RESUMO
Cervical cancer (CC) is caused by persistent infection of human papillomavirus of high oncogenic risk (hr-HPV); however, several cofactors are important in its carcinogenesis, such as smoking, multiparity, and prolonged use of oral hormonal contraceptives (COCs). Worldwide, 16% of women use COCs, whereas in Brazil this rate is of â¼ 30%. The safety and adverse effects of COCs are widely discussed in the literature, including the increase in carcinogenic risk. Due to the existence of several drugs, combinations, and dosages of COCs, it is hard to have uniform information in epidemiological studies. Our objective was to perform a narrative review on the role of COCs use in the carcinogenesis of cervical cancer. Several populational studies have suggested an increase in the incidence of cervical cancer for those who have used COCs for > 5 years, but other available studies reach controversial and contradictory results regarding the action of COCs in the development of CC.
O câncer cervical (CC) é causado pela infecção persistente pelo papilomavírus humano de alto risco oncogênico (hr-HPV); entretanto, vários cofatores são importantes na sua carcinogênese, como tabagismo, multiparidade e uso prolongado de contraceptivos hormonais orais (COCs). No mundo, 16% das mulheres usam AOCs, enquanto no Brasil essa taxa é de â¼ 30%. A segurança e os efeitos adversos dos COCs são amplamente discutidos na literatura, incluindo o aumento do risco carcinogênico. Devido à existência de várias drogas, combinações e dosagens de COCs, é difícil ter informações uniformes em estudos epidemiológicos. Nosso objetivo foi realizar uma revisão narrativa sobre o papel do uso de COCs na carcinogênese do câncer cervical. Vários estudos populacionais têm sugerido aumento da incidência de câncer de colo uterino para aquelas que usam COCs há mais de 5 anos, mas outros estudos disponíveis chegam a resultados controversos e contraditórios quanto à ação dos COCs no desenvolvimento do CCU.
Assuntos
Neoplasias do Colo do Útero , Feminino , Humanos , Neoplasias do Colo do Útero/induzido quimicamente , Neoplasias do Colo do Útero/epidemiologia , Anticoncepcionais Orais Combinados/efeitos adversos , Fatores de Risco , Fumar/efeitos adversos , Carcinogênese/induzido quimicamenteAssuntos
Estrogênios/efeitos adversos , Ginecologia/história , Progesterona/uso terapêutico , Neoplasias do Colo do Útero , Neoplasias Uterinas , Feminino , História do Século XX , Humanos , Neoplasias do Colo do Útero/induzido quimicamente , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/prevenção & controle , Neoplasias Uterinas/induzido quimicamente , Neoplasias Uterinas/patologia , Neoplasias Uterinas/prevenção & controleRESUMO
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
Assuntos
Humanos , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , /efeitos adversos , Anticoncepcionais Femininos/efeitos adversos , Neoplasias do Colo do Útero/induzido quimicamente , Anticoncepcionais Orais Combinados , Estudos de Casos e Controles , Fatores de Risco , Fatores de Tempo , Jamaica/epidemiologia , Neoplasias do Colo do Útero/epidemiologiaRESUMO
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.
Assuntos
Anticoncepcionais Femininos/efeitos adversos , Acetato de Medroxiprogesterona/efeitos adversos , Displasia do Colo do Útero/induzido quimicamente , Neoplasias do Colo do Útero/induzido quimicamente , Adolescente , Adulto , Estudos de Casos e Controles , Anticoncepcionais Orais Combinados , Feminino , Humanos , Jamaica/epidemiologia , Pessoa de Meia-Idade , Fatores de Risco , Fatores de Tempo , Neoplasias do Colo do Útero/epidemiologia , Displasia do Colo do Útero/epidemiologiaRESUMO
A hospital-based case-control study was conducted in two hospitals in Bangkok, Thailand, and in one hospital each in Chiang Mai, Thailand, Mexico City, Mexico and Nairobi, Kenya. One purpose of this study was to determine whether the long-acting progestational contraceptive, depot-medroxyprogesterone acetate (DMPA), alters risk of invasive cervical carcinomas with adenomatous histological features. Information on prior use of DMPA, screening for cervical cancer, and the suspected risk factors for this disease was ascertained from interviews of 239 women with adenocarcinomas and 85 women with adenosquamous carcinomas, as well of from a large pool of controls, 2534 of whom were matched to the cases included in this report. For selected subsets of these women, a smoking history was also elicited, blood specimens were collected for measurement of antibodies against herpes simplex and cytomegalovirus, and information on sexual behavior was obtained from interviews of their husbands. The relative risk (and 95% confidence interval) of adenomatous cervical carcinomas in women who ever used DMPA was estimated to be 0.75 (0.51, 1.11). No trends in risk were observed with duration of DMPA use, times since first or last use, or age at first use. The results provide reassurance that use of DMPA for over four years does not enhance risk of adenomatous cervical carcinomas, and risk is not increased after a potential latent period of over 12 years since initial exposure.
Assuntos
Adenocarcinoma/induzido quimicamente , Carcinoma Adenoescamoso/induzido quimicamente , Anticoncepcionais Femininos/efeitos adversos , Acetato de Medroxiprogesterona/efeitos adversos , Neoplasias do Colo do Útero/induzido quimicamente , Adenocarcinoma/epidemiologia , Adenocarcinoma/patologia , Adulto , Carcinoma Adenoescamoso/epidemiologia , Carcinoma Adenoescamoso/patologia , Estudos de Casos e Controles , China/epidemiologia , Feminino , Humanos , Cooperação Internacional , Quênia/epidemiologia , México/epidemiologia , Pessoa de Meia-Idade , Fatores de Risco , Inquéritos e Questionários , Tailândia/epidemiologia , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/patologia , Organização Mundial da SaúdeAssuntos
Humanos , Feminino , Gravidez , História do Século XX , Dietilestilbestrol/efeitos adversos , Adenocarcinoma de Células Claras/induzido quimicamente , Brasil , Genitália Feminina/anormalidades , Genitália Feminina/patologia , Neoplasias do Colo do Útero/induzido quimicamente , Neoplasias Vaginais/induzido quimicamenteRESUMO
BACKGROUND: Although the possible influence of oral contraceptives on risk of cervical carcinoma in situ has been the subject of multiple prior investigations, the results have been inconsistent. METHODS: Data from a multinational, collaborative case-control study were analysed to investigate further this possible relationship. To assess potential screening bias, some statistical analyses were restricted to subgroups of cases with and without symptoms at the time of their diagnosis. RESULTS: Relative risk estimates in relation to various features of oral contraceptive use tended to be highest for asymptomatic disease, lowest for disease presenting with vaginal bleeding, and intermediate for disease presenting with other symptoms, suggesting the presence of a screening bias. In women with vaginal bleeding, who are least likely to have been detected by routine screening, no elevated risk of cervical carcinoma in situ was observed in relation to ever having used combined oral contraceptives, but there was an increased risk in users of over 60 months' duration. An increasing trend in risk with duration of use was most pronounced in these women who first used oral contraceptives in the past 5-10 years; and in women who used oral contraceptives for more than 60 months, risk declined with time since last use. CONCLUSION: These findings could reflect a reversible effect of long-term use of oral contraceptives at an intermediate stage in the carcinogenic process, or a non-causal relationship due to unidentified sources of bias or confounding.
Assuntos
Carcinoma in Situ/induzido quimicamente , Anticoncepcionais Orais Combinados/efeitos adversos , Neoplasias do Colo do Útero/induzido quimicamente , Adulto , Viés , Carcinoma in Situ/diagnóstico , Estudos de Casos e Controles , Chile , Fatores de Confusão Epidemiológicos , Anticoncepcionais Orais Combinados/administração & dosagem , Interpretação Estatística de Dados , Feminino , Humanos , México , Pessoa de Meia-Idade , Fatores de Risco , Tailândia , Fatores de Tempo , Neoplasias do Colo do Útero/diagnósticoRESUMO
The relationship of depot-medroxyprogesterone acetate (D-MPA) use to risk of cervical carcinoma in situ was investigated using data from a large multi-national, hospital-based case-control study. To avoid possible detection bias from Pap smear screening, final analyses were restricted to a subset of cases with symptoms at the time of their diagnosis of cervical carcinoma in situ. Relative to nonusers, the risk was elevated in women who had ever used DMPA and increased with duration of use. Decreasing trends in relative risk with times since first and last uses were observed in long-term users. Results from another portion of this same study did not show a relationship of invasive cervical cancer to DMPA use. These findings suggested that if DMPA increases the risk of cervical carcinoma in situ then either this is a reversible effect, or the cervical lesions induced by DMPA tend not to progress to invasive disease.
Assuntos
Carcinoma in Situ/induzido quimicamente , Carcinoma in Situ/epidemiologia , Acetato de Medroxiprogesterona/efeitos adversos , Neoplasias do Colo do Útero/induzido quimicamente , Neoplasias do Colo do Útero/epidemiologia , Adulto , Estudos de Casos e Controles , Preparações de Ação Retardada , Feminino , Humanos , Acetato de Medroxiprogesterona/administração & dosagem , México/epidemiologia , Pessoa de Meia-Idade , Fatores de Risco , Tailândia/epidemiologia , Organização Mundial da SaúdeRESUMO
The relationship between depot-medroxyprogesterone acetate (DMPA), and other injectable contraceptives and cervical neoplasia was reviewed mainly on the basis of three studies: the WHO Collaborative Study of Neoplasia and Steroid Hormone Contraceptives (2,009 cases and 9,583 controls collected in several, mainly developing, countries); a study of 369 cases of carcinoma in situ, 133 of invasive cancer and 646 controls collected by the National Tumor Registry of Costa Rica; and a cooperative study of 759 cases of invasive cervical cancer and 1,430 controls from four countries in Latin America (Costa Rica, Peru, Mexico and Colombia). There was no evidence of an appreciably elevated risk since most relative risks for ever users ranged from between 0.8 and 1.4, nor of consistent duration-risk relationship which was observed only in one study. The relative risk estimates for longest duration of use ranged from between 0.9 and 2.4. The data are still compatible with the absence of a causal association and with a moderately increased risk (up to a factor 1.5), which finds some biological plausibility as it is in agreement with the overall evidence of the relation between oral contraceptives and cervical neoplasia.