Gastroenterol Res

Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access

Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc

Journal website https://www.gastrores.org

Original Article

Volume 13, Number 5, October 2020, pages 208-216

Cervical Cancer Screening in Inflammatory Bowel Disease: Who Should Be Screening?

**Table 1.** Cervical Cancer Screening and Management in IBD Questionnaire
IBD: inflammatory bowel disease; Pap: Papanicolaou.
1. How comfortable are you performing Pap smears?
1) Comfortable
2) Not comfortable
2. How often do you take care of patients with IBD?
1) 0 to 5 patients every month
2) 6 to 10 patients every month
3) 10 to 15 patients every month
4) 15 or more patients every month
3. How familiar are you with the current recommendations for cervical cancer prevention and screening in patients with IBD?
1) Not familiar
2) Familiar
4. In general, based on your practice, when do you start screening for cervical cancer in female patients with IBD on immunosuppressive therapy using a Pap smear?
1) Not usually
2) At age 9 years irrespective of the time of sexual activity
3) At age 16 years irrespective of the time of sexual activity
4) At age 21 years irrespective of the time of sexual activity
5) At age 23 years irrespective of the time of sexual activity
6) At the time of sexual activity initiation but no later than age 9 years
7) At the time of sexual activity initiation but no later than age 16 years
8) At the time of sexual activity initiation but no later than age 21 years
9) At the time of sexual activity initiation but no later than age 23 years
5. In general, based on your practice, how often do you screen for cervical cancer in female patients with IBD on immunosuppressive therapy using a Pap smear?
1) Not usually
2) Every 1 year
3) Every 2 years
4) Every 3 years
5) Every 5 years
6. In general, based on your practice, what age group of patients with IBD do you routinely offer the HPV vaccination?
1) Not usually
2) Once the diagnosis of IBD is made (regardless of age)
3) 7 to 21 years old
4) 9 to 26 years old
5) 11 to 23 years old
7. In your opinion, in general, who should be in charge of managing (ordering, documenting, keeping track, and following up on results) cervical cancer screening and Pap smears for patients with IBD?
1) Primary care physician
2) Gynecologist
3) Gastroenterologist/IBD specialist
8. In your opinion, in general, who should be performing Pap smears for patients with IBD?
1) Primary care physician
2) Gynecologist
3) Gastroenterologist/IBD specialist

Table 1. Cervical Cancer Screening and Management in IBD Questionnaire

IBD: inflammatory bowel disease; Pap: Papanicolaou.

1. How comfortable are you performing Pap smears?

1) Comfortable

2) Not comfortable

2. How often do you take care of patients with IBD?

1) 0 to 5 patients every month

2) 6 to 10 patients every month

3) 10 to 15 patients every month

4) 15 or more patients every month

3. How familiar are you with the current recommendations for cervical cancer prevention and screening in patients with IBD?

1) Not familiar

2) Familiar

4. In general, based on your practice, when do you start screening for cervical cancer in female patients with IBD on immunosuppressive therapy using a Pap smear?

1) Not usually

2) At age 9 years irrespective of the time of sexual activity

3) At age 16 years irrespective of the time of sexual activity

4) At age 21 years irrespective of the time of sexual activity

5) At age 23 years irrespective of the time of sexual activity

6) At the time of sexual activity initiation but no later than age 9 years

7) At the time of sexual activity initiation but no later than age 16 years

8) At the time of sexual activity initiation but no later than age 21 years

9) At the time of sexual activity initiation but no later than age 23 years

5. In general, based on your practice, how often do you screen for cervical cancer in female patients with IBD on immunosuppressive therapy using a Pap smear?

1) Not usually

2) Every 1 year

3) Every 2 years

4) Every 3 years

5) Every 5 years

6. In general, based on your practice, what age group of patients with IBD do you routinely offer the HPV vaccination?

1) Not usually

2) Once the diagnosis of IBD is made (regardless of age)

3) 7 to 21 years old

4) 9 to 26 years old

5) 11 to 23 years old

7. In your opinion, in general, who should be in charge of managing (ordering, documenting, keeping track, and following up on results) cervical cancer screening and Pap smears for patients with IBD?

1) Primary care physician

2) Gynecologist

3) Gastroenterologist/IBD specialist

8. In your opinion, in general, who should be performing Pap smears for patients with IBD?

1) Primary care physician

2) Gynecologist

3) Gastroenterologist/IBD specialist

**Table 2.** Primary Care Physicians Versus Gastroenterologists
Questions	PCPs, n (%)	GIs, n (%)	χ²	P value
IBD: inflammatory bowel disease; GI/IBD: gastroenterologist or IBD specialist; PCP: primary care physician; GYN: gynecologist; SA: sexual activity; HPV: human papillomavirus. *P < 0.001.
1. Comfort level			1.11	0.29
Comfortable	62 (53.0)	15 (42.9)
Not comfortable	55 (47.0)	20 (57.1)
2. Number of IBD patients seen monthly			47.42	< 0.001*
0 - 5	114 (97.4)	19 (54.3)
6 - 10	3 (2.6)	9 (25.7)
10 - 15	0 (0)	3 (8.6)
15+	0 (0)	4 (11.4)
3. Familiarity with guidelines			34.20	< 0.001*
Not familiar	114 (97.4)	22 (62.9)
Familiar	3 (2.6)	13 (37.1)
4. Timing of cervical cancer screening			12.23	0.09
Not usually	12 (10.3)	8 (22.9)
Age 9, regardless SA	2 (1.7)	0 (0)
Age 16, regardless SA	6 (5.1)	1 (2.9)
Age 21, regardless SA	62 (53.0)	11 (31.4)
Age 23, regardless SA	6 (5.1)	0 (0)
At SA, no later than 9	0 (0)	0 (0)
At SA, no later than 16	7 (6.0)	4 (11.4)
At SA, no later than 21	18 (15.4)	10 (28.6)
At SA, no later than 23	4 (3.4)	1 (2.9)
5. Frequency of cervical cancer screening			26.16	< 0.001*
Not usually	27 (23.1)	11 (31.4)
1 year	21 (17.9)	19 (54.3)
2 years	10 (8.5)	2 (5.7)
3 years	56 (47.9)	3 (8.6)
5 years	3 (2.6)	0 (0)
6. Who is offered HPV vaccine			4.05	0.40
Not usually	15 (12.8)	8 (22.9)
Once diagnosed with IBD	10 (8.5)	4 (11.4)
Age 7 - 21	11 (9.4)	2 (5.7)
Age 9 - 26	67 (57.3)	15 (42.9)
Age 11 - 23	14 (12.0)	6 (17.1)
7. Who should be in charge			1.97	0.37
PCP	61 (52.1)	14 (40.0)
GYN	46 (39.3)	16 (45.7)
GI/IBD	10 (8.5)	5 (14.3)
8. Who should be performing			4.35	0.11
PCP	56 (47.9)	11 (31.4)
GYN	58 (49.6)	24 (68.6)
GI/IBD	3 (2.3)	0 (0)

Table 2. Primary Care Physicians Versus Gastroenterologists

Questions

PCPs, n (%)

GIs, n (%)

χ²

P value

IBD: inflammatory bowel disease; GI/IBD: gastroenterologist or IBD specialist; PCP: primary care physician; GYN: gynecologist; SA: sexual activity; HPV: human papillomavirus. *P < 0.001.

1. Comfort level

1.11

0.29

Comfortable

62 (53.0)

15 (42.9)

Not comfortable

55 (47.0)

20 (57.1)

2. Number of IBD patients seen monthly

47.42

< 0.001*

0 - 5

114 (97.4)

19 (54.3)

6 - 10

3 (2.6)

9 (25.7)

10 - 15

0 (0)

3 (8.6)

15+

0 (0)

4 (11.4)

3. Familiarity with guidelines

34.20

< 0.001*

Not familiar

114 (97.4)

22 (62.9)

Familiar

3 (2.6)

13 (37.1)

4. Timing of cervical cancer screening

12.23

0.09

Not usually

12 (10.3)

8 (22.9)

Age 9, regardless SA

2 (1.7)

0 (0)

Age 16, regardless SA

6 (5.1)

1 (2.9)

Age 21, regardless SA

62 (53.0)

11 (31.4)

Age 23, regardless SA

6 (5.1)

0 (0)

At SA, no later than 9

0 (0)

At SA, no later than 16

7 (6.0)

4 (11.4)

At SA, no later than 21

18 (15.4)

10 (28.6)

At SA, no later than 23

4 (3.4)

1 (2.9)

5. Frequency of cervical cancer screening

26.16

< 0.001*

Not usually

27 (23.1)

11 (31.4)

1 year

21 (17.9)

19 (54.3)

2 years

10 (8.5)

2 (5.7)

3 years

56 (47.9)

3 (8.6)

5 years

3 (2.6)

0 (0)

6. Who is offered HPV vaccine

4.05

0.40

Not usually

15 (12.8)

8 (22.9)

Once diagnosed with IBD

10 (8.5)

4 (11.4)

Age 7 - 21

11 (9.4)

2 (5.7)

Age 9 - 26

67 (57.3)

15 (42.9)

Age 11 - 23

14 (12.0)

6 (17.1)

7. Who should be in charge

1.97

0.37

PCP

61 (52.1)

14 (40.0)

GYN

46 (39.3)

16 (45.7)

GI/IBD

10 (8.5)

5 (14.3)

8. Who should be performing

4.35

0.11

PCP

56 (47.9)

11 (31.4)

GYN

58 (49.6)

24 (68.6)

GI/IBD

3 (2.3)

0 (0)

**Table 3.** GYNs Versus GIs
Questions	GYN, n (%)	GI, n (%)	χ²	P value
IBD: inflammatory bowel disease; GI/IBD: gastroenterologist or IBD specialist; PCP: primary care physician; GYN: gynecologist; SA: sexual activity; HPV: human papillomavirus. *P < 0.01.
1. Comfort level			38.58	< 0.001*
Comfortable	52 (100)	15 (42.9)
Not comfortable	0 (0)	20 (57.1)
2. Number of IBD patients seen monthly			22.94	< 0.001*
0 - 5	50 (96.2)	19 (54.3)
6 - 10	2 (3.8)	9 (25.7)
10 - 15	0 (0)	3 (8.6)
15+	0 (0)	4 (11.4)
3. Familiarity with guidelines			0.66	0.42
Not familiar	37 (71.2)	22 (62.9)
Familiar	15 (28.8)	13 (37.1)
4. Timing of cervical cancer screening			16.20	0.006*
Not usually	2 (3.8)	8 (22.9)
Age 9, regardless SA	0 (0)	0 (0)
Age 16, regardless SA	1 (1.9)	1 (2.9)
Age 21, regardless SA	37 (71.2)	11 (31.4)
Age 23, regardless SA	0 (0)	0 (0)
At SA, no later than 9	0 (0)	0 (0)
At SA, no later than 16	4 (7.7)	4 (11.4)
At SA, no later than 21	8 (15.4)	10 (28.6)
At SA, no later than 23	0 (0)	1 (2.9)
5. Frequency of cervical cancer screening			13.46	0.004*
Not usually	7 (13.5)	11 (31.4)
1 year	25 (48.1)	19 (54.3)
2 years	0 (0)	2 (5.7)
3 years	20 (38.5)	3 (8.6)
5 years	0 (0)	0 (0)
6. Who is offered HPV vaccine			14.30	0.006*
Not usually	4 (7.7)	8 (22.9)
Once diagnosed with IBD	3 (5.8)	4 (11.4)
Age 7 - 21	4 (7.7)	2 (5.7)
Age 9 - 26	40 (76.9)	15 (42.9)
Age 11 - 23	1 (1.9)	6 (17.1)
7. Who should be in charge			27.02	< 0.001*
PCP	1 (1.9)	14 (40.0)
GYN	49 (94.2)	16 (45.7)
GI/IBD	2 (3.8)	5 (14.3)
8. Who should be performing			10.20	0.001*
PCP	3 (5.8)	11 (31.4)
GYN	49 (94.2)	24 (68.6)
GI/IBD	0 (0)	0 (0)

Table 3. GYNs Versus GIs

Questions

GYN, n (%)

GI, n (%)

χ²

P value

IBD: inflammatory bowel disease; GI/IBD: gastroenterologist or IBD specialist; PCP: primary care physician; GYN: gynecologist; SA: sexual activity; HPV: human papillomavirus. *P < 0.01.

1. Comfort level

38.58

< 0.001*

Comfortable

52 (100)

15 (42.9)

Not comfortable

0 (0)

20 (57.1)

2. Number of IBD patients seen monthly

22.94

< 0.001*

0 - 5

50 (96.2)

19 (54.3)

6 - 10

2 (3.8)

9 (25.7)

10 - 15

0 (0)

3 (8.6)

15+

0 (0)

4 (11.4)

3. Familiarity with guidelines

0.66

0.42

Not familiar

37 (71.2)

22 (62.9)

Familiar

15 (28.8)

13 (37.1)

4. Timing of cervical cancer screening

16.20

0.006*

Not usually

2 (3.8)

8 (22.9)

Age 9, regardless SA

0 (0)

Age 16, regardless SA

1 (1.9)

1 (2.9)

Age 21, regardless SA

37 (71.2)

11 (31.4)

Age 23, regardless SA

0 (0)

At SA, no later than 9

0 (0)

At SA, no later than 16

4 (7.7)

4 (11.4)

At SA, no later than 21

8 (15.4)

10 (28.6)

At SA, no later than 23

0 (0)

1 (2.9)

5. Frequency of cervical cancer screening

13.46

0.004*

Not usually

7 (13.5)

11 (31.4)

1 year

25 (48.1)

19 (54.3)

2 years

0 (0)

2 (5.7)

3 years

20 (38.5)

3 (8.6)

5 years

0 (0)

6. Who is offered HPV vaccine

14.30

0.006*

Not usually

4 (7.7)

8 (22.9)

Once diagnosed with IBD

3 (5.8)

4 (11.4)

Age 7 - 21

4 (7.7)

2 (5.7)

Age 9 - 26

40 (76.9)

15 (42.9)

Age 11 - 23

1 (1.9)

6 (17.1)

7. Who should be in charge

27.02

< 0.001*

PCP

1 (1.9)

14 (40.0)

GYN

49 (94.2)

16 (45.7)

GI/IBD

2 (3.8)

5 (14.3)

8. Who should be performing

10.20

0.001*

PCP

3 (5.8)

11 (31.4)

GYN

49 (94.2)

24 (68.6)

GI/IBD

0 (0)

**Table 4.** PCPs Versus GYNs
Questions	PCP, n (%)	GYN, n (%)	χ²	P value
IBD: inflammatory bowel disease; GI/IBD: gastroenterologist or IBD specialist; PCP: primary care physician: GYN: gynecologist; SA: sexual activity; HPV: human papillomavirus. *P < 0.001.
1. Comfort level			36.24	< 0.001*
Comfortable	62 (53.0)	52 (100)
Not comfortable	55 (47.0)	0 (0)
2. Number of IBD patients seen monthly			0.21	0.65
0 - 5	114 (97.4)	50 (96.2)
6 - 10	3 (2.6)	2 (3.8)
10 - 15	0 (0)	0 (0)
15+	0 (0)	0 (0)
3. Familiarity with guidelines			26.13	< 0.001*
Not familiar	114 (97.4)	37 (71.2)
Familiar	3 (2.6)	15 (28.8)
4. Timing of cervical cancer screening			10.20	0.18
Not usually	12 (10.3)	2 (3.8)
Age 9, regardless SA	2 (1.7)	0 (0)
Age 16, regardless SA	6 (5.1)	1 (1.9)
Age 21, regardless SA	62 (53.0)	37 (71.2)
Age 23, regardless SA	6 (5.1)	0 (0)
At SA, no later than 9	0 (0)	0 (0)
At SA, no later than 16	7 (6.0)	4 (7.7)
At SA, no later than 21	18 (15.4)	8 (15.4)
At SA, no later than 23	4 (3.4)	0 (0)
5. Frequency of cervical cancer screening			20.14	< 0.001*
Not usually	27 (23.1)	7 (13.5)
1 year	21 (17.9)	25 (48.1)
2 years	10 (8.5)	0 (0)
3 years	56 (47.9)	20 (38.5)
5 years	3 (2.6)	0 (0)
6. Who is offered HPV vaccine			7.61	0.11
Not usually	15 (12.8)	4 (7.7)
Once diagnosis with IBD	10 (8.5)	3 (5.8)
Age 7 - 21	11 (9.4)	4 (7.7)
Age 9 - 26	67 (57.3)	40 (76.9)
Age 11 - 23	14 (12.0)	1 (1.9)
7. Who should be in charge			45.17	< 0.001*
PCP	61 (52.1)	1 (1.9)
GYN	46 (39.3)	49 (94.2)
GI	10 (8.5)	2 (3.8)
8. Who should be performing			30.94	< 0.001*
PCP	56 (47.9)	3 (5.8)
GYN	58 (49.6)	49 (94.2)
GI/IBD	3 (2.3)	0 (0)

Table 4. PCPs Versus GYNs

Questions

PCP, n (%)

GYN, n (%)

χ²

P value

IBD: inflammatory bowel disease; GI/IBD: gastroenterologist or IBD specialist; PCP: primary care physician: GYN: gynecologist; SA: sexual activity; HPV: human papillomavirus. *P < 0.001.

1. Comfort level

36.24

< 0.001*

Comfortable

62 (53.0)

52 (100)

Not comfortable

55 (47.0)

0 (0)

2. Number of IBD patients seen monthly

0.21

0.65

0 - 5

114 (97.4)

50 (96.2)

6 - 10

3 (2.6)

2 (3.8)

10 - 15

0 (0)

15+

0 (0)

3. Familiarity with guidelines

26.13

< 0.001*

Not familiar

114 (97.4)

37 (71.2)

Familiar

3 (2.6)

15 (28.8)

4. Timing of cervical cancer screening

10.20

0.18

Not usually

12 (10.3)

2 (3.8)

Age 9, regardless SA

2 (1.7)

0 (0)

Age 16, regardless SA

6 (5.1)

1 (1.9)

Age 21, regardless SA

62 (53.0)

37 (71.2)

Age 23, regardless SA

6 (5.1)

0 (0)

At SA, no later than 9

0 (0)

At SA, no later than 16

7 (6.0)

4 (7.7)

At SA, no later than 21

18 (15.4)

8 (15.4)

At SA, no later than 23

4 (3.4)

0 (0)

5. Frequency of cervical cancer screening

20.14

< 0.001*

Not usually

27 (23.1)

7 (13.5)

1 year

21 (17.9)

25 (48.1)

2 years

10 (8.5)

0 (0)

3 years

56 (47.9)

20 (38.5)

5 years

3 (2.6)

0 (0)

6. Who is offered HPV vaccine

7.61

0.11

Not usually

15 (12.8)

4 (7.7)

Once diagnosis with IBD

10 (8.5)

3 (5.8)

Age 7 - 21

11 (9.4)

4 (7.7)

Age 9 - 26

67 (57.3)

40 (76.9)

Age 11 - 23

14 (12.0)

1 (1.9)

7. Who should be in charge

45.17

< 0.001*

PCP

61 (52.1)

1 (1.9)

GYN

46 (39.3)

49 (94.2)

10 (8.5)

2 (3.8)

8. Who should be performing

30.94

< 0.001*

PCP

56 (47.9)

3 (5.8)

GYN

58 (49.6)

49 (94.2)

GI/IBD

3 (2.3)

0 (0)