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P-101 Women with Inflammatory Bowel Disease are Inadequately Counseled About Human Papillomavirus Screening by Physicians of Different Specialties

BACKGROUND: Human Papillomavirus (HPV) infection is the most common sexually transmitted disease. Although the majority of infections will cause no clinical symptoms and are self-limited, persistent infection with oncogenic HPV types is the primary cause of cervical cancer. Women with inflammatory bowel disease often receive care from multiple physicians. Given the increased risk of abnormal Pap smears in women with inflammatory bowel disease and the potential for an enhanced risk with the use of immunosuppressants, it is necessary that all physicians involved in the care of IBD women recognize the importance of cervical cancer screening. This study evaluated the rate at which women with IBD were counselled about HPV screening by providers from different medical specialties. METHODS: A retrospective medical records review of women with inflammatory bowel disease cared for at a university medical center was conducted. There were no exclusion factors. Patient age, race, medications, physicians and documentation of HPV risk counselling were obtained. Medication categories were non-immunosuppressants (aminosalicylates, antibiotics) and immunosuppressants (steroids, 6-mercaptopurine, Imuran, methotrexate, cyclosporine and anti-tumor necrosis factor agents). A database, maintaining patient confidentiality, was created. Statistical analysis was performed using Fisher Exact Test, with significance set at P < 0.05. The study was approved by the university Institutional Review Board. RESULTS: Two hundred eight medical records were reviewed. There were 72 blacks, 67 whites, 5 Hispanics, 3 Asians and 61 who did not have their ethnicity documented. The mean age was 43 years (95% confidence interval 41–45). Sixty-three of 208 (30.3%) received HPV counselling. Twenty-nine (46%) were counselled by an obstetrician/gynecologist (Ob-Gyn), 17 (27%) by an internist and 15 (23.8%) by a gastroenterologist (GI). Three (4.8%) women received counselling by both an Ob-Gyn and an internist. There was a significant difference in the rate at which Ob-Gyn counselled woman compared to internists (P = 0.0413) and GI (P = 0.0147). There was no difference (P = 0.8381) in the rate at which internists and GI counselled women about HPV risk. In the 29 women counselled by Ob-Gyn, 15 (51.7%) were on immunosuppressants. In the 17 women counselled by internists, 5 (29.4%) were on immunosuppressants. In the 15 women who were counselled by GI, 11 (73.3%) were on immunosuppressants. There was no significant difference in the rate at which Ob-Gyn counselled immunosuppressed women compared to internists (P = 0.2186) and GI (P = 0.2083). There was a significant difference (P = 0.0320) in the rate at which GI counselled immunosuppressed women compared to internists. CONCLUSIONS: This study revealed that there was inadequate documentation of HPV-risk counselling in women with inflammatory bowel disease. Medical specialties differ in the rates of counselling, with obstetrician-gynecologists counselling more frequently than internists and gastroenterologists. Notably, gastroenterologists were more likely to counsel women on immunosuppressants when compared to internists suggesting an awareness that HPV oncogenic potential is greater with immunosuppressant medications. It is important that physicians caring for women with inflammatory bowel disease, especially those on immunosuppressants, inform their patients of HPV-associated risks. Increased counselling of the risks associated with HPV infection by all physicians caring for women with inflammatory bowel disease is important to promote optimum health.