Risk of Cervical Abnormalities in Women With Inflammatory Bowel Disease: A Population-Based Nested Case-Control Study

Background & Aims

We evaluated the risk of cervical abnormalities in women with inflammatory bowel disease (IBD) in a population-based, nested, case-control study.

Methods

Cases with abnormal Papanicolaou (Pap) smears or cervical biopsies were matched with up to 3 controls (normal Pap smears) by year of birth, year of first health care coverage, and number of Pap smears in the preceding 5 years. A diagnosis of IBD before the index date was identified from the University of Manitoba IBD Epidemiology Database. Exposures to immunosuppressant drugs and corticosteroids were determined from the provincial drug prescription database. Analyses were adjusted for socioeconomic status and exposure to oral contraceptives and nonsteroidal anti-inflammatory drugs.

Results

19,692 women with cervical cytologic and/or histologic abnormalities were matched with 57,898 controls with normal Pap smears. There was no association between cervical abnormalities and ulcerative colitis (odds ratio [OR], 1.03; 95% confidence interval [CI], 0.77–1.38). The increase in risk in women with Crohn's disease was limited to those exposed to 10 or more prescriptions of oral contraceptives (OR, 1.66; 95% CI, 1.08–2.54). The combined exposure to corticosteroids and immunosuppressants was associated with increased risk of cervical abnormalities (OR, 1.41; 95% CI, 1.09–1.81). There was no interaction between the effect of IBD and corticosteroids and/or immunosuppressants.

Conclusions

These findings do not support an association between IBD itself and the risk of developing cervical abnormalities. An increased risk in patients given a combination of corticosteroids and immunosuppressants should be considered in managing women with IBD.

Abbreviations used in this paper: CI, confidence interval, HPV, human papillomavirus, MCCSP, Manitoba Cervical Cancer Screening Program, MCR, Manitoba Cancer Registry, NSAID, nonsteroidal anti-inflammatory drug, OCP, oral contraceptive pills, OR, odds ratio, Pap, Papanicolaou's, SES, socioeconomic status