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Association of Geography With Screening and Development of Cervical Neoplasia in Those With Inflammatory Bowel
Quinn Goddard1,2, Stephanie Coward1,2, Cynthia H Seow1,2
1Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
Background:
While cancer risk is elevated in inflammatory bowel disease (IBD), results are less clear for cervical cancer. Screening has made cervical cancer relatively preventable, but geography impacts access, possibly increasing rates of cancer in rural and remote areas. We investigated (1) odds of cervical cancer, (2) cervical cancer screening participation, and (3) impact of geography (eg, rurality) and immunosuppression on the odds of cervical cancer and cervical cancer screening participation in the IBD population in Alberta, Canada.
Methods:
A population-based cohort using administrative healthcare databases (fiscal year 2003/04-2021/22) was used to identify females with IBD (n = 22 245), age- and sex-matched 10 to 1 to control subjects (n = 161 070). The average annual percent change of screening rates and incidence of cervical cancer was calculated through Poisson regression. The odds of cervical cancer were calculated with conditional logistic regression. The role of geography and immunosuppression were assessed in each analysis.
Results:
Individuals with IBD had lower odds of cervical cancer (odds ratio, 0.75; 95% confidence interval [CI], 0.68 to 0.83), but immunosuppressed individuals were at greater risk (odds ratio, 1.79; 95% CI, 1.48 to 2.15). Cases and controls had similar screening rates, but immunosuppressed individuals were screened more (incidence rate ratio, 1.05; 95% CI, 1.03 to 1.07). Screening declined among individuals with IBD (average annual percentage change, -5.15; 95% CI, -5.30 to -4.99), but incidence rates of cervical cancer remained stable (average annual percentage change, -1.95%; 95% CI, -4.25 to 0.41). While urban and metropolitan individuals with IBD were screened more, we observed no geographic variation in risk of cervical cancer.
Conclusions:
Similarities in screening between cases and controls suggest that lifestyle factors (eg, human papillomavirus vaccination, sexual history) may underpin the reduced odds of cervical cancer, rather than screening frequency. Efforts should be made to increase screening in immunosuppressed individuals.
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