Association of Geography With Screening and Development of Cervical Neoplasia in Those With Inflammatory Bowel Disease
Bibliographic record
Abstract
BACKGROUND: While cancer risk is elevated in inflammatory bowel disease (IBD), results are less clear for cervical cancer. Screening has made cervical cancer relatively preventable, but geography impacts access, possibly increasing rates of cancer in rural and remote areas. We investigated (1) odds of cervical cancer, (2) cervical cancer screening participation, and (3) impact of geography (eg, rurality) and immunosuppression on the odds of cervical cancer and cervical cancer screening participation in the IBD population in Alberta, Canada. METHODS: A population-based cohort using administrative healthcare databases (fiscal year 2003/04-2021/22) was used to identify females with IBD (n = 22 245), age- and sex-matched 10 to 1 to control subjects (n = 161 070). The average annual percent change of screening rates and incidence of cervical cancer was calculated through Poisson regression. The odds of cervical cancer were calculated with conditional logistic regression. The role of geography and immunosuppression were assessed in each analysis. RESULTS: Individuals with IBD had lower odds of cervical cancer (odds ratio, 0.75; 95% confidence interval [CI], 0.68 to 0.83), but immunosuppressed individuals were at greater risk (odds ratio, 1.79; 95% CI, 1.48 to 2.15). Cases and controls had similar screening rates, but immunosuppressed individuals were screened more (incidence rate ratio, 1.05; 95% CI, 1.03 to 1.07). Screening declined among individuals with IBD (average annual percentage change, -5.15; 95% CI, -5.30 to -4.99), but incidence rates of cervical cancer remained stable (average annual percentage change, -1.95%; 95% CI, -4.25 to 0.41). While urban and metropolitan individuals with IBD were screened more, we observed no geographic variation in risk of cervical cancer. CONCLUSIONS: Similarities in screening between cases and controls suggest that lifestyle factors (eg, human papillomavirus vaccination, sexual history) may underpin the reduced odds of cervical cancer, rather than screening frequency. Efforts should be made to increase screening in immunosuppressed individuals.
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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 | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
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".