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Cervical cancer and hormonal contraceptives: collaborative reanalysis of individual data for 16,573 women with cervical cancer and 35,509 women without cervical cancer from 24 epidemiological studies.
Lancet 2007; 370(9599):1609-21Lct

Abstract

BACKGROUND

Combined oral contraceptives are classified by the International Agency for Research on Cancer as a cause of cervical cancer. As the incidence of cervical cancer increases with age, the public-health implications of this association depend largely on the persistence of effects long after use of oral contraceptives has ceased. Information from 24 studies worldwide is pooled here to investigate the association between cervical carcinoma and pattern of oral contraceptive use.

METHODS

Individual data for 16,573 women with cervical cancer and 35,509 without cervical cancer were reanalysed centrally. Relative risks of cervical cancer were estimated by conditional logistic regression, stratifying by study, age, number of sexual partners, age at first intercourse, parity, smoking, and screening.

FINDINGS

Among current users of oral contraceptives the risk of invasive cervical cancer increased with increasing duration of use (relative risk for 5 or more years' use versus never use, 1.90 [95% CI 1.69-2.13]). The risk declined after use ceased, and by 10 or more years had returned to that of never users. A similar pattern of risk was seen both for invasive and in-situ cancer, and in women who tested positive for high-risk human papillomavirus. Relative risk did not vary substantially between women with different characteristics.

INTERPRETATION

The relative risk of cervical cancer is increased in current users of oral contraceptives and declines after use ceases. 10 years' use of oral contraceptives from around age 20 to 30 years is estimated to increase the cumulative incidence of invasive cervical cancer by age 50 from 7.3 to 8.3 per 1000 in less developed countries and from 3.8 to 4.5 per 1000 in more developed countries.

Authors+Show Affiliations

Cancer Research UK Epidemiology Unit, Oxford, UK.No affiliation info availableNo affiliation info availableNo affiliation info availableNo 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

Language

eng

PubMed ID

17993361

Citation

International Collaboration of Epidemiological Studies of Cervical Cancer, et al. "Cervical Cancer and Hormonal Contraceptives: Collaborative Reanalysis of Individual Data for 16,573 Women With Cervical Cancer and 35,509 Women Without Cervical Cancer From 24 Epidemiological Studies." Lancet (London, England), vol. 370, no. 9599, 2007, pp. 1609-21.
International Collaboration of Epidemiological Studies of Cervical Cancer, Appleby P, Beral V, et al. Cervical cancer and hormonal contraceptives: collaborative reanalysis of individual data for 16,573 women with cervical cancer and 35,509 women without cervical cancer from 24 epidemiological studies. Lancet. 2007;370(9599):1609-21.
Appleby, P., Beral, V., Berrington de González, A., Colin, D., Franceschi, S., Goodhill, A., ... Sweetland, S. (2007). Cervical cancer and hormonal contraceptives: collaborative reanalysis of individual data for 16,573 women with cervical cancer and 35,509 women without cervical cancer from 24 epidemiological studies. Lancet (London, England), 370(9599), pp. 1609-21.
International Collaboration of Epidemiological Studies of Cervical Cancer, et al. Cervical Cancer and Hormonal Contraceptives: Collaborative Reanalysis of Individual Data for 16,573 Women With Cervical Cancer and 35,509 Women Without Cervical Cancer From 24 Epidemiological Studies. Lancet. 2007 Nov 10;370(9599):1609-21. PubMed PMID: 17993361.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cervical cancer and hormonal contraceptives: collaborative reanalysis of individual data for 16,573 women with cervical cancer and 35,509 women without cervical cancer from 24 epidemiological studies. AU - ,, AU - Appleby,Paul, AU - Beral,Valerie, AU - Berrington de González,Amy, AU - Colin,Didier, AU - Franceschi,Silvia, AU - Goodhill,Adrian, AU - Green,Jane, AU - Peto,Julian, AU - Plummer,Martyn, AU - Sweetland,Siân, PY - 2007/11/13/pubmed PY - 2007/12/6/medline PY - 2007/11/13/entrez SP - 1609 EP - 21 JF - Lancet (London, England) JO - Lancet VL - 370 IS - 9599 N2 - BACKGROUND: Combined oral contraceptives are classified by the International Agency for Research on Cancer as a cause of cervical cancer. As the incidence of cervical cancer increases with age, the public-health implications of this association depend largely on the persistence of effects long after use of oral contraceptives has ceased. Information from 24 studies worldwide is pooled here to investigate the association between cervical carcinoma and pattern of oral contraceptive use. METHODS: Individual data for 16,573 women with cervical cancer and 35,509 without cervical cancer were reanalysed centrally. Relative risks of cervical cancer were estimated by conditional logistic regression, stratifying by study, age, number of sexual partners, age at first intercourse, parity, smoking, and screening. FINDINGS: Among current users of oral contraceptives the risk of invasive cervical cancer increased with increasing duration of use (relative risk for 5 or more years' use versus never use, 1.90 [95% CI 1.69-2.13]). The risk declined after use ceased, and by 10 or more years had returned to that of never users. A similar pattern of risk was seen both for invasive and in-situ cancer, and in women who tested positive for high-risk human papillomavirus. Relative risk did not vary substantially between women with different characteristics. INTERPRETATION: The relative risk of cervical cancer is increased in current users of oral contraceptives and declines after use ceases. 10 years' use of oral contraceptives from around age 20 to 30 years is estimated to increase the cumulative incidence of invasive cervical cancer by age 50 from 7.3 to 8.3 per 1000 in less developed countries and from 3.8 to 4.5 per 1000 in more developed countries. SN - 1474-547X UR - https://www.unboundmedicine.com/medline/citation/17993361/full_citation L2 - https://linkinghub.elsevier.com/retrieve/pii/S0140-6736(07)61684-5 DB - PRIME DP - Unbound Medicine ER -