Abnormal Pap smears in inflammatory bowel disease

Kane, Sunanda V.

doi:10.1002/ibd.20391

Cited by 25 publications

(22 citation statements)

References 15 publications

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“…Female patients with IBD, particularly those taking immunosuppressants, have an increased risk of cervical neoplasia; they are considered high risk and should undergo screening for cervical cancer per the American College of Gynecology guidelines. 63,64 Approximate Costs Both patients and primary care providers should be aware of the relatively high costs of advanced IBD therapies (Table 2). Fortunately, the manufacturers of these drugs have patient-assistance programs, which offer discounted or free therapies to eligible patients.…”

Section: Pregnancy and Family Planningmentioning

confidence: 99%

Advanced Therapy for Inflammatory Bowel Disease: A Guide for the Primary Care Physician

Thomas

Lodhia

2014

The Journal of the American Board of Family Medicine

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Primary care physicians care for patients with inflammatory bowel disease (IBD) who are receiving advanced therapies that include immunomodulator drugs (eg, azathioprine and methotrexate) and biologic therapy. These agents have significantly improved remission rates and the quality of life for patients suffering from IBD. However, patients taking these drugs need special care and counseling with regard to adverse effects, infection risk, cancer risk, and pregnancy. Newer treatment paradigms incorporate earlier use of biologic therapy, often in combination with immunomodulator drugs, to alter the natural course of the disease. Comprehensive care for these patients, including health maintenance, requires collaboration between primary care physicians and gastroenterologists. Despite their high cost, advanced therapies are likely to be cost-effective. This article discusses general concepts about azathioprine, 6-mercaptopurine, methotrexate, and common biologic drugs used in IBD. ( J Am Board Fam Med 2014;27:411-420.)

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Section: Pregnancy and Family Planningmentioning

confidence: 99%

Advanced Therapy for Inflammatory Bowel Disease: A Guide for the Primary Care Physician

Thomas

Lodhia

2014

The Journal of the American Board of Family Medicine

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“…An increased risk of cervical abnormalities has been reported in women with IBD [25,26] that does not appear to be related to IBD itself [27], but to various combinations of established risk factors for HPV-related cervix abnormalities, i.e. smoking, oral contraception, promiscuity and immunosuppression [28]. It has not been firmly demonstrated in the dedicated studies that the sole use of immunosuppressants is an independent major driver of the excess risk of cervix abnormalities [25,26].…”

Section: Uterine Cervix Abnormalitiesmentioning

confidence: 99%

“…It has not been firmly demonstrated in the dedicated studies that the sole use of immunosuppressants is an independent major driver of the excess risk of cervix abnormalities [25,26]. However, a yearly screening has been reasonably recommended in IBD women with IBD treated with an immunosuppressant [28]. In addition, HPV vaccination according to eligibility guidelines is recommended in women IBD patients [28], if possible, before the initiation of any immunosuppressive therapy [18].…”

Section: Uterine Cervix Abnormalitiesmentioning

confidence: 99%

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Immunosuppression-Related Lymphomas and Cancers in IBD: How Can They Be Prevented?

Beaugerie

2012

Dig Dis

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Most of the immunosuppressive therapy-associated excess lymphomas in IBD are due to a loss of control of Epstein-Barr virus (EBV) infection. Systemic EBV viral-load monitoring and preemptive treatments are extensively used in the posttransplant setting, but these methods have not yet been evaluated in IBD patients and cannot therefore be recommended in this context. However, the systemic EBV viral load should be measured in cases of unexplained fever, lymphadenopathy or hemophagocytic syndrome, in order to optimize the diagnostics of early EBV-related lymphoproliferations. The risk of hepatosplenic T cell lymphoma can, theoretically, be limited by avoiding prolonged combination therapy with thiopurines and anti-tumor necrosis factor (anti-TNF) beyond 2 years in young males. Young males seronegative for EBV are at risk for fatal forms of primary EBV infection, with postmononucleosis lymphoproliferation. This incidence could be limited by considering avoiding treatment with thiopurines in this subgroup of patients. There is a marked excess risk of nonmelanoma skin cancer in IBD patients currently or previously treated with thiopurines, which justifies lifelong sun protection and dermatological screening in these patients. The level of risk is still unclear for monotherapies with anti-TNF. An excess of human papilloma virus (HPV)-related uterine cervix dysplasia and cancer has been reported in various populations of women with IBD, but the proper role of immunosuppressive therapy remains to be quantified. However, yearly screening for uterine cervix abnormalities is recommended for all female IBD patients, along with HPV vaccination in young girls.

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“…This effect is reversible after discontinuation of thiopurines [8]. Regarding chronic HPV infection, it is unclear whether thiopurines are independent promoters of HPV-related uterine cervix dysplasia and cancer, among other factors such as smoking or multiple sexual partners [9]. …”

Section: Carcinogenic Effects Of Immunosuppressantsmentioning

confidence: 99%

Use of Immunosuppressants and Biologicals in Patients with Previous Cancer

Beaugerie¹

2013

Dig Dis

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Thiopurines promote Epstein-Barr virus-related lymphomas, nonmelanoma skin cancers and acute myeloid leukemias. Anti-tumor necrosis factor (anti-TNF) agents may inhibit or activate carcinogenesis according to the cellular pathways that are activated. A mild increase in the risk of melanoma has been reported in patients exposed to anti-TNF agents. Transplanted patients with previous history of cancer are at high risk of cancer recurrence when receiving posttransplant immunosuppressive therapy, particularly within the first 2 years of treatment. Few data exist for patients with chronic inflammatory disease. In the CESAME cohort that included essentially patients receiving thiopurines, there was no excess incidence of recurrent or new cancer associated with exposure to immunosuppressive therapy in the patients with previous cancer at cohort entry. In clinical practice, the decision to start or resume immunosuppressive therapy in inflammatory bowel disease (IBD) patients with recent cancer should be discussed case by case with cancer specialists. However, taken into account the experience of transplant specialists, it could be suggested not to consider a waiting period for women with adequately treated uterine high-grade cervical dysplasia. For invasive cancers, a waiting period of 2 years should be considered if possible. During this period, treatment of IBD should be restricted to 5-aminosalicylic acid, steroids, nutritional therapy, or surgery, except in case of aggressive IBD that cannot be controlled by these methods. A longer waiting period of 5 years could be recommended for the most aggressive forms of cancers, such as melanomas, aggressive breast cancers, sarcomas, urinary tract cancers, and myelomas.

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Abnormal Pap smears in inflammatory bowel disease

Cited by 25 publications

References 15 publications

Advanced Therapy for Inflammatory Bowel Disease: A Guide for the Primary Care Physician

Advanced Therapy for Inflammatory Bowel Disease: A Guide for the Primary Care Physician

Immunosuppression-Related Lymphomas and Cancers in IBD: How Can They Be Prevented?

Use of Immunosuppressants and Biologicals in Patients with Previous Cancer

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