There is increased risk of several malignancies in inflammatory bowel disease (IBD). However, evidence regarding risk of cervical cancer in IBD is conflicting. We aimed to investigate the risk for cervical cancer in IBD by undertaking a systematic review and meta-analysis of unselected, population-based studies.
Medline, Embase and Cochrane library were searched using Medical Subject Heading (MeSH) terms and 2 reviewers independently screened results. Pooled hazard ratios (HR) were calculated using random effects model (REM) meta-analysis for risk of cervical cancer in IBD. Subgroup meta-analysis was undertaken to assess risk of cervical cancer by IBD subtype (Crohn’s disease [CD] and ulcerative colitis [UC]), treatment exposure and grade of lesion.
We screened 1,393 articles to identify 5 population-based studies, including 74,310 IBD patients and 2,029,087 reference patients across 5 different countries. Pooled REM meta-analysis of these studies did not show statistically significant increased risk for cervical cancer in IBD compared with reference populations (HR: 1.24; 95% confidence interval [CI]: 0.94-1.63). Meta-analysis by grade of lesion showed increased risk of low-grade cervical lesions (HR: 1.15; 95% CI: 1.04-1.28). Meta-analysis by disease subtype indicated no statistically significant increased risk in CD (HR: 1.36; 95%CI: 0.83-2.23) or UC (HR: 0.95; 95%CI: 0.72-1.25), or in patients treated with anti-tumor necrosis factor (TNF) (HR: 1.19; 95% CI: 0.64-2.21) or thiopurines (HR: 0.96; 95% CI: 0.60-1.50).
CONCLUSIONS: This meta-analysis of high-quality, unselected population-based studies shows no statistically significant increased risk of cervical cancer in IBD patients. There is, however, increased risk of low-grade cervical lesions compared with the general population.