Oral contraceptive and intrauterine device use and the risk of cervical intraepithelial neoplasia grade III or worse: a population-based study

Loopik, Diede L.; IntHout, Joanna; Melchers, Willem J. G.; Massuger, Leon F.A.G.; Bekkers, Ruud L.M.; Siebers, Albert G.

doi:10.1016/j.ejca.2019.10.009

Cited by 20 publications

(16 citation statements)

References 20 publications

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“…Also, we did not have data on several other possible confounders such as sexual behaviour and oral contraceptive use. 43 It has been shown that a higher proportion of women with inflammatory bowel disease have sexual dysfunction compared with matched controls. 44 Since sexual activity is a strong risk factor for CIN, 32 it might be hypothesised that the association with IBD is even stronger.…”

Section: Discussionmentioning

confidence: 99%

Increased Risk of High-grade Cervical Neoplasia in Women with Inflammatory Bowel Disease: A Case-controlled Cohort Study

Goetgebuer

Kreijne

Aitken

et al. 2021

Journal of Crohn's and Colitis

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BACKGROUND AND AIMS Women with inflammatory bowel disease (IBD) may be at higher risk for cervical intraepithelial neoplasia (CIN). However, data are conflicting. The aim of this study is to assess the risk of high-grade dysplasia and cancer (CIN2+) in IBD women and identify risk factors. METHODS Clinical data from adult IBD women in a multicentre Dutch IBD prospective cohort (PSI) from 2007 onwards were linked to cervical cytology and histology records from the Dutch nationwide cytology and pathology database (PALGA) from 2000 to 2016. Patients were frequency matched 1:4 to a general population cohort. Standardized detection rates (SDR) were calculated for CIN2+. Longitudinal data were assessed to calculate CIN2+ risk during follow-up using incidence rate ratios (IRR) and risk factors were identified in multivariable analysis. RESULTS Cervical records were available from 2,098 IBD women (77%) and 8,379 in the matched cohort; median follow-up 13 years. CIN2+ detection rate was higher in the IBD cohort than in the matched cohort (SDR 1.27, 95%CI 1.05-1.52). Women with IBD had an increased risk of CIN2+ (IRR 1.66, 95%CI 1.21-2.25), and persistent or recurrent CIN during follow-up (OR 1.89, 95%CI 1.06-3.38). Risk factors for CIN2+ in IBD women were smoking and disease location (ileocolonic (L3) or upper-GI (L4)). CIN2+ risk was not associated with exposure to immunosuppressants. CONCLUSION Women with IBD are at increased risk for CIN2+ lesions. These results underline the importance of HPV vaccination and adherence to cervical cancer screening guidelines in IBD women, regardless of exposure to immunosuppressants.

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Section: Discussionmentioning

confidence: 99%

Increased Risk of High-grade Cervical Neoplasia in Women with Inflammatory Bowel Disease: A Case-controlled Cohort Study

Goetgebuer

Kreijne

Aitken

et al. 2021

Journal of Crohn's and Colitis

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“…OC users had an increased risk of CIN3+ compared with IUD users; RR 1.83 (95% CI 1.60–2.09). Results for cervical cancer pointed in the same direction but were statistically significantly increased in OC users only ( Loopik et al , 2020 ).…”

Section: Discussionmentioning

confidence: 67%

“…A comparison was made between our results and two previous studies investigating the risk of precancerous cervical lesions associated with use of HIUD, CIUD, and OC ( Averbach et al , 2018 ; Loopik et al , 2020 ).…”

Section: Methodsmentioning

confidence: 79%

Risk of precancerous cervical lesions in women using a hormone-containing intrauterine device and other contraceptives: a register-based cohort study from Denmark

et al. 2021

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STUDY QUESTION Is the risk of high-grade precancerous cervical lesions and/or is the risk of lesion progression increased in users of a hormone-containing intrauterine device (HIUD) compared with users of other contraceptive methods. SUMMARY ANSWER Women starting use of HIUD had the same subsequent risk of cervical intraepithelial neoplasia 3+ (CIN3+) as copper IUD (CIUD) users, and both groups tended to have lower risks than oral contraceptives (OC) users. WHAT IS KNOWN ALREADY HIUDs may cause inflammatory and immunosuppressive changes that may potentially affect the risk of persistent human papillomavirus infection and precancerous cervical lesions. STUDY DESIGN, SIZE, DURATION A Danish population-based cohort study was conducted using register data from 2008 to 2011 on 26–50-year-old users of HIUD (n = 60 551), CIUD (n = 30 303), or OC (n = 165 627). PARTICIPANTS/MATERIALS, SETTING, METHODS Within each user group, women were divided into two groups; normal cytology or abnormal diagnosis before start of contraceptive use (baseline). Follow-up histology and cytology diagnoses were registered during the 5 years after baseline. Adjusted relative risks (aRR) and 95% CI were calculated for precancerous cervical lesions in HIUD users compared with CIUD and OC users. MAIN RESULTS AND THE ROLE OF CHANCE Women with normal cytology at baseline: at follow-up HIUD users had the same risk of CIN3 or higher (3+) as CIUD users; aRR 1.08 (95% CI 0.94–1.22). For the HIUD and CIUD groups compared with OCs, the risks of CIN3+ were lower: aRR 0.63 (95% CI 0.57–0.69) and aRR 0.58 (95% CI 0.52–0.65), respectively. The same was observed for CIN2 risks: aRR 0.86 (95% CI 0.76–0.96) and aRR 0.68 (95% CI 0.58–0.79) for HIUD and CIUD groups, respectively. Women with abnormal diagnosis at baseline: a lower progression risk, except for CIN2+ at baseline, was observed in HIUD users compared with OC users. Similar progression risks were found in HIUD and CIUD users. There were no differences between the three contraceptive groups in persistence or regression of present lesions. LIMITATIONS, REASONS FOR CAUTION We adjusted for age, education, and region of residence as a proxy for socio-economic factors. Data on smoking and sexual behavior were not available thus we cannot exclude some differences between the three user groups. WIDER IMPLICATIONS OF THE FINDINGS These findings suggest that women may safely use HIUDs. STUDY FUNDING/COMPETING INTEREST(S) A.P. Møller Foundation for the Advancement of Medical Science, Else and Mogens Wedell-Wedellborgs Fund, Direktør Emil C. Hertz og Hustru Inger Hertz Fund, and the Fund for Development of Evidence Based Medicine in Private Specialized Practices. EL is principle investigator for a study with HPV-test-kits provided by Roche. The other authors have nothing to declare. TRIAL REGISTRATION NUMBER N/A.

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“…Our analysis results showed that women aged 20-35 and those who had used oral contraceptives for more than 1 year were more likely to develop CIN1+. Oral contraceptive use has been reported to increase the risk of developing cervical cancer in women with normal cytology in a retrospective population-based cohort study [30]. Recently, a UK prospective cohort study found that the progression probability of normal cervical cytology to CIN2+ decreased with age, with the highest in the 25-34 years old population [31].…”

Section: Discussionmentioning

confidence: 99%

Genotype-specific Distribution and Change of High-risk Human Papillomavirus Infection and the Association with Cervical Progression Risk in Women with Normal Pathology and Abnormal Cytology in a Population-based Cohort Study in China

Jia¹,

Ding²,

Han³

et al. 2021

J. Cancer

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Objectives: Women with normal pathology screened from abnormal cervical cytology are a special population with higher progression risk than women with normal cytology. However, the associations between genotype distribution and changes of high-risk human papillomavirus (HR-HPV) infection and cervical progression risk in this special population remain unclear. Methods: A total of 1232 women with normal pathology screened from abnormal cervical cytology were enrolled into this cohort with 2-year follow-up. HPV genotyping detection was performed through flow-through hybridization. Hazard ratios (HRs) and Odds ratios (ORs) were calculated using Cox proportional hazard regression and logistic regression models, respectively. Results: Overall HR-HPV prevalence at baseline was 29.0%, with HPV16, 52, 58, 53 and 51 the top five genotypes. The 2-year persistence rate of HR-HPV infection was 31.9%. Compared with HR-HPV negative, the adjusted HRs of overall HR-HPV, HPV16, 31/33, 58, 51, and 53 infections for the progression risk of normal cervix were 5. 31, 7.10, 6.95, 5.74, 5.04, and 4.88, respectively. Multiple HR-HPV infection cannot lead to an additional risk of progression relative to single HR-HPV infection. In comparison with HR-HPV persistently negative, same-type HR-HPV persistence was positively associated with progression risk of normal cervix (adjusted OR: 22.26), but different-type HR-HPV persistence was not linked to cervical progression. Conclusion: Genotypes and persistence of HR-HPV infection could stratify the cervical progression risk in women with normal cervical pathology and abnormal cytology and provide evidence for development of next generation of vaccines. HPV51 and 53 deserved attention apart from HPV16, 31, 33, and 58.

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Oral contraceptive and intrauterine device use and the risk of cervical intraepithelial neoplasia grade III or worse: a population-based study

Cited by 20 publications

References 20 publications

Increased Risk of High-grade Cervical Neoplasia in Women with Inflammatory Bowel Disease: A Case-controlled Cohort Study

Increased Risk of High-grade Cervical Neoplasia in Women with Inflammatory Bowel Disease: A Case-controlled Cohort Study

Risk of precancerous cervical lesions in women using a hormone-containing intrauterine device and other contraceptives: a register-based cohort study from Denmark

Genotype-specific Distribution and Change of High-risk Human Papillomavirus Infection and the Association with Cervical Progression Risk in Women with Normal Pathology and Abnormal Cytology in a Population-based Cohort Study in China

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