We read with interest the article by Dr de Bie and colleagues assessing the screening history of women with cervical cancer in which half were never screened before diagnosis. Given recent guideline revisions on cervical cancer screening, which no longer recommend routine annual examinations for all women, there is a need to promote the continued importance of screening, especially for women at increased risk. Women identified in guidelines as high-risk include women with human immunodeficiency virus or those previously treated for advanced cervical intraepithelial neoplasia. Although women with inflammatory bowel disease (IBD) are unnamed among the high-risk, numerous articles published in recent years support an increased risk of cervical abnormalities, largely attributed to the use of immunomodulators (eg, 6-mercaptopurine, antitumor necrosis factor), among these women.

We evaluated the rate of cervical cancer screening in women with IBD treated with aminosalicylates or immunomodulators. The medical records of 177 women with IBD seen at a university medical center, during a 2-year period, were reviewed. The mean age was 41 years (range, 19–85 years). Of the total, 75 patients between 20-35 years (mean 28 years) were identified. Papanicolaou (Pap) smears were performed in 48 (64%) from this younger cohort, and cervical dysplasia was found among the results of 8 (16.6%). None had a history of tobacco use. Women on aminosalicylates had 18 (37%) documented Pap smears, 2 (11%) exhibiting dysplasia, all human papilloma virus (HPV) negative. Women on immunomodulators had 30 (63%) documented Pap smears, 6 (20%) exhibiting dysplasia, 5 HPV positive. There were significantly less women on aminosalicylates with HPV compared with those on immunomodulators ( P = .02). This study revealed that women with IBD had suboptimal Pap smear performance and increased rates of cervical dysplasia and HPV infection, particularly those on immunomodulators. Although this study is limited by sample size and single institution evaluation, it nevertheless offers useful information to the growing literature supporting increased risk of HPV infection and cervical dysplasia in women with IBD.

de Bie and colleagues have shown that inadequate screening is the most important modifiable risk factor in the development of cervical cancer. Although current cervical cancer screening guidelines generally recognize immunosuppression as an indication for increased screening, we offer specific information on IBD as a condition requiring such vigilance.