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Recommendations for Contraceptive Use |
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Cervical Cancer Prevention |
Q.4. Has the use of family planning
methods been shown to increase the risk of cervical cancer?
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| a) Barrier methods of
contraception help to decrease the risk of cervical cancer. |
a) In several studies, women
reporting use of barrier methods (including condoms) appear to have a lower risk of
cervical cancer. These findings have not been found in all studies, however. If cervical
cancer is caused by a sexually transmitted disease (STD) such as HPV, it is plausible that
barrier use will protect a woman from cervical cancer or pre-cancer, but she would need to
use the barrier method whenever engaging in intercourse. |
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| b) Intrauterine devices (IUDs)
and tubal ligation do not increase the risk. |
b) Research has not found
IUDs or tubal ligation to increase cervical cancer risk in comparison to using no method. |
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| c) There remains concern that
hormonal contraceptives are associated with a low level increased squamous cervical cancer
risk. (There is stronger evidence for a relationship between oral contraceptives (OCs) and
adenocarcinoma, a more rare form of cervical cancer than the squamous cell cancer.) |
c) Some researchers believe that
long-term combined oral contraceptive (COC) use (beyond five years) may be associated with
a slight increased risk of cervical cancer. Other researchers disagree, saying that this
association may not be due to COCs, but may result if COC users receive better medical
care and more frequent screening (screening biases), are not using barrier methods, are
having more sexual partners, are initiating intercourse at an earlier age, or a number of
other factors. Additionally, because COCs may increase cervical ectopy, it may be easier
to get a positive Pap smear from a COC user.
- Feldblum P, Joanis C. Modern barrier
methods: effective contraception and disease prevention. Durham, NC: Family Health
International, 1994, p 24.
- La Vecchia C.
Depot-medroxyprogesterone acetate, other injectable contraceptives, and cervical
neoplasia. Contraception 1994;49:223-30.
- Schlesselman JJ. Net effect of oral
contraceptive use on the risk of cancer in women in the United States. Obstetrics and
Gynecology 1995;85(5 pt 1):793-801.
- Swan S, Petitti D. A review of
problems of bias and confounding in epidemiologic studies of cervical neoplasia and oral
contraceptive use. American Journal of Epidemiology 1982;115(1):10-8.
- Thomas DB, Ray RM.
Depot-medroxyprogesterone acetate (DMPA) and risk of invasive adenocarcinomas and
adenosquamous carcinomas of the uterine cervix. Contraception 1995;52(5):307-12.
- World Health Organization. Improving
access to quality care in family planning: eligibility criteria for contraceptive use.
Geneva: WHO, 1996.
- WHO. Invasive squamous cell carcinoma
and combined oral contraceptives: results from a multi-national study. International
Journal of
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