Depo medroxyprogesterone acetate (DMPA) and combined oral contraceptives and cervical carcinoma in-situ in women aged 50 years and under

ABSTRACT

Most low-resource settings depend on hormonal contraceptives for their family planning programmes and cervical cancer occurs in higher frequency in these populations. To determine whether hormonal contraception use increases cervical carcinoma in-situ (CIS) risk, a case-control study was conducted in the Kingston and St Andrew Corporate area of Jamaica, using 119 cases from the Jamaica Tumour Registry and 304 population controls matched on year of Papanicolaou (Pap) smear and clinic where Pap smear was obtained. While CIS cases were more likely to have 'ever used' combined oral contraceptives (COC) (OR = 1.4, 95 CI 0.8, 2.5), depo-medroxyprogesterone acetate (DMPA) use was similar. Compared to women who never used hormonal contraceptives, the risk of CIS was elevated in women who had used COCs five years or more (OR = 2.1, 95 CI 1.0, 4.6), women who first used COC for less than 10 years prior to the interview (OR = 1.8, 95 CI 0.9, 3.7) and women who were 18 to 24 years old when they first used COCs (OR = 1.8, 95 CI 0.9, 3.4). Similarly, compared to women who never used DMPA, the risk of CIS was elevated in women using DMPA five years or more (OR = 1.9, 95 CI 0.7, 4.8), women reporting use within a year prior to interview (OR = 2.8, 95 CI 0.7, 10.7) and women who initiated use of DMPA when they were 20 and 24 years old (OR = 1.4, 95 CI 0.7, 3.1). These results suggest that if hormonal contraceptive use confers any risk of CIS, it is confined to long-term users. Increased risk in some groups, however, warrant further study