COC and cervical cancer

In 2002, an analysis of eight case-control studies of patients with invasive cervical carcinoma (ICC) and two studies of patients with carcinoma in situ (ISC) was published. This reported that the use of oral contraceptives for longer than five years increased the risk of ICC or ISC in human papilloma virus (HPV) positive women compared with never users (1):

• OR 2.82, 95%CI 1.46–5.42 for 5–9 years
• OR 4.03, 95%CI 2.09–7.79 for use for 10 years or more

A review noted that (2) "..oral contraceptive use may contribute to the development of cervical cancer in women with HPV infection.... The absolute risk of developing cervical cancer is low, whether women use oral contraceptives or not. All sexually active women, especially those on long-term oral contraceptives, should be encouraged to have regular cervical smears..."

Cervical adenocarcinoma:

In an "ever taken" versus "never taken" analysis of oral contraceptive use the odds ratios for adenocarcinoma of the cervix were (3):

• 2.1 (95% Cl 1.1-3.8) for patients who had ever taken oral contraceptives versus controls
• 4.4 (95% Cl 1.8-10.8) for oral contraceptive use exceeding 12 years versus controls There was no additional risk for the following:
  • age of starting oral contraceptive use
  • particular formulations
  • use before first pregnancy

Women should be advised that current use of CHC for more than 5 years is associated with a small increased risk of cervical cancer; risk reduces over time after stopping CHC and is no longer increased by about 10 years after stopping (4).

Reference:

1. Moreno V, et al. Effect of oral contraceptives on risk of cervical cancer in women with human papillomavirus infection: the IARC multicentric case-control study. Lancet 2002;359:1085–92
2. MeReC Bulletin 2006; 17(2):1-9.
3. Ursin, G. et al. Oral contraceptive use and adenocarcinoma of cervix. Lancet 1994;344:1390-1394.
4. FSRH (July 2019). Combined Hormonal Contraception