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P-123 Cervical Dysplasia May Occur More Frequently in White Women with Inflammatory Bowel Disease

BACKGROUND: Women with inflammatory bowel disease (IBD) may have an increased risk for cervical malignancy. Infection with human papilloma virus (HPV) and immunosuppression are proposed to be the primary factors for the increased rate of cervical dysplasia. Recommendations for increased frequency of Pap smears have been proposed. However, there are limited studies that have evaluated other factors that may be associated with cervical abnormalities and inflammatory bowel disease. This study evaluated the impact of patient race, IBD disease type and immunosuppressants upon cervical dysplasia in women with IBD. METHODS: A retrospective medical record review of women with inflammatory bowel disease at a university medical center during a 1.5 year period was performed. There were no exclusion criteria. Patient race, IBD type, and Pap smear results were obtained. Abnormal Pap smears were defined as evidence of HPV positivity or cervical dysplasia. A database, maintaining patient confidentiality, was created. Analysis was performed using Fisher Exact Test, with significance set at P < 0.05. The study was approved by the university IRB. RESULTS: 208 medical records were reviewed. There were 72 black, 67 white, 5 Hispanic, 3 Asian, and 61 patients with no ethnicity documented. The mean age was 43.0 years (95% confidence interval 41.0-45.0). One hundred eleven women had Crohn’s disease, 95 had ulcerative colitis and 2 had indeterminate colitis. One hundred seven women (51.4%; 42 black, 41 white, 1 Hispanic, 1 Asian, 22 with no ethnicity documented) had Pap smears. There was no significant difference in the rate at which Pap smears were performed based upon race (P = 0.4922). Fifty-five of 111 women with Crohn’s disease, 51 of 95 with ulcerative colitis and 1 of 2 with indeterminate colitis had Pap smears performed. There was no significant difference in the rate of Pap smears based on disease type (P = 0.578). Twenty-three women (30.8%; 4 black, 11 white, 1 Hispanic, 7 with no ethnicity documented) had abnormal Pap smears. There was a significant difference (P = 0.0495) in the rate at which 4 of 42 (9.5%) black and 11 of 41 (26.8%) white women had cervical dysplasia. Seven of 22 white women and 4 of 15 black women on immunosuppressants had abnormal Pap smears. There was no significant difference (P = 1.000) in the rate of abnormal Pap smears in white and black women who were on immunosuppressants. CONCLUSIONS: Despite the recognition that women with IBD may have an increased rate of cervical dysplasia, physicians inconsistently performed Pap smears. This study revealed that only one-half of IBD women had cervical cancer screening. While there was no difference in the frequency of Pap smears, white women had significantly greater rate of cervical dysplasia than black women. Notably, there was no difference in the cervical dysplasia rates in women of different races who were on immunosuppressants. Further study is necessary to clarify the potential impact of patient race upon cervical dysplasia in IBD. Increased awareness of cervical dysplasia risk is important to ensure optimum health outcome in women with inflammatory bowel disease.