Abstract Background Inflammatory bowel disease (IBD) and its treatments may increase opportunistic infections, but the link with human papillomavirus (HPV) remains unclear1. Immunosuppression and smoking can hinder viral clearance, favouring persistence and premalignant lesions. Despite guideline recommendations2,3, Spanish data on precancerous lesions, cervical cancer, and screening adherence in women with IBD are lacking. This study aimed to assess cervical screening practices and identify risk factors associated with HPV-related lesions in women with IBD. Methods We conducted a retrospective, multicentre, case-control study based on the ENEIDA registry, a nationwide, prospectively maintained database promoted by GETECCU. Women aged 25–65 years with a confirmed IBD diagnosis and at least one cervical cytology result recorded in the past ten years (2015–2024) were included in the study. Cases were defined as patients with pathological cytology, meaning the presence of low or high-grade squamous intraepithelial lesions, while controls were patients with normal cytology, defined as the absence of lesions or the presence of atypical squamous cells of undetermined significance according to the Bethesda classification. Results Twelve centres in Spain participated with a study population of 3,843. A total of 894 women were included (23% of the study population, interquartile range 13.8-41% per centre). Seventy-nine presented pathological cytology (8.8%) vs. 815 with normal cytology (91%). 48.7% with normal cytology vs. 67.1% with pathological cytology had Crohn’s disease (p = 0.001). 500 women (56%) required therapeutic immunosuppression during the follow-up period (70.9% has pathological cytology vs. 39.1% without immunosuppression, p = 0.005). Over a 10-year period, 68/500 immunosuppressed women (13.6%) had five or more cytologies. During the same period, 110/394 (28%) non-immunosuppressed women had three or more cytologies. 11.2% of women with immunosuppression vs. 5.8% without immunosuppression (p = 0.005) presented pathological cytology. 60.8% of women with pathological cytology were HPV vaccinated vs. 12.6% of women without pathology (p 0.001). Multivariate analysis showed that being younger than 48years (OR 2.03, p = 0.027) and perianal surgery (OR 3.045, p = 0.003) were associated with the risk of pathological cytology. Conclusion In this multicentre cohort of women with IBD who are of cervical screening age, compliance with the routine HPV detection program was suboptimal, especially among patients undergoing immunosuppression, although these patients had a higher prevalence of pathological cytology. These results reinforce the need to enhance screening and vaccination, prioritizing high-risk patients. References: 1. Allegretti JR, Barnes EL, Cameron A. Are patients with inflammatory bowel disease on chronic immunosuppressive therapy at increased risk of cervical high-grade dysplasia/cancer? A meta-analysis. Inflamm Bowel Dis. 2015;21(5):1089-1097. 2. Torné A, del Pino M, Andía D, Bruni L, Centeno C, Coronado P, et al. AEPCC-Guía: Prevención secundaria del cáncer de cuello del útero, 2022. Conducta clínica ante resultados anormales de las pruebas de cribado. Madrid: Asociación Española de Patología Cervical y Colposcopia (AEPCC); 2022. 3. Kucharzik T, Ellul P, Greuter T, et al. on behalf of the European Crohn’s and Colitis Organisation ECCO. ECCO Guidelines on the Prevention, Diagnosis, and Management of Infections in Inflammatory Bowel Disease. J Crohns Colitis. 2021;15(6):879-913. 4. Ferreiro-Iglesias R, Piqueras M, Ricart E, Sempere L, Roca M, Martín de Carpi J, Benítez O, Zabana Y, Mañosa M, Rodríguez-Moranta F, Barreiro-de Acosta M; en representación de GETECCU. Recommendations of the Spanish Group on Crohn’s Disease and Ulcerative Colitis on the importance, screening, and vaccination in inflammatory bowel disease patients. Gastroenterol Hepatol. 2022;45(10):805-818. Conflict of interest: Arnero, Arnau: No conflict of interest Borras Garriga, Pere: No conflict of interest Balcells, Laura: No conflict of interest Ruiz, Dolores: No conflict of interest Ponferrada Diaz, Angel: financial support for travelling and educational activities from Johnsson and Johnsson, AbbVie, Takeda, Alfasigma, Lilly, Faes Farma and Ferring. Piqueras Cano, Marta: No conflict of interest Lucendo, Alfredo: No conflict of interest Betoré Glaría, Elena: No conflict of interest Palau Barbera, Rosa: No conflict of interest Febles, Angel: No conflict of interest Moralejo Lozano, Óscar: I have received educational funding from Abbvie, Johnson & Johnson, Takeda, Kern Pharma, Alfasigma, Pfizer, Lilly, Sandoz, Dr. Falk Pharma, Ferring, and Tillotts. I have also served as a speaker for Abbvie, Takeda, Alfasigma, and Lilly. Teller, Marta: No conflict of interest Corsino, Pilar: No conflict of interest Redondo, Yune: No conflict of interest Merino Ochoa, Olga: No conflict of interest Brunet, Eduard: I have served as a speaker and consultant for Janssen and Chiesi, Kern, Takeda and Alfasigma. Dr. Zabana, Yamile: Personal Fees: AbbVie, Adacyte Therapeutics, Alfa-Sigma, Amgen, Boehringer Ingelheim, Dr Falk Pharma, FAES Pharma, Fresenius Kabi, Ferring, Galapagos, Janssen-J & J, Kern Pharma, Lilly, MSD, Pfizer, Sanofi, Sandoz, Takeda, Tillots Pharma Non-financial Support: Shire, Otsuka, Almirall
Artero et al. (Thu,) studied this question.