S1583 Adherence to Cervical Cancer Screening and HPV Vaccination Recommendations Amongst IBD Patients on Immunosuppressive Medications

Introduction: Patients with inflammatory bowel disease (IBD) on immunosuppressive medications are at increased risk of developing low-grade cervical lesions, high-grade cervical dysplasia, and cervical cancer. American College of Gastroenterology (ACG) Clinical Guidelines for Preventative Care recommend annual cervical cancer screening for women on chronic immunosuppression and human papillomavirus (HPV) vaccination in all IBD patients. We evaluated the adherence to these guidelines, as well as American College of Obstetrics and Gynecology (ACOG) guidelines, in our IBD clinic. We also assessed the percentage of patients in our IBD clinic who completed a full HPV vaccination series. Methods: We performed a retrospective chart review of all patients in our IBD clinic through 2024. Women with an IBD diagnosis and ≥1 prescription for immunosuppressive therapy were included. ACG guideline compliance was defined as ≥1 Papanicolaou (Pap) smear annually, beginning at initiation of immunosuppressive therapy. ACOG guideline compliance was defined as: one Pap smear every 3 years for women aged 21-29; one Pap smear and HPV co-testing every 5 years, or one Pap smear every 3 years, or HPV testing alone every 5 years for women 30-65. A full schedule of HPV vaccination was defined as completion of either the 2- or 3-dose vaccination series. Descriptive statistics were used to calculate overall adherence rates. Results: Seventy patients met inclusion criteria. 17% (12/70) completed a full HPV vaccination series. 36% (25/70) received ≥1 dose of an HPV vaccine. Thirteen patients received either incomplete or improperly timed doses of HPV vaccines. Nine percent (6/70) were compliant with ACG guidelines for cervical cancer surveillance while 61% (43/70) were compliant with ACOG guidelines (compared to 67% at our primary care clinic in the same location). Barriers to providing this care included lack of awareness of current ACG guidelines, logistical challenges in coordinating care for required testing and vaccinations in the allotted time, and patient unwillingness or inability to complete invasive testing yearly. Conclusion: Our data demonstrate that compliance with ACG guidelines for cervical cancer screening is poor in our IBD clinic, which is consistent with earlier studies. These findings suggest that there are significant challenges in coordinating annual cervical cancer screening in patients with IBD. Raising awareness of this issue, improving patient education, and introducing programmatic screening within the field of gastroenterology, as well as amongst our primary care and obstetrics and gynecology colleagues, will be paramount to improving compliance with these guidelines.