The relationship between hormonal contraception and cervical dysplasia/cancer controlling for human papillomavirus infection: A systematic review

Anastasiou, Elle; McCarthy, Katharine; Gollub, Erica L.; Ralph, Lauren; Wijgert, Janneke van de; Jones, Heidi E.

doi:10.1016/j.contraception.2021.10.018

Cited by 17 publications

(16 citation statements)

References 31 publications

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“…On the other hand, confounding by sexual behaviour may also explain the observed association 42 . Previous studies have found conflicting results regarding the association between oral contraceptive use and cervical carcinogenesis 43‐45 …”

Section: Discussionmentioning

confidence: 99%

Cervical precancer and cancer incidence among insured women with and without HIV in South Africa

Fernández Villalobos,

Ruffieux,

Haas

et al. 2023

Intl Journal of Cancer

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HIV infection increases the risk of developing cervical cancer; however, longitudinal studies in sub‐Saharan Africa comparing cervical cancer rates between women living with HIV (WLWH) and women without HIV are scarce. To address this gap, we compared cervical precancer and cancer incidence rates between WLWH and women without HIV in South Africa using reimbursement claims data from a medical insurance scheme from January 2011 to June 2020. We used Royston‐Parmar flexible parametric survival models to estimate cervical precancer and cancer incidence rates as a continuous function of age, stratified by HIV status. Our study population consisted of 518 048 women, with exclusions based on the endpoint of interest. To analyse cervical cancer incidence, we included 517 312 women, of whom 564 developed cervical cancer. WLWH had an ~3‐fold higher risk of developing cervical precancer and cancer than women without HIV (adjusted hazard ratio for cervical cancer: 2.99; 95% confidence interval [CI]: 2.40‐3.73). For all endpoints of interest, the estimated incidence rates were higher in WLWH than women without HIV. Cervical cancer rates among WLWH increased at early ages and peaked at 49 years (122/100 000 person‐years; 95% CI: 100‐147), whereas, in women without HIV, incidence rates peaked at 56 years (40/100 000 person‐years; 95% CI: 36‐45). Cervical precancer rates peaked in women in their 30s. Analyses of age‐specific cervical cancer rates by HIV status are essential to inform the design of targeted cervical cancer prevention policies in Southern Africa and other regions with a double burden of HIV and cervical cancer.

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Section: Discussionmentioning

confidence: 99%

Cervical precancer and cancer incidence among insured women with and without HIV in South Africa

Fernández Villalobos,

Ruffieux,

Haas

et al. 2023

Intl Journal of Cancer

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“…29,30 Current literature is inconsistent regarding the effect of OC intake on the development of cervical cancer, which is also associated with HPV status as a subset of HNC. 31,32 A protective effect of female endogenous and exogenous sex hormones in the development of HNC has been hypothesized. 11,12 Hashim et al 11 previously suggested the protective role of sex hormones in the development of HNC in female participants.…”

Section: Discussionmentioning

confidence: 99%

Exogenous Estrogen in the Development of Head and Neck Cancer

Doll,

Hofmann,

Preissner

et al. 2024

JAMA Otolaryngol Head Neck Surg

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ImportanceSex differences in head and neck cancer (HNC) incidence suggest a potential contribution of sex hormones.ObjectiveTo assess the role of exogenous estrogen exposure in the development of HNC in female patients.Design, Settings, and ParticipantsThis large multicenter cohort study using clinical records from the TriNetX real-world database included 20 years of data (through May 31, 2023) from 87 health care organizations. The TriNetX database was searched for medical records for female patients with and without exogenous estrogen exposure according to their chronological age. Cohort 1 included 731 366 female patients aged 18 to 45 years old with regular oral contraceptive (OC) intake and cohort 2 included 3 886 568 patients in the same age group who did not use OC. Cohort 3 comprised 135 875 female patients at least 50 years old receiving hormone replacement therapy (HRT), whereas cohort 4 included 5 875 270 patients at least 50 years old without HRT. Propensity score matching was performed for the confounders age, alcohol dependence, and nicotine dependence. Data analyses were performed in May 2023.Main Outcome and MeasuresDiagnosis of HNC (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision: C00-C14), and after propensity score matching (1:1 nearest-neighbor greedy matching), a risk analysis to investigate risk differences and risk ratios (RRs) with a 95% CI.ResultsAmong the 718 101 female patients in each of cohorts 1 and 2 (mean [SD] age at diagnosis, 25.9 [6.7] years), those with OC intake had a higher risk of an HNC diagnosis (RR, 1.47; 95% CI, 1.21-1.78) than those without OC use. Among the 131 835 female patients in each of cohorts 3 and 4 (mean [SD] age, 67.9 [12.0] years), those with postmenopausal HRT intake had a lower risk of an HNC diagnosis (RR, 0.77; 95% CI, 0.64-0.92) than those without HRT use.Conclusions and RelevanceThe findings of this cohort study illustrate a positive association between OC and a negative association between HRT and the development of HNC in female patients. Given the limitations of the TriNetX database, future research should include detailed information on the intake of OC and HRT and reproductive health information (eg, age at menarche/menopause, number of pregnancies) to more accurately define the strength and direction of the possible association between exogeneous estrogen exposure and the development of HNC in female patients.

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“…Whilst the National Institute for Health and Care Excellence (NICE) states that OCP use increases cervical cancer risk, the association is not well-established and has been the subject of debate among clinicians [ 56 , 57 ]. Several systematic reviews and meta-analyses concluded that there was no evidence to suggest that OCP use was associated with increased risk, whilst others concluded that hormonal contraceptives have the potential to affect the HPV-dependent pathway of carcinogenesis due to the cervix being an oestrogen-sensitive organ [ 58 , 59 , 60 , 61 , 62 ]. A recent systematic review and meta-analysis found that OCP use is significantly associated with cervical cancer, particularly adenocarcinomas [ 57 ].…”

Section: Other Risk Factorsmentioning

confidence: 99%

HPV and Cervical Cancer: A Review of Epidemiology and Screening Uptake in the UK

et al. 2023

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Cervical cancer is the fourth most common malignancy in females worldwide, and a leading cause of death in the United Kingdom (UK). The human papillomavirus (HPV) is the strongest risk factor for developing cervical intraepithelial neoplasia and cancer. Across the UK, the national HPV immunisation programme, introduced in 2008, has been successful in protecting against HPV-related infections. Furthermore, the National Health Service (NHS) implemented the cytology-based cervical cancer screening service to all females aged 25 to 64, which has observed a decline in cervical cancer incidence. In the UK, there has been an overall decline in age-appropriate coverage since April 2010. In 2019, the COVID-19 pandemic disrupted NHS cancer screening and immunisation programmes, leading to a 6.8% decreased uptake of cervical cancer screening from the previous year. Engagement with screening has also been associated with social deprivation. In England, incidence rates of cervical cancer were reported to be 65% higher in the most deprived areas compared to the least, with lifestyle factors such as cigarette consumption contributing to 21% of cervical cancer cases. In this article, we provide an update on the epidemiology of cervical cancer, and HPV pathogenesis and transmission, along with the current prevention programmes within the NHS.

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The relationship between hormonal contraception and cervical dysplasia/cancer controlling for human papillomavirus infection: A systematic review

Cited by 17 publications

References 31 publications

Cervical precancer and cancer incidence among insured women with and without HIV in South Africa

Cervical precancer and cancer incidence among insured women with and without HIV in South Africa

Exogenous Estrogen in the Development of Head and Neck Cancer

HPV and Cervical Cancer: A Review of Epidemiology and Screening Uptake in the UK

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