Cervical cancer risk of Hormonal Contraception

However, the risk was not statistically significant.Considering the duration of use, women who had used OC for 3 years or less did not have an increased risk of cervical cancer (OR 0.78).

Nevertheless,  the odds ratio of oral contraceptive pill use for more than 3 years was 2.57 which was statistically significant.

So, long-term use of oral contraceptives might be a cofactor that increases the risk of cervical carcinoma by up to four-fold in women who are positive for cervical HPV (55,56,57).  For this reason,many U.S.gynecologists refuse prescription of hormonal   contraceptives   in   women   without   cervical   cancer   screening (58).

Although the World Health Organization does not recommend any change in oral contraceptive use   (59). So,a risk-benefit analysis supports the continuation of contraceptive use among women who have abnormal smears but also, who have access   to   educational   counselling   and   clinical   surveillance (60).

Cervical cytological   studies   reported   the   significantly   high   frequency   of   squamous intraepithelial lesions (SILs)  in the early stages of contraception with Norplant insertion,  but after 1 year a progressive decline of them was found and after 3 years no SIL was seen (61).

Data suggest that in adolescents and young women HPV infections and their sequalae,squamous intraepithelial lesions (SILs) occur more commonly among human immunodeficiency (HIV)-infected girls because of the HIV associated CD4+T-cell immunosuppression (62)

However, the risk of developing the HPV-associated precancer high-grade squamous intraepithelial lesion (HSIL)in HIV-infected adolescent is unknown.  It seems that the use of hormonal contraceptives,either combined oral contraceptives or intramuscolar MPA , high cervical mucous concentrations of interleukin-12, a positive HPV test, and   a   persistent   low-grade   squamous   intraepithelial   lesion (LSIL)  were significantly associated with the development of HSIL (63)

Rosa Sabatini and Giuseppe Loverro
Dept. Obstetrics and Gynecology,
General Hospital Policlinico-University of Bari, Italy


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