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Cervical cancer and use of hormonal contraceptives: a systematic review.
Lancet 2003; 361(9364):1159-67Lct

Abstract

BACKGROUND

Human papillomavirus (HPV) is believed to be the most important cause of cervical cancer. Recent studies suggest that long duration use of oral contraceptives increases the risk of cervical cancer in HPV positive women.

METHODS

Results from published studies were combined to examine the relationship between invasive and in situ cervical cancer and duration and recency of use of hormonal contraceptives, with particular attention to HPV infection.

FINDINGS

28 eligible studies were identified, together including 12531 women with cervical cancer. Compared with never users of oral contraceptives, the relative risks of cervical cancer increased with increasing duration of use: for durations of approximately less than 5 years, 5-9 years, and 10 or more years, respectively, the summary relative risks were 1.1 (95% CI 1.1-1.2), 1.6 (1.4-1.7), and 2.2 (1.9-2.4) for all women; and 0.9 (0.7-1.2), 1.3 (1.0-1.9), and 2.5 (1.6-3.9) for HPV positive women. The results were broadly similar for invasive and in situ cervical cancers, for squamous cell and adenocarcinoma, and in studies that adjusted for HPV status, number of sexual partners, cervical screening, smoking, or use of barrier contraceptives. The limited available data suggest that the relative risk of cervical cancer may decrease after use of oral contraceptives ceases. However, study designs varied and there was some heterogeneity between study results.

INTERPRETATION

Although long duration use of hormonal contraceptives is associated with an increased risk of cervical cancer, the public health implications of these findings depend largely on the extent to which the observed associations remain long after use of hormonal contraceptives has ceased, and this cannot be evaluated properly from published data.

Authors+Show Affiliations

International Agency for Research on Cancer, Lyon, France.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review
Systematic Review

Language

eng

PubMed ID

12686037

Citation

Smith, Jennifer S., et al. "Cervical Cancer and Use of Hormonal Contraceptives: a Systematic Review." Lancet (London, England), vol. 361, no. 9364, 2003, pp. 1159-67.
Smith JS, Green J, Berrington de Gonzalez A, et al. Cervical cancer and use of hormonal contraceptives: a systematic review. Lancet. 2003;361(9364):1159-67.
Smith, J. S., Green, J., Berrington de Gonzalez, A., Appleby, P., Peto, J., Plummer, M., ... Beral, V. (2003). Cervical cancer and use of hormonal contraceptives: a systematic review. Lancet (London, England), 361(9364), pp. 1159-67.
Smith JS, et al. Cervical Cancer and Use of Hormonal Contraceptives: a Systematic Review. Lancet. 2003 Apr 5;361(9364):1159-67. PubMed PMID: 12686037.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cervical cancer and use of hormonal contraceptives: a systematic review. AU - Smith,Jennifer S, AU - Green,Jane, AU - Berrington de Gonzalez,Amy, AU - Appleby,Paul, AU - Peto,Julian, AU - Plummer,Martyn, AU - Franceschi,Silvia, AU - Beral,Valerie, PY - 2003/4/11/pubmed PY - 2003/4/23/medline PY - 2003/4/11/entrez SP - 1159 EP - 67 JF - Lancet (London, England) JO - Lancet VL - 361 IS - 9364 N2 - BACKGROUND: Human papillomavirus (HPV) is believed to be the most important cause of cervical cancer. Recent studies suggest that long duration use of oral contraceptives increases the risk of cervical cancer in HPV positive women. METHODS: Results from published studies were combined to examine the relationship between invasive and in situ cervical cancer and duration and recency of use of hormonal contraceptives, with particular attention to HPV infection. FINDINGS: 28 eligible studies were identified, together including 12531 women with cervical cancer. Compared with never users of oral contraceptives, the relative risks of cervical cancer increased with increasing duration of use: for durations of approximately less than 5 years, 5-9 years, and 10 or more years, respectively, the summary relative risks were 1.1 (95% CI 1.1-1.2), 1.6 (1.4-1.7), and 2.2 (1.9-2.4) for all women; and 0.9 (0.7-1.2), 1.3 (1.0-1.9), and 2.5 (1.6-3.9) for HPV positive women. The results were broadly similar for invasive and in situ cervical cancers, for squamous cell and adenocarcinoma, and in studies that adjusted for HPV status, number of sexual partners, cervical screening, smoking, or use of barrier contraceptives. The limited available data suggest that the relative risk of cervical cancer may decrease after use of oral contraceptives ceases. However, study designs varied and there was some heterogeneity between study results. INTERPRETATION: Although long duration use of hormonal contraceptives is associated with an increased risk of cervical cancer, the public health implications of these findings depend largely on the extent to which the observed associations remain long after use of hormonal contraceptives has ceased, and this cannot be evaluated properly from published data. SN - 0140-6736 UR - https://www.unboundmedicine.com/medline/citation/12686037/Cervical_cancer_and_use_of_hormonal_contraceptives:_a_systematic_review_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0140673603129492 DB - PRIME DP - Unbound Medicine ER -