P-027 YI Are Patients With Inflammatory Bowel Disease on Chronic Immunosuppressive Therapy at Increased Risk of Cervical High-Grade Dysplasia/Cancer? A Meta-Analysis
Bibliographic record
Abstract
Immunosuppression is a mainstay of therapy for both induction and maintenance of remission for moderate to severe inflammatory bowel disease (IBD). Women who are chronically immunosuppressed have been shown to be at higher risk of developing cervical high-grade dysplasia and/or carcinoma. There is contradictory data whether immunosuppressed patients with IBD have the same risk profile for cervical cancer as patients who are chronically immunosuppressed secondary to solid organ transplant or HIV infection. To determine if the risk of cervical high-grade dysplasia and/or cancer is higher in patients with IBD on immunosuppressive therapy compared to the rates in the general population. Data sources: A systematic review of English articles was performed using PubMed (1980–2014), Web of Science (1980–2014), and Embase (1980–2014). Additional studies were identified by searching bibliographies as well as abstracts. Search terms included Inflammatory Bowel Disease, Crohn’s Disease (CD), Ulcerative Colitis (UC), cervical cancer, and cervical dysplasia. The studies were restricted to full text retrospective cohort studies and case controls that had a high (6–9) Newcastle- Ottawa Score. These studies addressed rates of cervical high-grade dysplasia and cancer in patients with IBD on immunosuppressive medications compared to the general population. Independent extraction of articles by 3 authors using predefined data fields, as well as the Newcastle-Ottawa Scale for study quality. Data Synthesis: All pooled analyses were based on a random effects model. Five cohort studies and 3 case control studies of patients with IBD on any immunosuppression with cervical high-grade dysplasia/cancer (n = 995) were included in the meta-analysis. The total IBD population in these studies was 77,116. The duration of follow up and time on immunosuppression was variable but ranged from 2 to 36 years. IBD patients had an increased risk of cervical high-grade dysplasia/cancer compared to healthy controls (OR = 1.34, 95% CI, 1.23–1.46). Heterogeneity was detected (I2 = 34.23, Q = 10.64, df = 7; P = 0.15). The source of this heterogeneity was found to be from the type of study, as well as the OR presented (crude versus adjusted). Limitations: There were few studies that met the inclusion criteria of comparing the rates of cervical high-grade dysplasia/cancer in patients with IBD on immunosuppressive medication compared to the rates of high-grade dysplasia and cancer in the general population. The heterogeneity within the studies is also a constraint of the results in the study. There is sufficient evidence to suggest there is an increased risk of cervical high-grade dysplasia/cancer in patients with IBD on immunosuppressive medications compared to the general population. Given this increased risk, increased screening intervals are indicated compared to the current screening guidelines for the general population.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.026 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.014 | 0.059 |
| Bibliometrics | 0.005 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.004 | 0.003 |
| Insufficient payload (model declined to judge) | 0.009 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".