S1048 Cervical Cancer Screening for Patients With Inflammatory Bowel Disease: A Tertiary Care Center Experience

Abstract

Introduction: Evidence has suggested an increased risk of cervical high-grade dysplasia and cancer in females with Inflammatory Bowel Disease (IBD) on immunosuppressive medications. Therefore, gastroenterology societies have recommended annual cervical cancer screening for this IBD specific population. This is ultimately performed to improve earlier detection of cervical cancer in high-risk patients. Methods: A sample of patients were selected from a medical records database at a tertiary care. Inclusion criteria included a confirmed diagnosis of Ulcerative Colitis (UC) or Crohn’s Disease (CD) and an established primary care clinic relationship with the internal medicine residents or non-teaching internists of the same medical center. General Demographics, referrals to Obstetrics/Gynecology, department from where the referrals were placed, performance of the Papanicolaou tests, results of the tests, and the dates of the tests were tabulated and studied. Information relating to the clinical aspects of IBD including current and previous medical therapies was also collected. Results: A total of 30 patients with a diagnosis of IBD receiving biologic therapy were included in the study. 23 patients were cared for in the resident clinic and 7 were followed by non-teaching internists. 9 out of 30 patients had not completed a Papanicolaou test and all of whom were diagnosed with IBD beyond three years of the time of data collection. Of the 21 patients who completed the first Papanicolaou test, 19 had normal results, the remaining 2 had atypical squamous cells of undetermined significance. No further procedures, such as colposcopy or LEEP, were performed in these 2 patients. No statistically significant difference was found in patients receiving their first Papanicolaou test between CD and UC patients. 10 out of the 19 patients with initial normal results completed their second Papanicolaou test, however there was a median of 581.5 days between the two screenings. Only 8 patients completed a third Papanicolaou test. Of the 30 patients, only 6 were referred to Obstetrics/Gynecology, with all these referrals being made by internal medicine physicians. Conclusion: Although the sample size was small, this study does demonstrate a gap in current application of cervical cancer screening guidelines in this high risk IBD population. Ultimately, a follow up study to evaluate the provider and patient knowledge as well as adherence to screening guidelines would be needed to highlight reasons for this gap in care.