Cancer Causes & Control

, Volume 14, Issue 5, pp 485–495

Risk of invasive cancer of the cervix in relation to the use of injectable progestogen contraceptives and combined estrogen/progestogen oral contraceptives (South Africa)

  • Samuel Shapiro
  • Lynn Rosenberg
  • Margaret Hoffman
  • Judith P. Kelly
  • Diane D. Cooper
  • Henri Carrara
  • Lynnette E. Denny
  • George du Toit
  • Bruce R. Allan
  • Ilse A. Stander
  • Anna-Lise Williamson
Article

Abstract

Background: Cervical cancer is caused by specific types of the human papilloma virus (HPV), but not all infected women develop cancer. It has been hypothesized that hormonal contraceptives may potentiate the oncogenicity of HPV infection. Methods: In a case–control study of colored and black women in the Western Cape Province, South Africa, 524 incident cases of clinically evident invasive cervical cancer (stages lb–1V) were compared with 1541 controls, and with a subgroup of 254 HPV-positive controls. Findings: For injectable progestogen contraceptives (95% of which were depot medroxyprogesterone acetate) the overall relative risk, adjusted for confounding, was 1.0 (95% confidence interval 0.8–1.3); for combined estrogen/progestogen oral contraceptives the corresponding estimate was 0.8 (0.7–1.1). When the data were divided into categories of duration of use extending to ≥15 years, or according to age, ethnic group, or recency of use, there was no consistent evidence of an increased risk. The findings were unchanged when the cases were compared with the HPV-positive controls. Interpretation: The present findings suggest that neither injectable progestogen-only nor combined estrogen/progestogen oral contraceptives increase the risk of clinically evident invasive cancer of the cervix.

cervical carcinoma oral contraceptives progestogen-only contraceptives 

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Copyright information

© Kluwer Academic Publishers 2003

Authors and Affiliations

  • Samuel Shapiro
    • 1
  • Lynn Rosenberg
    • 2
  • Margaret Hoffman
    • 3
  • Judith P. Kelly
    • 2
  • Diane D. Cooper
    • 3
  • Henri Carrara
    • 3
  • Lynnette E. Denny
    • 3
  • George du Toit
    • 4
  • Bruce R. Allan
    • 3
  • Ilse A. Stander
    • 5
  • Anna-Lise Williamson
    • 3
  1. 1.Department of EpidemiologyMailman School of Public Health, Columbia UniversityNew YorkUSA
  2. 2.Slone Epidemiology UnitBoston University School of MedicineBostonSouth africa
  3. 3.Department of Community HealthUniversity of Cape Town Medical School, ObservatoryCape TownSouth Africa
  4. 4.Department of GynecologyTygerberg Hospital, Belleville, and the University of Stellenbosch Medical SchoolBellevilleSouth Africa
  5. 5.Medical Research Council of South AfricaBellevilleSouth Africa

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