Immunosuppressive therapy for inflammatory bowel disease does not increase womens risk of vulvar or vaginal cancer

However significantly earlier onset of vulvovaginal malignancies in IBD patients, compared with the general population, is reported by researchers in Digestive and Liver Disease


Oxford, March 11, 2020

In a new retrospective study, researchers found that the use of immunosuppressive therapy does not increase the occurrence or recurrence of vulvar or vaginal cancer in women with inflammatory bowel disease (IBD). However, earlier onset of cancer was reported, and lymphomas were found in some patients, which is very rare in the genital tract. Their results appear in Digestive and Liver Disease, published by Elsevier.

Immunosuppressive drugs are the cornerstone for treatment of IBD, but they have been associated with an increased risk of certain cancers including lymphoma and urinary tract cancer. A team of researchers in The Netherlands and the Dutch Workgroup on IBD and Vulvovaginal Neoplasia investigated whether the use of these drugs also increases the risk of vulvar and vaginal cancer.

The researchers retrieved histopathological data of all IBD patients with vulvovaginal malignancies from the nationwide network and registry of histopathology and cytopathology reports in the Netherlands (PALGA) over a 24-year period, from 1991 to 2015. Medical histories for these patients were obtained from their treating physicians, including demographics, medication history, HPV status, smoking and use of immunosuppressive drugs.

The rate of vaginal and vulvar carcinoma or pre-stage neoplasia in IBD patients did not differ significantly from that of the general population, the researchers found. In addition, in patients with IBD the use of immunosuppressive drugs did not increase the rate of these diseases. However, IBD patients who were treated with immunosuppressive therapy were, on average, 11 years younger than other IBD patients when their vaginal or vulvar cancer was diagnosed. Sixty-seven percent of the women with vulvovaginal cancers had Crohn’s disease versus 33 percent with ulcerative colitis.

“A high percentage of HPV-related tumors might explain the younger age at diagnosis. HPV is strongly associated with higher rates of vaginal cancer in the general population, and other research suggests that IBD patients are at an increased risk for other cancers including cervical cancer,” explained investigator Maxine D. Rouvroye, MD, PhD Candidate, Amsterdam UMC, Vrije Universiteit Amsterdam, Gastroenterology and Hepatology, Amsterdam Gastroenterology & Metabolism, Amsterdam, The Netherlands. “Unfortunately, our data on HPV status are incomplete, as HPV status was analyzed in very few cases.”

In a commentary accompanying the article, Vito Annese, MD, Valiant Clinic & American Hospital, Dubai, United Arab Emirates, noted, “These malignancies are clearly more frequent in Crohn’s disease patients, were frequently very advanced at the time of diagnosis, and sometimes atypical. Although the authors did not find evidence for more advanced screening yet, it is cautious to recommend yearly gynecological surveillance starting at 40, especially in patients with Crohn’s disease who are under immunosuppressive therapy.”

This study first appeared online in November 2019 and was subsequently published in the February 2020 issue of Digestive and Liver Disease. It is openly available here.

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Notes for editors
The article is “Vulvar and vaginal neoplasia in women with inflammatory bowel disease,” by Maxine D. Rouvroye, Greetje J. Tack, Constantine H. Mom, Brigit I. Lissenberg-Witte, Marieke J. Pierik, E. Andra Neefjes-Borst, Nanne K.H. de Boer, and the Dutch Workgroup on IBD and Vulvovaginal Neoplasia (https://doi.org/10.1016/j.dld.2019.10.002). The commentary is “IBD and malignancies: The gender matters,” by Vito Annese (https://doi.org/10.1016/j.dld.2019.10.006). They appear in Digestive and Liver Disease, volume 52, issue 2 (February 2020) published by Elsevier. The article and commentary are openly available.

Full text of the article and commentary is also available to credentialed journalists upon request; contact Victoria Wetherell at hmsmedia@elsevier.com. Journalists wishing to speak to the study’s authors should contact Maxine D. Rouvroye at m.rouvroye@amsterdamumc.nl. To reach Vito Annese for comment please contact him at vito.annese@valant.ae or Mrs. Akkela, Media & Marketing Office, at +971 4 378 2264 or 2151.

About Digestive and Liver Disease
Digestive and Liver Disease
is an international journal publishing papers on basic and clinical research in the fields of gastroenterology and hepatology. Contributions consist of Original Papers, Correspondence to the Editor, Editorials, Reviews and Special Articles, Progress Reports, Image of the Month, Congress Proceedings, Symposia, and Mini-symposia. www.dldjournalonline.com

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