Inflammatory Bowel Diseases

The Incidence and Prevalence of Human Papilloma Virus–associated Cancers in IBD

Abstract Aim The human papilloma virus has been associated with anal, cervical, vaginal, and penile cancers. The primary aim of this population-based study is to determine whether HPV-associated cancers are more commonplace in patients with inflammatory bowel disease (IBD). Method The Hospital Episode Statistics (HES) database from 1997 to 2012, linked with officer for age standardized rates (ASR), were calculated using population data, and Cox regression analysis was used to determine whether IBD patients have poorer survival compared with non-IBD patients. Results A total of 61,648 patients were included in this study; of these, 837 patients had a preexisting diagnosis of IBD (1.4%). Inflammatory bowel disease patients had a significantly higher ASR of anal cancers than the non-IBD population: 5.5 per 100,000 in the IBD group compared with 1.8 in the non-IBD group. The IBD group was also diagnosed with anal cancers at a younger age (60 years compared with 66 years in the non-IBD group, P < 0.001). The survival of IBD patients with anal cancer was also poorer than the non-IBD group (hazard ratio, 1.32; 95% confidence interval, 1.15–1.52; P < 0.001). On average, survival was significantly shorter in the IBD group with anal cancer (46 months) compared with the non-IBD group (61 months, P < 0.001). Age standardized rates for cervical cancer was significantly higher in the IBD group (5.2 of 100,000) compared with the non-IBD group (4.6 of 100,000 P = 0.042). Conclusion Patients with IBD have a higher rate of anal cancer compared with the general population. Survival is also worse for anal cancers in the IBD group.

Interventions to Improve Adherence to Preventive Care in Inflammatory Bowel Disease: A Systematic Review

Abstract Background Preventive health measures reduce treatment and disease-related complications including infections, osteoporosis, and malignancies in patients with inflammatory bowel disease (IBD). Although guidelines and quality measures for IBD care highlight the importance of preventive care, their uptake remains variable. This systematic review evaluates interventions aimed at improving the rates of provision and uptake of preventive health measures, including vaccinations, bone density assessment, skin cancer screening, cervical cancer screening, and smoking cessation counseling. Methods We searched PubMed, MEDLINE, EMBASE, and CENTRAL for full text articles published until March 2021. Studies were included if they evaluated interventions to improve the provision or uptake of 1 or more preventive health measures in adult IBD patients and if they reported pre- and postintervention outcomes. Results In all, 4655 studies were screened, and a total of 17 studies were included, including 1 randomized controlled trial, 1 cluster-controlled trial, and 15 prospective interventional studies. A variety of interventions were effective in improving the rates of adherence to preventive health measures. The most common interventions targeted gastroenterologists, including education, electronic medical records tools, and audit feedback. Other interventions targeted patients, such as education, questionnaires, and offering vaccine administration at clinic visits. Few interventions involved IBD nurses or primary care physicians. Conclusions A range of interventions—targeted at gastroenterologists, patients, or both—were effective in improving the provision and uptake of preventive care. Future studies should involve randomized controlled trials evaluating multifaceted interventions that target barriers to adherence and involve IBD nurses and primary care physicians.

Association of Geography With Screening and Development of Cervical Neoplasia in Those With Inflammatory Bowel Disease

Abstract 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.