P2603 - Risk of Gynecologic Malignancies in Females With Crohn’s Disease: A Multi-Network Study

Shaina Ailawadi, MD¹, Abdullah Mahmood, MD¹, Elleson G. Harper, BS¹, Jaime A. Perez, PhD², Preetika Sinh, MD³, Gregory Cooper, MD⁴, Vu Q. Nguyen, MD, MS⁴, Jeffry Katz, MD⁴, Fabio Cominelli, MD, PhD⁴, Miguel D Regueiro, MD⁵, Emad Mansoor, MD^4
1University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH; ²University Hospitals Clinical Research Center, Cleveland, OH; ³Medical College of Wisconsin, Milwaukee, WI; ⁴Digestive Health Institute, University Hospitals Cleveland Medical Center, Cleveland, OH; ⁵Cleveland Clinic, Cleveland, OH

Introduction: In females with Crohn’s Disease (CD), the nature of chronic inflammation and immune dysregulation can increase the risk of extraintestinal manifestations including gynecologic malignancies (GM). However, the evidence on the association of CD and GM is sparse and conflicting. Our study investigates the intersection between CD and women’s health by analyzing the incidence of GM in females with CD compared to irritable bowel syndrome (IBS) (a functional GI disorder), and rheumatoid arthritis (RA) (a chronic systemic inflammatory disorder).

Methods: Using TriNetX, a de-identified database of over 113 million patients, we performed a retrospective study identifying adult females with a diagnosis of CD (ICD-10: K50) who were prescribed at least one CD-specific medication or advanced therapy on or after January 1, 2015. Positive control groups included females with RA or IBS. We used propensity score matching (PSM) to balance cohorts based on demographics, Charlson Comorbidity Index, and risk factors for developing GM (Table 1). Outcomes included the incidence of cervical, vulvar, vaginal, endometrial, or ovarian cancer at least six months after diagnosis of IBD or RA and three months after a hospital/clinic visit for IBS. Odds ratios and 95% confidence intervals were reported and P-values < 0.05 were considered statistically significant.

Results: We identified 42,884 patients in our CD and RA group and 32,018 patients in our CD and IBS group after PSM. Compared to the IBS and RA control groups, the CD group showed no evidence of increased risk of developing cervical cancer, vaginal cancer, endometrial cancer, or ovarian cancer. However, there was a statistically significant increased risk of developing vulvar cancer among patients with CD compared to IBS (OR 2.168, 95% CI 1.240, 3.787, p=0.0005), but this risk was not increased compared to RA (OR 1.62, 95% CI 0.99, 2.64, p=0.052).

Discussion: This is the one of the first large retrospective population-based studies analyzing the incidence of GM in females with CD compared to an alternative inflammatory disease and a predominantly functional gastrointestinal disease. Our results show increased incidence of vulvar cancer in the CD population compared to IBS, without the increased risk of other GM. Isolated cases of vulvar neoplasms associated with CD have been reported, but further prospective studies are needed to evaluate this. Clinicians should encourage standard-of-care gynecologic surveillance protocols in patients with CD.


Disclosures:


Shaina Ailawadi, MD¹, Abdullah Mahmood, MD¹, Elleson G. Harper, BS¹, Jaime A. Perez, PhD², Preetika Sinh, MD³, Gregory Cooper, MD⁴, Vu Q. Nguyen, MD, MS⁴, Jeffry Katz, MD⁴, Fabio Cominelli, MD, PhD⁴, Miguel D Regueiro, MD⁵, Emad Mansoor, MD⁴. P2603 - Risk of Gynecologic Malignancies in Females With Crohn’s Disease: A Multi-Network Study, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.