Screening differences and risk of cervical cancer in inflammatory bowel disease.
BACKGROUND
Cervical cancer risk is high among immune suppressed women.


OBJECTIVE
To evaluate inflammatory bowel disease (IBD) with medications and risk of cervical cancer.


METHODS
Members of Kaiser Permanente Northern California (KPNC), 15-68 years from 1996 to 2006 with IBD were compared with age-matched women without IBD. Cervical cancer was ascertained using the KPNC Cancer Registry. IBD medications of interest were aminosalicylates (ASA), corticosteroids, immune modulators and infliximab. Odds of cervical cancer were analysed with adjusted logistic regression. The prevalence of Pap smear testing was compared using a log binomial model.


RESULTS
Ten cervical cancer cases occurred among 1165 women with IBD and 72 cancers among 12 124 controls. The adjusted odds ratio (OR) of IBD with risk of cervical cancer was 1.45 [95% confidence interval (CI) 0.74-2.84]. Medication ORs were 1.65 for ASA, 2.79 for corticosteroids and 3.45 for immune modulators (all P > 0.05). No cancer case used infliximab. The adjusted absolute increase in Pap smears among IBD women compared to women without IBD was 4% (95% CI 2-5%).


CONCLUSIONS
Although a trend of elevated risk for cervical cancer with IBD and IBD medications was observed, it was not statistically significant. Regular cervical cancer screening for women with IBD is recommended.
Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612, USA.
S
S
Hutfless
B
B
Fireman
S
S
Kane
L J
LJ
Herrinton
D000293:Adolescent; D000328:Adult; D000368:Aged; D002140:California / Q000453:epidemiology; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D018570:Risk Assessment; D002583:Uterine Cervical Neoplasms / Q000139:chemically induced* / Q000453:epidemiology / Q000276:immunology
D007166:Immunosuppressive Agents