Abstract
Background: Cervical cancer is caused by specific types of the human papilloma virus (HPV), but not all infected women develop cancer. It has been hypothesized that hormonal contraceptives may potentiate the oncogenicity of HPV infection. Methods: In a case–control study of colored and black women in the Western Cape Province, South Africa, 524 incident cases of clinically evident invasive cervical cancer (stages lb–1V) were compared with 1541 controls, and with a subgroup of 254 HPV-positive controls. Findings: For injectable progestogen contraceptives (95% of which were depot medroxyprogesterone acetate) the overall relative risk, adjusted for confounding, was 1.0 (95% confidence interval 0.8–1.3); for combined estrogen/progestogen oral contraceptives the corresponding estimate was 0.8 (0.7–1.1). When the data were divided into categories of duration of use extending to ≥15 years, or according to age, ethnic group, or recency of use, there was no consistent evidence of an increased risk. The findings were unchanged when the cases were compared with the HPV-positive controls. Interpretation: The present findings suggest that neither injectable progestogen-only nor combined estrogen/progestogen oral contraceptives increase the risk of clinically evident invasive cancer of the cervix.
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Parkin DM, Pisani P, Ferlay J (1999) Estimates of the worldwide incidence of 25 major cancers in 1990. Int J Cancer 80: 827-841.
Walboomers JMM, Jacobs MV, Manos MM, et al. (1999) Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol 189: 12-19.
Woodman CBJ, Collins S, Winter H, et al. (2001) Natural history of cervical human papillomavirus infection in young women: a longitudinal cohort study. Lancet 357: 1831-1836.
La Vecchia C (1994) Depot-medroxyprogesterone acetate, other injectable contraceptives, and cervical cancer. Contraception 49: 223-229.
IARC Working Group (1999) IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. Vol. 72. Hormonal Contraception and PostMenopausal Hormonal Therapy. Lyon: International Agency for Research on Cancer.
Ostor AG (1993) Natural history or cervical intraepithelial neoplasia: a critical review. Int J Gynecol Pathol 12: 186-192.
Sitas F, Madhoo J, Wessie J (1998) Incidence of Histologically Diagnosed Cancer in South Africa 1993-1995. Johannesburg National Cancer Registry of South Africa, South African Institute of Medical Research.
Bailie R, Katznellenbogen J, Hoffman M, et al. (1997) A case control study of breast cancer risk and exposure to injectable progestogen contraceptives. S Afr Med J 87: 302-305.
Schlecht NF, Kulaga S, Robitaille J, et al. (2001) Persistent human papillomavirus infection as a predictor of cervical intraepithelial neoplasia. JAMA 24: 3016-3014.
Roche JK, Crum CP (1991) Local immunity and the uterine cervix: implications for cancer-associated viruses. Cancer Immunol Immunother 33: 203-209.
Pater MM, Mittal R, Pater A (1994) Role of steroid hormones in potentiating transformation of cervical cells by human papilloma viruses. Trends Microbiol 2: 229-234.
Monsonego J, Magdalenat H, Catalan F, et al. (1991) Estrogen and progesterone receptors in cervical human papillomavirus related lesions. Int J Cancer 48: 533-539.
Dullenbach-Hellweg G (1981) Structural variations of cervical cancer and its precursors under the influence of exogenous hormones. In: Current Topics in Pathology. Springer-Verlag, New York, pp. 144-145.
WHO Collaborative Study (1992) Depot medroxyprogesterone acetate (DMPA) and risk of invasive squamous cell cervical cancer. Contraception 45: 299-312.
Brinton LA (1991) Oral contraceptives and cervical neoplasia. Contraception 43: 581-595.
Delgado-Rodriguez M, Sillero-Arenas M, Martin-Moreno JM, Galvez-Vargas R (1992) Oral contraceptives and cancer of the cervix uteri. A meta-analysis. Acta Obstet Gynecol Scand 71: 368-376.
Moreno V, Bosch X, Munoz N, et al. (2002) Effect of oral contraceptives on risk of cervical cancer in women with human papillomavirus infection: the IARC multicentric case-control study. Lancet 359: 1085-1192.
Skegg DCG (2002) Oral contraceptives, parity, and cervical cancer. Lancet 359: 1080-1081 ( editorial).
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Shapiro, S., Rosenberg, L., Hoffman, M. et al. Risk of invasive cancer of the cervix in relation to the use of injectable progestogen contraceptives and combined estrogen/progestogen oral contraceptives (South Africa). Cancer Causes Control 14, 485–495 (2003). https://doi.org/10.1023/A:1024910808307
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DOI: https://doi.org/10.1023/A:1024910808307