Introduction ECCO guidelines strongly recommend regular cervical screening for women with inflammatory bowel disease (IBD), especially if treated with immunomodulators. We wanted to investigate if our immunosuppressed female IBD patients were being screened in accordance with the NHS Cervical Screening Programme (CSP) and identify if they were at increased risk of cytological abnormalities.
Method We searched our database for patients commenced on azathioprine, mercaptopurine, methotrexate, infliximab or adalimumab from June 2005 to October 2013. We excluded patients who were on these drugs for less than one year, were not of cervical screening age (25–64) or had had a hysterectomy. Information provided from general practitioners, local cytology department and Open Exeter (CSP database) were used to identify women participating in CSP and if they showed any abnormalities.
Results 153 patients met the criteria to participate in the CSP. 115 (75%) were up-to-date compared to a national participation rate of 78.3%. 25 (16%) had participated in the CSP but were not up-to-date at the time of report. 9 (6%) had not participated in the CSP and 4 (3%) actively declined participation. Date from the 2013 National CSP demonstrates that 5.3% of those screened displayed low grade abnormalities and 1.2% had high grade abnormalities. Of our 153 patients 13 (8.5%) had cytological abnormalities. 5 (3%) patients had abnormalities before immunosuppressive therapy with 1 (0.7%) patient showing high grade abnormality (moderate dyskaryosis with CIN1 confirmed) which subsequently remained negative whilst on immunosuppression. Our results identified 7 (4.6%) patients with low grade abnormal cytology results after commencing immunomodulators (3; borderline nuclear changes in squamous cells, 2; mild dyskaryosis, 2; low grade dyskaryosis and high risk HPV detected). Only 1 (0.7%) patient had high grade dyskaryosis during immunosuppression but their follow up cytology was negative.
Conclusion IBD patients are at increased risk of cytology abnormalities which is concerning since our CSP participation is below the national average. However data from our unit suggests that commencing immunosuppression therapy did not increase that risk any further. This data underlines that IBD specialists need to educate and encourage patients to participate in the CSP programme.
Disclosure of interest K. Wade Conflict with: Abbvie sponsorship to attend ECCO, H. Johnson: None Declared, H. Dewhurst: None Declared, S. Weaver Conflict with: been on advisory board for MSD and Abbvie but not for past 12 months, S. McLaughlin Conflict with: Abbvie sponsorship to attend DDW, Abbvie Advisory board, Ferring sponsorship to attend ECCO.