Cervical carcinogenesis associated with the use of combined oral contraceptives: is there a relationship?

Abstract

BACKGROUND: Cervical cancer is one of the leading cancers in women of reproductive age. The etiological role of the human papillomavirus (HPV) in cancer development is long known and undisputed. However, owing to the widespread use of combined oral contraceptives (COCs), scientists actively investigate possible mechanisms of interrelation between sex steroids and HPV in terms of cervical cancer risk.

AIM: This study aimed to assess the risk of cervical cancer in women of reproductive age, depending on the use of COCs for different durations.

MATERIALS AND METHODS: The study included 411 patients of reproductive age who were treated at the Center for Gynecology and Reproductive Technologies of the Russian Ministry of Health and the Department of Oncogynecology at the University Clinical Hospital No. 4 of the I.M. Sechenov First Moscow State Medical University between January 2015 and December 2021. All patients were divided into two groups. The study group included 291 patients with verified cervical cancer, and the control group included 120 patients without cancer.

RESULTS: The study group was significantly more likely to take COCs (56, or 19.2%) than the control group (11, or 6.5%; p=0.018). In addition, the study group had significantly longer treatment durations (p=0.011). Overweight (n = 52, or 17.9%) and grade II obesity (n = 11, or 3.8%, vs. 0; p=0.03) were significantly more common in the study group than in the control group (n = 8, or 4.7%; p=0.003). The result of the multivariate analysis showed that taking COCs negatively affect cervical cancer development (p=0.018; odds ratio (OR) 1.230; CI 1.064–1.423). The receiver operating characteristic analysis revealed that the use of COCs has a high predictive value for determining the risk of cervical cancer (area under the curve, AUC=0.742); the sensitivity and specificity of this predictor were 74.07% and 72.73%, respectively. In the assessment on the effect of duration of COC use on the risk of cervical cancer, the results showed that total use of COCs for over 7 years was associated with a higher risk of cervical cancer development (p=0.010; OR 1.68; CI 1.1–2.5).

CONCLUSIONS: Prescribing COCs in patients with HPV infection requires a personalized approach to consider etiologic factors of cervical cancer and reduce possible carcinogenic risks.

Keywords

cervical cancer / human papillomavirus / combined oral contraceptives / endogenous estradiol

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