Risk of uterine cervical cancer in inflammatory bowel disease: a systematic review and meta-analysis

Abstract

Background and aims

There are limited data on the association between uterine cervical cancer (UCC) and inflammatory bowel disease (IBD), which includes Crohn’s disease (CD) and ulcerative colitis (UC).

Methods

This systematic review and meta-analysis assessed the risk of UCC in patients with IBD. We searched MEDLINE, Embase, Cochrane Library, Scopus, Web of Science, ClinicalTrials.gov, gray literature and conference proceedings for studies published before 21 January 2022. Two reviewers independently screened studies, extracted data and assessed quality using the Newcastle–Ottawa Scale. Subgroup analyses were based on IBD type, biologic era, immunosuppression status, study location and design, and publication status. Fifteen studies were included.

Results

The pooled relative risk (RR) of UCC in IBD was 1.34 (95% confidence interval [CI], 1.07–1.69; I² = 53.4%). In subgroup analyses, the pooled RRs of UCC in CD and UC were 1.18 (95% CI, 0.97–1.42) and 1.50 (95% CI, 1.01–12.21), respectively. The pooled RRs of UCC in pre-biologic and biologic eras were 1.36 (95% CI, 0.83–2.23) and 1.99 (95% CI, 1.03–3.86), respectively. The pooled RR of UCC in immunomodulator users was 2.18 (95% CI, 0.81–5.87). The pooled RRs of UCC in Asia, Europe and North America were 5.65 (95% CI, 2.65–12.07), 1.13 (95% CI, 0.96–1.34) and 1.38 (95% CI, 1.10–1.73), respectively.

Conclusions

The risk of UCC was significantly increased in IBD, particularly in UC but not in CD, suggesting that women with IBD should undergo regular UCC screening and consider vaccination.

Keywords:

• Inflammatory bowel diseases
• uterine cervical neoplasms
• systematic review
• meta-analysis
• ulcerative colitis

Author contributions

JK: drafting the manuscript, analysis and interpretation of data. JHJ: drafting and revising the manuscript, substantial contributions to the conception or design of the work. HJ: substantial contributions to the conception or design of the work. MHK: substantial contributions to the conception or design of the work. DRK: substantial contributions to the conception or design of the work. HMK: final approval of the version to be published, critical revision for important intellectual content.

Disclosure statement

No potential competing interest was reported by the authors.

Data availability statement

Data, analytic methods and study materials will not be made available to other researchers.

Additional information

Funding

This study was supported by a grant from the Korean Gastrointestinal Endoscopy Research Foundation (2023 Investigation Grant).