Increased Awareness of the Cervical Cancer Risk and Need for Pap Smears in Women with Inflammatory Bowel Disease Is Necessary

Women with inflammatory bowel disease (IBD) are at increased risk for the development of cervical cancer. It has been suggested that women at increased risk, including IBD women, undergo annual Pap smears. However, there is no consensus regarding the frequency at which IBD women should undergo cervical cancer screening. This study evaluated the rate at which Pap smears were performed in women treated at a university inflammatory bowel disease center. Medical records of women with ulcerative colitis and Crohn's disease cared for at a university inflammatory bowel disease center during a three year period were evaluated. Patient age, disease type, and frequency of Pap smears were obtained. Patients were excluded if they had a hysterectomy, were not ageeligible for a Pap smear or their gynecologist or primary care providers were outside of the university and their medical records were not available. A database was created using Microsoft Excel. Statistical analysis was performed using Fisher's Exact test with significance set at P < 0.05. 130 medical records of IBD women were reviewed. There were 49 African-American and 81 non-African American women (mean age 41.95 years). 57 women had UC and 73 had Crohn's disease. 68 women with IBD were eligible to undergo Pap smears. 45 women (66.18%; 26 of 43 with UC, 19 of 25 with Crohn's disease) had a Pap smear performed. 23 had a Pap smear within the past 3 years and 22 (32.35%) women had their Pap smear within the past 1 year. Women with UC patients were significantly more likely (P = 0.0198) to have Pap smears compared to women with Crohn's disease. There was no significant difference in the rate at which women underwent cervical cancer screening based upon race (P = 0.2102). There was no significant difference (P = 1.0) in whether women with IBD had Pap smears were performed at 3 years or 1 year (P = 1.0). Women with UC compared to Crohn's disease more frequently had a Pap smear at 1 year (approaching significance at P = 0.0639) and were statistically more likely to undergo Pap smears at 3 years (P = 0.0198). There was no significant difference in the performance of Pap smears at 3 years (P = 0.2102) and at 1 year (P = 0.1563) based upon race. Woman at increased risk for the development of cervical cancer should undergo annual Pap smears. It has been suggested that since IBD women are at increased risk for cervical cancer, Pap smears should be performed more frequently than performed in the general population. This study revealed that IBD women inconsistently undergo Pap smears, with only twothirds of eligible patients undergoing cervical cancer screening. In addition, only half of the IBD women who had Pap smears had one performed within the past year. While this study limited due to size and retrospective design, it suggests that there should be heightened awareness among physicians and patients of the importance of cervical cancer in IBD women. There is also a need for a consensus on the appropriate frequency of Pap smear screening in patients with IBD.