Women who have inflammatory bowel disease, particularly those with Crohn’s disease, are at increased risk for developing cervical neoplasia, according to a report published online in Clinical Gastroenterology and Hepatology.
In a population-based nationwide cohort study involving 27,408 Danish women with newly diagnosed IBD and 1,508,334 control subjects matched for age and area of residence, a significant excess in cervical neoplasia also was observed for up to 10 years before the GI diagnosis. This bidirectional association indicates that an as-yet-unknown factor underlies susceptibility to both disorders, said Dr. Christine Rungoe of the department of epidemiology research, Statens Serum Institut, Copenhagen, and her associates.
“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,” they noted.
Some previous studies have shown an increased risk of cervical neoplasia among IBD patients, but others have found no association. Some experts have proposed that either the underlying immunologic changes in IBD or the treatment of IBD with immunosuppressive drugs may impair patients’ ability to clear HPV infections, thus raising the risk of cervical neoplasia.
Dr. Rungoe and her colleagues examined the issue using data from Danish national registries that covered approximately 4 million women residing there during the past 32 years. They identified 18,691 women newly diagnosed with ulcerative colitis and 8,717 newly diagnosed as having Crohn’s disease and compared their rates of cervical neoplasia against those of control subjects during a median of 8 years of follow-up.
Women with ulcerative colitis showed a slightly but significantly increased risk of developing both low-grade (RR, 1.15) and high-grade (RR, 1.12) squamous intraepithelial lesions but no increased risk of cervical cancer. Women with Crohn’s disease showed a significantly increased risk of developing both low-grade (RR, 1.26) and high-grade (RR, 1.28) squamous intraepithelial lesions, as well as an even greater risk (RR, 1.53) of cervical cancer.
These associations were not the result of higher rates of cervical screening among the women with IBD than among the control subjects, since the two study groups had comparable screening rates. The associations also were not related to IBD therapy, since the use of mesalamine, azathioprine, and corticosteroids appeared to have no influence on rates of cervical neoplasia. The one exception to this finding was that women with Crohn’s disease who used TNF-alpha antagonists were at increased risk only for high-grade intraepithelial lesions of the cervix, the investigators said (Clin. Gastroenterol. Hepatol. 2014 July 30 [doi:10.1016/j.cgh.2014.07.036]).
An additional notable finding was that the odds of having a history of both high-grade intraepithelial and cancerous lesions of the cervix were markedly higher in the women with IBD than in the control subjects. “This is a novel finding that may suggest a yet unexplored common susceptibility to IBD and cervical neoplasia rather than an etiologic role of IBD … in the development of cervical neoplasia,” Dr. Rungoe and her associates wrote.
This study was funded in part by the Danish Council of Independent Research. The investigators reported having no relevant financial disclosures.