BackgroundThis study was conducted to determine whether use of hormonal contraceptives is associated with cervical dysplasia and cancer in a population where there is widespread use of hormonal contraception and the rates of cervical cancer remain high at 27.5/100,000.MethodsA case-control study was conducted among women visiting the colposcopy and gynaelogical clinics at a tertiary referral hospital. Two hundred and thirty six cases CIN I (72), II (59), III (54), cancer (51) and 102 controls, consented and were interviewed on use of contraceptives using a structured questionnaire. Logistic regression was used to determine odds ratios (ORs) and 95% confidence intervals (CIs) associated with use of hormonal contraception in cases and controls and in low and high risk cases. Recruitment was carried out from 2001–2002.ResultsContraceptives used were: oral contraceptives – 35%, injections (depot medroxy progesterone acetate (Depo-provera) – 10%, Intrauterine devices – 2%, combinations of these and tubal ligation – 30%. 23% reported use of 'other' methods, barrier contraceptives or no form of contraception. Barrier contraceptive use was not significantly different between cases and controls. Current and/or past exposure to hormonal contraceptives (HC) by use of the pill or injection, alone or in combination with other methods was significantly higher in the cases. In multivariate analysis with age and number of sexual partners as co-variates, use of hormonal contraception was associated both with disease, [OR, 1.92 (CI 1.11, 3.34; p = 0.02] and severity of the disease [OR, 2.22 (CI 1.05, 4.66) p = 0.036]. When parity and alcohol consumption were added to the model, hormonal contraception was no longer significant. The significant association with high risk disease was retained when the model was controlled for age and number of sexual partners. Depo-provera use (with age and number of sexual partners as covariates) was also associated with disease [OR, 2.43 (CI 1.39, 4.57), p = 0.006] and severity of disease [OR 2.51 (1.11, 5.64) p = 0.027]. With parity and alcohol added to this model, depo-provera use retained significance. Exposure to HC > 4 years conferred more risk for disease and severity of disease.ConclusionHormonal contraception did confer some risk of dysplasia and women using HC should therefore be encouraged to do regular Pap smear screening.
In Jamaica, as in other developing countries, cervical cancer is the most common cancer among females with rates of 27.5 per 100 000 and is second only to breast cancer as a cause of cancer death in women w1x. The objective of the present study was to assess whether lifestyle factors and sexual practices are associated with development of cervical dysplasia. Risk factors were compared in 242 women recruited from the Colposcopy Clinic, University Hospital of the West Indies (abnormal Pap smears) and a control group (ns 102) without a history of abnormal Pap smear results. Diagnosis of the cases was confirmed by colposcopic biopsy histology. Data were collected by a female interviewer and associations analyzed using SSPS software (version 11).Most women were single (72% of cases and 70.1% of the controls), very few smoked-(12% of the cases and 6.3% of the controls). Alcohol consumption was significantly higher among cases (20.3% cases compared with 10.4% controls) Table 1.
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