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Screening for cervical and breast cancer among women with inflammatory bowel disease: A populationbased study

Singh, Harminder MD, MPH1,2,3; Nugent, Zoann PhD2,3,4; Demers, Alain A. PhD2,4; Bernstein, Charles N. MD1,3

doi: 10.1002/ibd.21567
Original Clinical Articles

Background: There are limited data on rates and predictors of cervical and/or breast cancer screening among women with inflammatory bowel disease (IBD). Immunosuppressant medications used to manage IBD may increase the risk of cervical cancer precursor lesions.

Methods: Women diagnosed with IBD prior to 2002 were matched to up to 10 Manitoba residents without the disease. Logistic regression analyses were performed to compare utilization of Papanicolaou (Pap) tests and mammograms in the two groups. Among women with IBD, we analyzed the differences in screening between those with and without exposure to immunosuppressant medications and/or corticosteroids and effect of age, socioeconomic status, prior diagnostic testing, and intensity of healthcare utilization.

Results: In all, 54% of the 2344 women with IBD and 52% of the 15,333 controls had regular Pap tests between 2002 and 2008. In multivariate analyses, older age, lower socioeconomic status, lower intensity of healthcare utilization, Crohn's disease, and exposure to immunosuppressant medications were independent predictors of lower use of Pap testing. Although there were no significant differences in the use of mammograms in women with or without IBD or among women with IBD with or without exposure to immunosuppressant medications, only 47% of women with IBD in the target age group had mammograms regularly.

Conclusions: Despite a need for higher testing, women with IBD on immunosuppressant medications are less likely to undergo Pap testing. Healthcare providers involved in the care of women with IBD need to remind these individuals about regular preventive care. (Inflamm Bowel Dis 2010;)

1Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada

2Community Health Sciences, University of Manitoba, Winnipeg Manitoba, Canada

3University of Manitoba IBD Clinical and Research Centre, Winnipeg, Manitoba, Canada

4CancerCare Manitoba, Canada, Department of Epidemiology and Cancer Registry, Winnipeg, Manitoba, Canada

Reprints: Harminder Singh, MD, MPH, Section of Gastroenterology, 805‐715 McDermot Ave., Winnipeg, Manitoba, Canada R3E3P4

Email: singh@cc.umanitoba.ca

Received 6 October 2010; Accepted 11 October 2010

Published online 12 November 2010 in Wiley Online Library (wileyonlinelibrary.com).

1 Dr. Singh is supported in part by an ACG Junior Faculty Development Grant. Dr. Bernstein is supported in part by a Research Scientist Award of the Crohn's and Colitis Foundation of Canada. Dr. Bernstein holds the Bingham Chair in Gastroenterology. In the past year Dr. Bernstein has been on the advisory board and/or received consultant fees from Abbott Canada and has received an unrestricted educational grant from Axcan Pharma.

© Crohn's & Colitis Foundation of America, Inc.
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