Cervical Cancer Screening in Inflammatory Bowel Disease Patients: Practice and Perceptions of Responsibility Among Gastroenterologists and Internists

Introduction: IBD is a spectrum of diseases that include Ulcerative Colitis and Crohn's disease. IBD patients are at increased risk of complicating illnesses, which are exaggerated by the use of immunemodulators and biologic agents. Despite established guidelines, it is suspected that cervical cancer (CCA) screening in this population is less than ideal, and it is unclear whether the assumed responsibility of CCA screening falls under gastroenterologists (GI) or internists (IM). Methods: We anonymously surveyed 33 GI and 96 IM physician affiliates or trainees of Saint Louis University using paper self-administered instruments. The study questionnaire was developed based on recommendations published by the American College of Gastroenterology and American College of Obstetricians and Gynecologists. Results: Response rates were 90.9 % (GI) and 100% (IM). As outlined in table 1, GI and IM were as likely to offer HPV vaccine and start screening for CCA at the correct age. However, GI were more likely to screen for CCA annually. GI were more likely to report familiarity with current recommendations for CCA prevention and screening in IBD patients. Interestingly, of the GI who reported familiarity with current recommendations, 8 (72.7%) indicated routinely providing HPV vaccines to patients of ages 9 to 26 years old, 7 (63.6%) indicated completing CCA screening every year, and 4 (36.3%) indicated starting CCA screening at the time of sexual activity initiation but no later than age 21 years. Finally, with regards to CCA screening and Pap smear management (ordering, documenting, keeping track, and following up on results), GI and IM were as likely to report that GI should manage (13% vs. 3.13%), IM should manage (43% vs. 53.13%) and Obstetrician-gynecologists (Ob/Gyn) should manage (43% vs. 37.5%). However, with regards to performing Pap smears, GI and IM were as likely to report that GI should perform (0% vs. 3.13%), IM should perform (37% vs. 51.04%) and Ob/Gyn should perform (63% vs. 45.83%).661 Figure 1. ˆ1Data represent number (%) of respondents. ˆ2Data represent percentage points. GI, gastroenterologists; IM, internists; CCA, cervical cancer; IS, immunosuppressive therapy; 95% CI, 95% confidence interval. P value is 2-sided.Conclusion: CCA screening in IBD patients does not have a clearly defined protocol regarding which specialty should manage and/or perform Pap smears. GI may encounter more IBD patients, but they are not more likely to manage and perform screening. However, they do overall appear to be more familiar with CCA screening guidelines. This survey highlights the discrepancy between knowledge of CCA screening guidelines in IBD patients versus reality of practice.