Department of Obstetrics and Gynaecology, Radboud university medical center, PO Box 9101, 6500HB, Nijmegen, the Netherlands. Electronic address: leon.massuger@radboudumc.nl.
Department of Obstetrics and Gynaecology, Catharina Hospital, PO Box 1350, 5602ZA, Eindhoven, the Netherlands. Electronic address: ruud.bekkers@radboudumc.nl.
Hormonal contraceptive use has been associated with the development of cervical cancer, although inconsistent results are reported on the association with intrauterine device (IUD) use. The aim of this study was to evaluate the association between the type of contraceptive use and the development of cervical intraepithelial neoplasia grade III or worse (CIN3+).
Methods
A retrospective population-based cohort study including women aged 29-44 years attending the cervical cancer screening program with normal cytology between 2005 and 2009 identified from the Dutch Pathology Registry. Subgroups with at least 5 years registered use of an oral contraceptive (OC) or IUD were compared with non-users. Risk ratios of CIN3+ were estimated per contraceptive type.
Result
s702,037 women were included with a median follow-up of 9.7 years, of which 6705 (0.96%) and 559 (0.08%) women developed CIN3 and cervical cancer, respectively. IUD use was associated with an increased risk of developing CIN3+ (risk ratio (RR) 1.51, 95% confidence interval (CI) 1.32-1.74), and OC use was associated with an increased risk of developing CIN3+ (RR 2.77, 95%CI 2.65-3.00) and cervical cancer (RR 2.06, 95%CI 1.52-2.79). The risk of developing CIN3+ and cervical cancer was higher for OC users compared with IUD users (RR 1.83, 95%CI 1.60-2.09 and RR 1.70, 95%CI 1.00-2.90, respectively).
Conclusions
Both OC use and IUD use were associated with an increased risk of developing CIN3+. However, for women with a contraceptive wish, an IUD seems safer than an OC as the risk of developing CIN3+ and cervical cancer was higher for OC users.
oral contraceptive cervical intraepithelial neoplasia CIN3 risk, intrauterine device IUD cervical cancer risk population-based, hormonal contraceptive cervical cancer screening cohort study, oral contraceptive versus IUD cervical dysplasia risk comparison, CIN3 cervical cancer oral contraceptive long-term use, Dutch pathology registry cervical cancer screening contraceptive use, IUD safer alternative oral contraceptive cervical neoplasia, Loopik Bekkers contraceptive use cervical intraepithelial neoplasia, population-based retrospective cohort contraception cervical cancer risk, contraceptive type cervical cancer HPV-related disease progression
PMID 31760309 31760309 DOI 10.1016/j.ejca.2019.10.009 10.1016/j.ejca.2019.10.009 Loopik et al. 2020, Loopik 2020
Cite this article
Loopik, D. L., IntHout, J., Melchers, W. J. G., Massuger, L. F. A. G., Bekkers, R. L. M., & Siebers, A. G. (2020). Oral contraceptive and intrauterine device use and the risk of cervical intraepithelial neoplasia grade III or worse: a population-based study. European journal of cancer (Oxford, England : 1990), 124, 102-109. https://doi.org/10.1016/j.ejca.2019.10.009
Loopik DL, IntHout J, Melchers WJG, Massuger LFAG, Bekkers RLM, Siebers AG. Oral contraceptive and intrauterine device use and the risk of cervical intraepithelial neoplasia grade III or worse: a population-based study. Eur J Cancer. 2020;124:102-109. doi:10.1016/j.ejca.2019.10.009
Loopik, D. L., et al. "Oral contraceptive and intrauterine device use and the risk of cervical intraepithelial neoplasia grade III or worse: a population-based study." European journal of cancer (Oxford, England : 1990), vol. 124, 2020, pp. 102-109.
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