Cervical Cancer Screening in African Americans With Inflammatory Bowel Disease

Abstract

Introduction:Several studies have shown an increased risk for having abnormal Papanicolaou (Pap) smears in women with Inflammatory Bowel Disease(IBD). It is unknown if this is due to the disease itself or from receiving immunosuppressants.In addition, no studies to date have validated this in non-caucasian populations.Higher cervical cancer incidence has been described in healthy blacks in the face of lower screening rates.The aim of our study was to ascertain the rate of abnormal Pap smears in blacks with IBD and identify factors leading to less screening.Methods: Using ICD9 codes, a retrospective chart review was done on selected women seen in our institution for IBD management over the last 10 years.Data on age at disease onset/study entry,family history of IBD, disease pattern and distribution, extraintestinal manifestations, clinical status, frequency of follow up, and Pap smears were taken from clinicians' notes and endoscopic/radiologic reports.Exclusion criteria were male gender and age <18. Fisher's exact test was used to test association between groups who have and have not had Pap smears and dichotomous outcomes; t-test was used for continuous outcomes.The bootstrap method of inflating p-values to account for the multiple testing problem was used. All analysis was done through SAS (SAS Institute,Cary NC) Release 9.2 software. Results:150 black women with IBD were included in the study.96 (64%) of women had a Pap smear performed in our institution with 38/96 (40%) being abnormal (29 atypical squamous cells of undetermined significance, 7 low grade squamous intraepitheliel lesion, 1 high grade squamous intraepitheliel lesion, 1 cervical cancer).49/96 (51%) had been exposed to immunosuppressive therapy for IBD and 18/96 (19%) had been on estrogen containing contraception. The 96 women who had a Pap smear were then compared to 54 women who had not had a Pap smear (See Table 1).Women who had not had a Pap smear tended to have not been seen in the gastroenterology clinic within one year (6/54 vs. 41/ 96; p=0.0007) and noted to be less frequently in remission of IBD (12/54 vs. 51/96; p= 0.0033).Conclusions: There is an absence of data on predictors of cervical cancer screening among blacks with IBD. 36% of blacks seen in our institution had not had a Pap smear. Of those screened, 40% of women had an abnormal Pap smear. While older age, lower socioeconomic status, Crohn's disease, and exposure to immunosuppressants have been reported as independent predictors of lower use of cervical cancer screening, we instead found that less follow-up with a gastroenterologist and less disease remission were more common in those not screened. We encourage gastroenterologists,particularly those servicing nonwhite communities, to be mindful that women with IBD are at increased risk for cervical cancer and to take responsibility in having their patients screened. Comparison of IBD Black women with and without Pap Smears