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Oral Contraceptives as Risk Factors for Cervical Adenocarcinomas and Squamous Cell Carcinomas

National Cancer Institute, Bethesda, Maryland 20852-7234 [J. V. L., L. A. B., A. H.]; Sinai Hospital, Baltimore, Maryland 21215 [F. M. A.]; Lombardi Cancer Center, Georgetown University, Washington, DC 20007 [W. A. B.]; Roche Molecular Systems, Inc., Alameda, California 94501 [P. E. G.]; Graduate Hospital, Philadelphia, Pennsylvania 19146 [M. D. G.]; Westat, Inc., Rockville, Maryland 20850 [S. M. G.]; Yale University School of Medicine, New Haven, Connecticut 06504 [O. C. H., P. E. S.]; George Washington University, Washington, DC 20052 [L. M.]; Milton S. Hershey Medical Center, Hershey, Pennsylvania 17033 [R. M.]; and University of Maryland, Baltimore, Maryland 21201 [S. G. S.].

To assess the hypothesis that oral contraceptives (OCs) increase the risk of cervical adenocarcinomas, we conducted a six-center case-control study of 124 patients with adenocarcinomas, 139 with squamous cell carcinomas, and 307 population controls. Women between the ages of 18 and 69 who were newly diagnosed with cervical adenocarcinomas between 1992 and 1996 were eligible. Healthy female controls and a second case group of incident cervical squamous cell carcinomas were matched to the adenocarcinoma cases. All participants were interviewed regarding OCs, other risk factors for cervical carcinoma, and utilization of cytological screening, and a PCR-based test determined HPV genotype of cervical samples for both case groups and controls. Use of OCs was positively and significantly associated with adenocarcinomas and positively but weakly associated with squamous cell carcinomas. Associations between OCs and invasive adenocarcinomas (n = 91), squamous cell carcinoma in situ (n = 48), and invasive squamous cell carcinomas (n = 91) disappeared after accounting for HPV infection, sexual history, and cytological screening, but a positive association remained between current use of OCs and cervical adenocarcinoma in situ (n = 33). This association persisted after stratification by screening and sexual history and after restriction according to HPV status, but small numbers made it difficult to exclude detection bias, selection bias, or residual confounding by HPV as potential explanations. Current OC use was associated with cervical adenocarcinomas in situ, but we saw no other evidence that OCs independently increase the risk of cervical carcinomas.

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