How Does the Use of Birth Control Pills Affect the Incidence of Cervical Cancer?

[Loren Booda]

How does use of the birth control pill correlate with the incidence of cervical cancer since the 1960s?

 

[ETOPS]

Are you asking for the historical correlation, like specifically whether the rate of birth control / oral contraceptive use among women is directly proportional to the incidence of cervical cancer? Or are you asking if there is indeed an established causal relationship between birth control and cervical cancer which increases a woman's risk?

From what I can gather of the National Cancer Institute statistics, there isn't a strong correlation between birth control usage and cervical cancer rates. This isn't assuming all other factors are held constant, of course, so there are always other things to consider, namely Gardasil vaccination (which wasn't approved until 2006), trends in sexually-transmitted disease protection, trends in pap smear procedures and how frequently women sought out their doctors for this, etc. The first oral contraceptive pill was Enovid, approved by the FDA in 1957.

Recent research indicates http://www.webmd.com/sex/birth-control/news/20071108/pill-raises-cervical-cancer-risk" . However, birth control is beneficial in several ways and may be worth the slight elevation of risk for an easily-detectable cancer with good prognoses provided it is caught early. Cancer of the cervix is quite rare, after all. I would also say that it is possible women relying on birth control pills may not be as insistent upon condom use during sex. This means they sacrifice the contraceptive and protective latex barrier for a pill, thereby losing the barrier and its decent protection against human papillomavirus (HPV). The pill, of course, offers no protection against sexually-transmitted infections.

 

[Evo]

The pill has drastically changed since it first came out. I don't have time to look up cervical cancer statistics, but the incredible change in the pill itself would certainly be a factor, if there ever was any.

 

[Loren Booda]

I heard on the news the other night that condom use does not guard much against HPV.

ETOPS, I seek the historical correlation.

 

[nismaratwork]

I'd add, there is no one "pill" anymore either... I doubt there is a comprehensive study of the type you're looking for, but I'll look... hell, if I find it, I'll even buy it and post some.

 

[Proton Soup]

How does use of the birth control pill correlate with the incidence of cervical cancer since the 1960s?

probably increased promiscuity

 

[nismaratwork]

probably increased promiscuity

Really? I would have guessed that sexual relations have been pretty much ongoing for a long time. Certainly rates of STDs were not low prior to the 60's...

 

[Proton Soup]

Really? I would have guessed that sexual relations have been pretty much ongoing for a long time. Certainly rates of STDs were not low prior to the 60's...

really. sex drive has always been there, yes, but the culture has changed. people don't have to sneak around now.

looks like syphilis started coming down when we developed a treatment for it. got to wonder if that's part of the sexual revolution right there. finding the cure for syphilis was like curing AIDS. but then, other diseases go up in incidence, which is a pretty good sign that promiscuity went up, even though aggressive programs to combat syphilis knocked it down.

http://www.nytimes.com/2009/03/17/health/17stat.html

HPV, of course, is another of those that can spread silently, and cause cancers later in life.

 

[nismaratwork]

really. sex drive has always been there, yes, but the culture has changed. people don't have to sneak around now.

looks like syphilis started coming down when we developed a treatment for it. got to wonder if that's part of the sexual revolution right there. finding the cure for syphilis was like curing AIDS. but then, other diseases go up in incidence, which is a pretty good sign that promiscuity went up, even though aggressive programs to combat syphilis knocked it down.

http://www.nytimes.com/2009/03/17/health/17stat.html

HPV, of course, is another of those that can spread silently, and cause cancers later in life.

I'm with you so far, but the question I have: "later in life"... is this a rising cancer rate, or just more people dying older? Is it a matter of promiscuity, or is there something else in these stats... I find it hard to believe that it's promiscuity.

What I'm seeing is this:
http://www.cdc.gov/cancer/hpv/statistics/cervical.htm

and the big risk factor seems to be: http://www.cdc.gov/cancer/hpv/statistics/poverty.htm
http://www.ncbi.nlm.nih.gov/pubmed/15061598
poverty.

That also correlates with unsafe sex practices, but not promiscuity. The latter is present, but it doesn't seem to be causal.

 

[nismaratwork]

Oh yeah... and this:
http://www.nejm.org/doi/full/10.1056/NEJMoa053284

Results
The incidence of genital HPV infection was 37.8 per 100 patient-years at risk among women whose partners used condoms for all instances of intercourse during the eight months before testing, as compared with 89.3 per 100 patient-years at risk in women whose partners used condoms less than 5 percent of the time (adjusted hazard ratio, 0.3; 95 percent confidence interval, 0.1 to 0.6, adjusted for the number of new partners and the number of previous partners of the male partner). Similar associations were observed when the analysis was restricted to high-risk and low-risk types of HPV and HPV types 6, 11, 16, and 18. In women reporting 100 percent condom use by their partners, no cervical squamous intraepithelial lesions were detected in 32 patient-years at risk, whereas 14 incident lesions were detected during 97 patient-years at risk among women whose partners did not use condoms or used them less consistently.

So, actually condoms do help to reduce risk for genital-gential contact.

I'm not seeing much fact in this thread... every time I look for stats, the only ones supporting the promiscuity hypothesis are religious groups, and PACs. Seems this has been the line for every form of birth control, and now the HPV vaccine.

I'm not buying it.

edit: Oh, and this: http://www.fda.gov/ForConsumers/byAudience/ForPatientAdvocates/HIVandAIDSActivities/ucm126372.htm

 

[Proton Soup]

I'm with you so far, but the question I have: "later in life"... is this a rising cancer rate, or just more people dying older? Is it a matter of promiscuity, or is there something else in these stats... I find it hard to believe that it's promiscuity.

What I'm seeing is this:
http://www.cdc.gov/cancer/hpv/statistics/cervical.htm

and the big risk factor seems to be: http://www.cdc.gov/cancer/hpv/statistics/poverty.htm
http://www.ncbi.nlm.nih.gov/pubmed/15061598
poverty.

That also correlates with unsafe sex practices, but not promiscuity. The latter is present, but it doesn't seem to be causal.

i don't know. I'm not even sure i want to go there. people of european decent may just have increased resistance to disease.

you're also not addressing a couple of important factors. first, the change in STD exposure over time. and second, healthcare even among the poor now is surely better than people of means in the 60s.

 

[nismaratwork]

i don't know. I'm not even sure i want to go there. people of european decent may just have increased resistance to disease.

you're also not addressing a couple of important factors. first, the change in STD exposure over time. and second, healthcare even among the poor now is surely better than people of means in the 60s.

I wouldn't assume any of that... I'd go by the stats. Race is there, yes, but poverty is the common theme, here and abroad.

edit: Again... none of this argues for a link between the pill, and cervical cancer, or promisuity. What conclusions can be drawn?... none yet, AFAICS.

 

[Proton Soup]

I wouldn't assume any of that... I'd go by the stats. Race is there, yes, but poverty is the common theme, here and abroad.

edit: Again... none of this argues for a link between the pill, and cervical cancer, or promisuity. What conclusions can be drawn?... none yet, AFAICS.

there's plenty of these out there. i have no interest in making a moral judgement, or arguing against HPV vaccinations because it might increase promiscuity. the promiscuous ones need the vaccine the most. now, one funny one here, where it http://www.bmj.com/content/340/bmj.c1439/reply" ?

http://www.ncbi.nlm.nih.gov/pubmed/8237988

Am J Epidemiol. 1993 Nov 1;138(9):735-45.
Risk factors associated with cervical human papillomavirus infections: a case-control study.

Kataja V, Syrjänen S, Yliskoski M, Hippelïnen M, Väyrynen M, Saarikoski S, Mäntyjärvi R, Jokela V, Salonen JT, Syrjänen K.

Department of Radiotherapy and Clinical Oncology, Kuopio University Hospital, Finland.
Abstract

As a part of the long-term prospective follow-up study conducted for women with genital human papillomavirus (HPV) infections in Kuopio University Hospital, Finland, since 1981, a case-control study was designed to assess risk factors for genital HPV infections. The cases (n = 691) were women who had been invited to attend the follow-up program on the basis of an abnormal cervical smear consistent with HPV-induced cytopathic changes, i.e., had a clinical HPV infection. The controls (n = 706) were a randomly selected group of women who had normal smears in the screening. Both groups were asked to fill in an extensive questionnaire focusing on detailed epidemiologic data on previous gynecologic and obstetric history, sexual practices, sexual partners, and smoking habits. In the multivariate analysis, eight variables emerged as independent risk factors for prevalent HPV infection. These variables could explain over 80% of the risk for infection. The risk for the infection varied with age, being highest in the age group 20-29 years, thereafter declining in the following 10-year age groups. The strongest independent risk factor was the number of sexual partners during the past 2 years (adjusted odds ratio = 12.1; 95% confidence interval 4.3-33.8 for five or more vs. one or no partners). Among the independent risk factors that increased the risk were also current smoking (adjusted odds ratio = 2.7; 95% confidence interval 1.7-4.3), warts in sexual partner(s) (adjusted odds ratio = 3.2; 95% confidence interval 1.6-6.5), and increasing frequency of sexual intercourse per week. Independent risk factors with a protective effect included a normal result in the last Papanicolaou smear, regular use of an intrauterine device as a contraceptive method, and good personal hygiene. No significant association between oral contraceptive use and risk for HPV infection was found. Condom use did not result in protection from the infection. The results of this study support the concepts that sexual intercourse is the main form of transmission among adults and that sexual promiscuity is the most important determinant for genital HPV infections.

PMID: 8237988 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/pubmed/7732287

Rev Sanid Hig Publica (Madr). 1993 May-Jun;67(3):217-25.
[Cervical cancer of the uterus. Analytic epidemiology].

[Article in Spanish]

Gimeno Ortiz A, Jiménez Romano R, Camps Pérez del Bosque JR.

Junta de Extremadura, Consejería de Sanidad y Consumo.
Abstract

BACKGROUND: Malignant tumour in cervix is an important cause of death in young women. Through community programmes of detection and early diagnosis, a significant reduction in the incidence of invading forms and mortality due to this cause has been achieved. Knowing the Prevalence of premalignant lesions and cancer in the sexually active women population, establishing the frequency of risk to different factors and associated risk to these ones in this population, constitutes a part of this study objectives.

METHODS: A transversal study is carried out, with a sample of population older than 20 years or younger, but sexually active, constituted by 4262 women, selected at random from a population of 7222 persons cared in family planning centers and distributed in 15 localities. In every case, the colposcopy has been made in a systematic way, associated to the cytology with a biopsy of every atypical image. Among the risk factors studied, the expositions to Rx, sexual promiscuity, genital infections, mycosis and infertility are included. The existence, as a clinical discovery, of a suspected lesion or an atypical colposcopy are includes as risk markers. The test of, the calculation of Odds Ratio, and 95% confidence interval, the etiological fractions, the multivariant analysis and the calculation of OR, adjusted to qualitative variables and the comparison of means for quantitative variables, are used in the analysis. The programme SAS is used as a software.

RESULTS: The prevalence of cancer found was 0.938 per one thousand women and the frequency of precursory lesions was 38.2 per one thousand. The comparative study with regard to different variables between women with benign deteriorations or normality and women presenting a diagnosis of premalignant lesions or carcinoma, proves that, without existing differences in relation to age, beginning of sexual relations ans number of pregnancies, the risk of suffering from cervix cancer increases with sexual promiscuity, exposition to Rx, genital infections, mycosis and infertility.

CONCLUSIONS: On the basis of the prevalence detected, it is considered necessary keep and to increase the coverage of actions of cervix cancer prevention in women, increasing the participation of the whole of sexually active women in the programmes. The presence of risk factor would modify the number and periodicity of gynecological controls.

PMID: 7732287 [PubMed - indexed for MEDLINE]

even within a low-income demographic, promiscuity plays a role
http://ije.oxfordjournals.org/content/26/3/491.abstract

Sexual risk factors for cervical cancer among rural Indian women: a case-control study.

1. L N Biswas,
2. B Manna,
3. P K Maiti and
4. S Sengupta

1.
Department of Radiotherapy and Oncology, NRS Medical College, Calcutta, India.

Abstract

BACKGROUND: The association between sexual behaviour and cervical cancer is well established. Despite a high incidence of cervical cancer in India, its role has not been widely investigated in Indian women among whom the rate of sexual promiscuity is known to be very low. A hospital-based case-control study was carried out to investigate the role of sexual risk factors in cervical cancer among rural Indian women. METHODS: A case-control design was used in which a total of 268 subjects, comprising 134 women with invasive cervical cancer as cases and 134 control women were studied. A multiple logistic regression model was used to analyse the data. RESULTS: The risk factors found to be associated with cervical cancer were early age at first coitus, extramarital sex partners of women and the time interval since first exposure. In a multiple logistic regression model, independent effects were observed for early age at first coitus, showing maximum risk in women who reported their first intercourse at < 12 years of age, compared to that of women at > or = 18 years (odds ratio [OR] = 3.5. 95% confidence interval [CI]: 1.1-10.9). Increased risk was also seen for women who had extramarital sex relationships (OR = 5.5, 95% CI: 1.5-19.5). The significant effect of early age at first coitus persisted after adjustment for latency period which also showed its independent risk association with cervical cancer in the multivariate analysis. CONCLUSION: These findings confirm the association between early age at first coitus and cervical cancer in women with a low rate of sexual promiscuity and define the role of these risk factors in cervical carcinogenesis among rural Indian women.

 

[nismaratwork]

there's plenty of these out there. i have no interest in making a moral judgement, or arguing against HPV vaccinations because it might increase promiscuity. the promiscuous ones need the vaccine the most. now, one funny one here, where it http://www.bmj.com/content/340/bmj.c1439/reply" ?

http://www.ncbi.nlm.nih.gov/pubmed/8237988


http://www.ncbi.nlm.nih.gov/pubmed/7732287


even within a low-income demographic, promiscuity plays a role
http://ije.oxfordjournals.org/content/26/3/491.abstract

True... actually I have a 65 year old male friend who is likely to die soon from oral cancer as a result of HPV... he freely admits that he... well... he frequented prostitutes, and you can guess where his face was.

Still, low income and promiscuity doesn't link to the pill, or HPV... and in this case this man is extremly, EXTREMELY wealthy.

 

[Proton Soup]

True... actually I have a 65 year old male friend who is likely to die soon from oral cancer as a result of HPV... he freely admits that he... well... he frequented prostitutes, and you can guess where his face was.

Still, low income and promiscuity doesn't link to the pill, or HPV... and in this case this man is extremly, EXTREMELY wealthy.

maybe. the more i read, the more I'm getting the trend that women on the pill have more sex, but with fewer partners. but there is still some risk there. http://en.wikipedia.org/wiki/Combined_oral_contraceptive_pill#cite_ref-IARC2007_0-3

 

[nismaratwork]

maybe. the more i read, the more I'm getting the trend that women on the pill have more sex, but with fewer partners. but there is still some risk there. http://en.wikipedia.org/wiki/Combined_oral_contraceptive_pill#cite_ref-IARC2007_0-3

Hmmm... it's possible... I'm not seeing anything conclusive, but yes... certainly evidence.


I wonder what this might mean for a male "pill", and how it would effect the spread of STDs?

 

[Proton Soup]

Hmmm... it's possible... I'm not seeing anything conclusive, but yes... certainly evidence.


I wonder what this might mean for a male "pill", and how it would effect the spread of STDs?

probably similar in committed relationships, but women won't trust men on this issue in more random encounters.

or are you thinking that the pill is causing physiological changes in the woman that offer some disease resistance?

 

[nismaratwork]

probably similar in committed relationships, but women won't trust men on this issue in more random encounters.

or are you thinking that the pill is causing physiological changes in the woman that offer some disease resistance?

No... the former... I've seen no evidence that the pill confers resistance, and exposure is mitigated by mutation usually.