Abstract
Objective
Studies on the effect of long-term use of combined oral contraceptives (COCs) on cervical
dysplasia and/or cancer risk have been inconsistent. Less is known about the effects
of other forms of hormonal contraception (HC). We examine whether HC use increases
the risk of incident cervical intraepithelial neoplasia (CIN) 2, 3 and/or cancer after
accounting for preexisting human papillomavirus (HPV) infection.
Study Design
Systematic review of prospective studies on HC use as risk factor for cervical dysplasia
with HPV infection documented prior to outcome assessment including PubMed and EMBASE
records between January 2000 and February 2020 (Prospero #CRD42019130725).
Results
Among nine eligible studies, seven described recency and type of HC use and therefore
comprise the primary analysis; two studies limit comparisons to ever versus never
use and are summarized separately. All seven studies explored the relationship between
oral contraceptive (OC) use and cervical dysplasia/cancer incidence: two found increased
risk (adjusted odds ratio, aOR = 1.5–2.7), one found no association but decreased
risk when restricted to women with persistent HPV (adjusted hazard ratio = 0.5), and
four found no association. None of the seven studies differentiated between COC and
progestin-only pills (POPs) by use recency or duration. The only study that included
injectable progestin-only contraception (DMPA) found increased CIN3 incidence among
current versus never users (aOR = 1.6). The one study that included Norplant found
no association. Two studies included intrauterine device (IUD) use, but did not differentiate
between hormonal and copper IUDs, and found no association.
Conclusion
We found no consistent evidence that OC use is associated with increased risk for
cervical dysplasia/cancer after controlling for HPV infection. There were too few
studies of progestin-only injectables, implants or IUDs to assess their effect on
cervical dysplasia/cancer risk.
Implications
Use of single self-reported HC measures and insufficient distinction by hormonal constituent
cloud our understanding of whether some HCs increase risk for cervical cancer. Methodologically
rigorous studies with distinct HCs measured as time-varying exposures are needed to
inform cervical cancer prevention efforts and improve our understanding of cervical
cancer etiology.
Key Words
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Article info
Publication history
Published online: November 06, 2021
Accepted:
October 28,
2021
Received in revised form:
October 27,
2021
Received:
January 29,
2021
Footnotes
Funding: This work was supported in part by the National Institutes of Health [Einstein-Rockefeller-CUNY Center for AIDS Research, Grant 5P30AI124414] as salary support for HEJ, and the Eunice Kennedy Shriver National Institute of Child Health and Human Development [Office of Research on Women's Health, Building Interdisciplinary Research Careers in Women's Health, Grant 2K12 HD052163] as salary support for LR.
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