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Long-term use of oral contraceptives could increase risk of cervical cancer for women with HPV

Women who are positive for the sexually transmitted human papillomavirus (HPV) could be at a three times greater risk of cervical cancer if they have used oral contraceptives for five years or longer, suggest authors of a study in this weeks issue of THE LANCET. However, there is no evidence that long-term oral-contraceptive use increases the risk of cervical cancer in the absence of HPV.

The absolute risk of cervical cancer ranges from around 1% in developed countries to 5% in less-developed settings. The effect of HPV-the main cause of cervical cancer-has not usually been taken into account in previous studies investigating a possible link between oral-contraceptive use and cervical cancer. Victor Moreno and colleagues from the International Agency for Research on Cancer (IARC) aimed to assess how use of oral contraceptives affected risk of cervical cancer in women who tested positive for HPV DNA.

The investigators pooled data from eight case-control studies of patients with histologically confirmed invasive cervical carcinoma (ICC) and from two studies of patients with carcinoma in situ (ISC [a precursor of ICC]). Information about use of oral contraceptives was obtained from personal interviews. Data were available for around 1900 women from Thailand, the Philippines, Morocco, Brazil, Peru, Paraguay, Colombia, and Spain.

94% of women with ICC, 72% with ISC, and 13% of women without cervical cancer were positive for HPV DNA. Compared with women who had never used oral contraceptives, those who had used oral contraceptives for fewer than 5 years did not have an increased risk of cervical cancer. Women who used oral contraceptives for between five and nine years were around three times more likely to have cervical cancer; there was a four-fold increased risk for oral contraceptive use of 10 years or more.

Silvia Franceschi comments: "We think that our results lend support to the existence of an association between oral contracept
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Contact: Richard Lane
richard.lane@lancet.com
44-20-7424-4949
Lancet
27-Mar-2002


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