynaecologic Oncology, Rotterdam, The Netherlands, 12PALGA, the nationwide network and registry of histo- and cytopathology in the Netherlands, Houten, The Netherlands

Background

Women with inflammatory bowel disease (IBD) may be at higher risk for cervical intraepithelial neoplasia (CIN). Possible explanations for this elevated risk include increased persistence of high-risk human papillomavirus (hrHPV) and rapid progression of premalignant lesions in immunocompromised individuals. However, data on CIN in IBD are conflicting. The aim of this study was to assess the prevalence of CIN in a large cohort of female Dutch IBD patients when compared with the general cervical screening population.

Methods

We retrieved all cervical cytology and histology records from the nationwide Dutch Pathology Database (PALGA) for women with IBD in the Parelsnoer study; a large multi-centre cohort study (Parelsnoer Institute, Dutch IBD Biobank) in which clinical data are prospectively collected. Women in the IBD cohort were frequency matched 1:4 to a control group of women from the general cervical screening population from PALGA, based on age at first smear and year of screening.

Results

Cervical smears were available on 2,098 IBD patients (1,370 Crohn’s disease (65.3%), 678 ulcerative colitis (32.3%), median age at IBD diagnosis 28.5 years). We found a significant difference in prevalence of CIN 2 or more severe (CIN 2+) lesions in IBD women (110/2,098, 5.2%) compared with the control group (324/8,439, 3.8%) with an odds ratio of 1.4 (95% confidence interval 1.1–1.7, p = 0.004). CIN 2 and CIN 3 were found more often in the IBD cohort (2.2% CIN 2, 2.9% CIN 3) than in the control group (1.4% CIN 2, 2.2% CIN 3, p = 0.002). Two cervical cancers occurred in our IBD cohort (2/2,098) compared with 20 cervical cancers in the control group (20/8,439) (p = 0.20). Possible risk factors associated with CIN, such as disease behaviour, smoking and immunosuppressive drugs are currently investigated in this study population.

Conclusion

Women with IBD are at increased risk for CIN2+ lesions compared with their age-matched controls. These results underline the current ECCO guideline on HPV vaccination in young IBD women, and the importance of adherence to screening guidelines. In addition, the benefits of more intensive cervical cancer screening, potentially starting at younger age, need to be assessed.