Cervical Cancer Risk in Women with IBD

You may know that having inflammatory bowel disease (IBD) ups your risk of colon cancer, but did you know that women with IBD, especially Crohnís disease, are at an increased risk of developing cervical cancer? This disease will affect an estimated 12,900 women in the U.S. in 2015, and will kill 4,100, according to the American Cancer Society.

The characteristics of both Crohnís and ulcerative colitis (another form of IBD) include abdominal pain, bloody stools, cramping, diarrhea, fatigue, and lack of appetite. Symptoms may be mild or severe, but see your physician if you notice any changes to your bowel habits along with any of the above symptoms.

For the study, published in Clinical Gastroenterology and Hepatology, the researchers followed 27,408 Danish women with IBD for 35 years. Compared to a control group, women with ulcerative colitis or Crohnís disease were 12-26% more likely to have abnormal cervical cells, which can lead to cancer. What's more, women with Crohnís disease had a 53% increased risk of cervical cancer.

What IBD Patients Need to Know About Cervical Cancer Risk

In addition to IBD, there are cervical cancer risk factors you should know about:

  1. Not getting the HPV vaccine. The single most important thing you can do to prevent cervical cancerówhether you have IBD or notóis to get the Human Papilloma Virus (HPV) vaccine, says Bincy Abraham, MD, a gastroenterologist at Houston Methodist Hospital. HPV is associated with abnormal changes in cells, and cervical cancer. The vaccine is recommended for people ages 9 to 26, and has been shown to be effective in the prevention of cancers caused by HPV-16 and HPV-18. These forms of HPV are responsible for about 70 percent of all cases, according to the National Institutes of Health. While the recommendations are for the general population, Abraham says itís especially important for women with IBD, because the disease suppresses their immune system.

    "We know that immune suppression can contribute to increased virus replication," Abraham explains. "That means there is an increased risk of HPVís causing dysplasia [changes to cervical cells] and later cancer. The vaccine covers the four main [virus] strains that are linked to cancer," she adds. "If women with IBD are vaccinated, then their overall risk of HPV- associated cervical cancer is reduced."
  2. Having IBD and taking certain medications. The researchers found a significantly higher risk of abnormal cervical cells in women treated with the immune system suppressant azathioprine. Abraham says that immunosuppressants like azathioprine (prescribed to treat rheumatoid arthritis) and 6-mercaptopurine medications (used to treat IBD) have been shown to increase the risk of abnormal cervical cells.

    The study also noted that immunosuppressants called tumor necrosis factor-a (TNF-a) antagonists, used by people with IBD, rheumatoid arthritis, and other rheumatic diseases, may also up the risk of abnormal cervical cells.
  3. Using hormonal birth control methods. The study found that hormonal contraception devices, such as a patch, hormonal injections, vaginal ring (NuvaRing) and implants (Implanon), may play a role in the increased risk. There was no cause-and-effect found in the study, but if you have IBD, speak with your OB/GYN to determine the best option for you.

What Can You Do to Reduce Your Risk?

Keep up with your Pap tests, which screen for precancerous cells on the cervix. Current screening guidelines recommend all women ages 21 or older be screened for cervical cancer every three years. Abraham assures women with IBD that the same guidelines apply to them.

Finally, keep this good news in mind: If abnormal cell changes are found early, there is a good chance those cells might not develop into cancer if treated appropriately.

Bincy Abraham, MD, reviewed this article.

Sources

Bincy Abraham, MD. Email interview May 6, 2015.

"What Are the Key Statistics About Cervical Cancer?" American Cancer Society. Page last revised February 26, 2015.

"Diagnosing and Managing IBD." Crohnís & Colitis Foundation of America. April 30, 2011.

Rungoe, Christine, J. Simonsen, L. Riis, M. Frisch, E. Langholz, T. Jess. "Inflammatory Bowel Disease and Cervical Neoplasia: A Population-Based Nationwide Cohort Study." Clinical Gastroenterology and Hepatology 13, 4 (2015): 693-700. doi: 10.1016/j.cgh.2014.07.036. Epub 2014 Jul 30.

Karon, Amy. "Study Found Two-Way Link Between IBD and Cervical Cancer." GI & Hepatology News. April 1, 2015.

"Cervical Dysplasia." MedlinePlus. Page updated February 24, 2014.

Hariri, S., E. Dunne, M. Saraiya, E. Unger, L. Markowitz. Manual for the Surveillance of Vaccine-Preventable Diseases. Chapter 5: Human Papillomavirus (HPV). U.S. Centers for Disease Control and Prevention. Updated April 1, 2014.

"Cervical Cancer Screening Guidelines for Average-Risk Women." Centers for Disease Control and Prevention. Page accessed May 29, 2015.