Health Administrator Vol: XVII, Number 1 : 225-226,pg.
CANCER OF THE CERVIX AND ORAL CONTRACEPTIVES:
There is some evidence that long-term use of
OCs may increase the risk of cancer of the cervix (the
narrow, lower portion of the uterus). The results of a
study conducted by scientists at NCI and other cancer
centers support a relationship between extended use
of the pill (5 or more years) and a slightly increased
risk of cervical cancer. However, the exact nature of
the association between OC use and risk of cervical
cancer remains unclear.
One reason that the association is unclear is that
many studies on OCs and cervical cancer have not
accounted for the influence of Human Papillomaviruses
(HPVs) on cervical cancer risk. HPVs are a group of
more than 70 types of viruses, some of which are known
risk factors for cervical cancer. Compared to non-OC
users, women who use OCs may be less likely to use
barrier methods of contraceptions (such as condoms).
Since condoms can prevent the transmission of HPVs,
OC users who do not use them may be at increased
risk of becoming infected with HPVs. Therefore, the
increased risk of cervical cancer that some studies
found to be caused by prolonged OC use may actually
be the result of undetected HPV infection.
There is evidence that pill users who never use
a barrier method of contraception or who have a history
of genital infections are at a higher risk for developing
cervical cancer. This association suggests the
possibility that OCs may act together with sexually
transmitted agents (such as HPVs) in the development
of cervical cancer. Researchers continue to investigate
the exact nature of relationship between OC use and
cancer of the cervix.
OC product labels have been revised to warn of
the possible risk of cervical cancer; OC users are
advised to have a yearly Pap test to monitor for possible
cellular changes in the cervix.
Liver Tumors and Oral Contraceptives
There is evidence that OCs may increase the
risk of certain malignant (cancerous) liver tumors.
However, the risk is difficult to evaluate because of
different patterns of OC use and because these tumors
are very rare in American women (the incidence is less
than 1 case per 100,000 white women). A benign
(noncancerous) tumor of the liver called hepatic
adenoma has also been found to occur although rarely,
among OC users. These tumors do not spread, but
225
they may rupture and cause internal bleeding. They
occur in about 1 in 33,000 pill users per year, mostly
in women who have taken OCs for 5 years or longer.
Minimizing Oral Contraceptive Risks
After more than 20 years on the U.S. market,
the overall health effects of OCs are still mixed. The
most serious side effect of the pill continues to be an
increased risk of cardiovascular disease in certain
groups, such as women who smoke; women over age
35; obese women; and those with a history of high blood
pressure, diabetes, or elevated serum cholesterol
levels.
The NCI recommends that all women in their
forties or older who are at average risk for breast cancer
get screening mammograms every 1 to 2 years. Women
who are at higher risk of breast cancer should seek
expert medical advice about whether to begin screening
before age 40 and to determine their mammography
schedule in their forties. Women should also talk with
their doctor about clinical breast exams and breast
self-examination. A yearly Pap test to detect any
cervical changes is also suggested for pill users.
References for Oral Contraceptives and Cancer
Risk:
Breast Cancer
Brinton LA, Daling JR, Liff JM, et al. Oral
contraceptives and breast cancer risk among younger
women. Journal of the National Cancer Institute 1995;
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the National Institute of Child Health and Human
Development Cancer and Steroid Hormone Study, New
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Chilvers C, McPherson K, Pike MC, et al. Oral
contraceptive use and breast cancer risk in young
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McPherson K, Vessey MP, Neil A, et al. Early
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 Meirik O, Lund E, Adami HO, et al. Oral
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Miller DR, Rosenberg L, Kaufman DW, et al.
Breast cancer before age 45 and oral contraceptive use:
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Olsson H, Olsson ML, Moeller TR, et al. Oral
contraceptive use and breast cancer in young women
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Paul C, Skegg DCG, Spears GFS. Oral
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Pike MC, Henderson BE, Krailo MD, et al.
Breast cancer in young women and use of oral
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Wingo PA, Lee NC, Ory HW, et al. Age-specific
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Ovarian and Endometrial Cancers
Brinton LA, Huggins GR, Lehman HF, et al.
Long-term use of oral contraceptives and risk of
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invasive cervical cancer. International Journal of
Cancer 1986; 38:339-344.
The Centers for Disease Control. Oral
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Centers for Disease Control Cancer and Steroid
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The Centers for Disease Control. Oral
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The Centers for Disease Control Cancer and Steroid
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The Centers for Disease Control and the
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Cervix:
Brinton LA, Huggins GR, Lehman HF, et al.
Long-term use of oral contraceptives and risk of
invasive cervical cancer. International Journal of
Cancer 1986;38(3): 399-444.
Munoz N, Bosch FX, de Sanjose S, et al. The causal
link between human papillomavirus and invasive
cervical cancer: a population-based case-control study
in Colombia and Spain. International Journal of
Cancer 1992;52(5):743-749.
Liver
Rooks JB, Ory HW, Ishak KG, et al.
Epidemiology of hepatocellular adeonoma: the role of
oral contraceptive use. Journal of the American
Medical Association 1979,242:644-648.
Tao, LC. Oral contraceptive-associated liver cell
adenoma and hepatocellular carcinoma. Cancer 1991;
68:341-347.
Palmer J, Rosenberg L, Kaufman DW, et al.
Oral contraceptive use and liver cancer. American
Journal of Epidemiology 1989; 130:878-882.