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  • Title: Oral contraceptive use and cervical intraepithelial neoplasia.
    Author: Coker AL, McCann MF, Hulka BS, Walton LA.
    Journal: J Clin Epidemiol; 1992 Oct; 45(10):1111-8. PubMed ID: 1474407.
    Abstract:
    To explore the somewhat controversial relationship between oral contraceptives and pre-invasive cervical cancer, 103 cases of biopsy-confirmed cervical intraepithelial neoplasia (CIN) II or CIN III were compared with 258 controls who had normal cervical cytology. Cases were slightly less likely than controls to have ever used oral contraceptives; the odds ratio, controlling for age, socioeconomic status, barrier method use, smoking history, age at first sexual intercourse, number of sex partners, current marital status, and number of Pap smears, was 0.7 (95% CI 0.3-1.6). Recency, latency, duration, and age at first oral contraceptive use were evaluated and in no instance was oral contraceptive use positively associated with CIN. This study adds to the body of knowledge that oral contraceptives are not associated with pre-invasive cervical cancer. Further, if oral contraceptive users continue to be regularly screened, their risk of developing the more invasive lesions should be very low. Between September 1987 and November 1988, 103 University of North Carolina Hospitals (UNCH) Dysplasia Clinic patients with newly diagnosed, biopsy-confirmed cervical intraepithelial neoplasia (CIN) II or CIN III were enrolled as cases. They were 18-45 years old, black or white, nonpregnant North Carolina residents. 40 cases were CIN II and 63 cases were CIN III confirmed histologically. The controls were 258 UNCH Family Practice Center patients with normal cervical cytology. All subjects participated in a 15-minute structured interview. The Hollingshead Index was used as a proxy for socioeconomic status (SES). Known risk factors for cervical neoplasia were found to be risk factors for CIN II and CIN III. Compared with controls, cases were younger (odds ratio [OR] = 3.4 for those under 25 years of age), less educated (OR - 13.3 for 13 years), and of lower SES. Cases were more likely to have been divorced (OR - 2.7), to be cigarette smokers (OR = 3.4), to have ever been pregnant (OR - 2.6), to have had more than 2 sex partners (OR = 5.0), to have reported having had a sexually transmitted disease (gonorrhea, chlamydia, herpes, venereal warts, or pelvic inflammatory disease) (OR = 2.9), and to have had at least 3 Pap smears in the 5 years prior to study recruitment (OR = 1.7). Cases were less likely to have used a barrier method of contraception (OR = 0.3). 80.6% of cases and 81.0% of controls had ever used oral contraceptives (OCs); thus, the crude OR was 1.0. Adjustment of the OR for all confounders (age, SES, ever-use of barrier methods, smoking history, age at 1st sexual intercourse, lifetime number of male sex partners, current marital status, and number of Pap smears) reduced the OR to 0.7 (95% confidence interval 0.3-1.6). Recency, latency, duration, and age at 1st OC use were compared without finding any positive association between OC use and CIN.
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