Cervical dysplasia and cancer and the use of hormonal contraceptives in Jamaican women

Abstract

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.

Spousal migration and human papillomavirus infection among women in rural western Nepal

“…22 The type of contraception used was included in the final models because it has been associated with abnormal cervical cytology in previous studies. 23,24 Multivariable logistic regression models were also used to determine odds ratios and 95% CI associated with an abnormal cervical cytology.…”

Neoplasia iNtraepitelial CerviCal: da etiopatogeNia ao desempeNho da teCNologia No rastreio e No seguimeNto

“…Contudo, estudos citados por McFarlane-Anderson et al reportam que a contracepção hormonal (pílulas ou injetáveis) aumenta o risco para o câncer cervical, particularmente em mulheres HPV-positivo, sugerindo que o contraceptivo oral atue como um promotor da carcinogênese induzida pelo HPV (25) . Em adição a qualquer efeito promotor direto do hormônio no desenvolvimento da displasia cervical, o uso de contraceptivos hormonais pode resultar ainda em maior frequência de atividade sexual desprotegida, colocando o indivíduo em maior risco de infecção pelo vírus HPV e outras doenças sexualmente transmissíveis (15,25) . Os mecanismos de interação entre HPV e esteroides sexuais não são totalmente esclarecidos (11) .…”

Racism and Disparities in Women’s Use of the Depo-Provera Injection in the Contemporary USA

“…The potential side effects of DP include irregular menstrual bleeding and weight gain (Berenson and Rahman, 2009;Matson et al, 1997), adverse effects on bone density (Pitts and Emans, 2008;Westhoff, 2003), a potentially increased risk of cervical cancer (McFarlane-Anderson et al, 2008), and an increased risk of sexually transmitted diseases (Martin et al, 1998;Morrison et al, 2007). Concerns about the potential carcinogenic side effects of DP were substantial enough that the US Food and Drug Administration (FDA) ruled against Upjohn's request to distribute DP for contraceptive purposes several times in the 1970s and 1980s (Caron, 2008).…”