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January 1, 1988, Vol 259, No. 1 >
ARTICLE | January 1, 1988

Oral Contraceptives and Cervical Cancer Risk in Costa Rica: Title and subTitle BreakDetection Bias or Causal Association? FREE

Kathleen L. Irwin, MD; Luis Rosero-Bixby; Mark W. Oberle, MD; Nancy C. Lee, MD; Anne S. Whatley, MS; Judith A. Fortney, PhD; Michele G. Bonhomme, MSPH
[+] Author Affiliations

The opinions expressed in this article are the authors' and do not necessarily reflect the views of the US Agency for International Development.

Reprint requests to Division of Reproductive Health, Centers for Disease Control, Atlanta, GA 30333 (Dr Irwin).


JAMA. 1988;259(1):59-64. doi:10.1001/jama.1988.03720010037037
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References

To examine the relationship between cervical cancer and oral contraceptive (OC) use, we analyzed data from a population-based, case-control study in Costa Rica. Women aged 25 to 58 years in whom cervical cancer was diagnosed and reported to the National Tumor Registry were examined as two separate case groups: invasive cervical cancer and carcinoma in situ (CIS). Controls were women aged 25 to 58 years identified through a national survey. Women who had used OCs had no increased risk of invasive cervical cancer compared with women who had never used OCs (relative risk, 0.8; 95% confidence interval, 0.5 to 1.3). Women who had used OCs had an increased risk of CIS compared with those who had never used OCs (relative risk, 1.6; 95% confidence interval, 1.2 to 2.2). However, further analyses indicated that this increased risk was confined to those who had recently used OCs. Also, the risk of CIS was not elevated in subgroups in which a history of cervical smears was not strongly linked to OC use. The elevated risk of CIS among OC users may therefore reflect a bias caused by enhanced detection of disease rather than a causal association.

(JAMA 1988;259:59-64)

REFERENCES

1 +
Piper JM:  Oral contraceptives and cervical cancer. Gynecol Oncol 1985;;22:1-14.
2 +
Brinton LA, Huggins GR, Lehman HF, et al:  Long-term use of oral contraceptives and risk of invasive cervical cancer. Int J Cancer 1986;;38:339-344.
3 +
 WHO Collaborative Study of Neoplasia and Steroid Contraceptives: Invasive cervical cancer and combined oral contraceptives. Br Med J 1985;;290:961-965.
4 +
Reeves WC, Brinton LA, Brenes MM, et al:  Case control study of cervical cancer in Herrera Province, Republic of Panama. Int J Cancer 1985;;36:55-60.
5 +
Swan SH, Petitti DB:  A review of problems of bias and confounding in epidemiologic studies of cervical neoplasia and oral contraceptive use. Am J Epidemiol 1982;;115:10-18.
6 +
De Bermudez DG:  The National Tumor Registry in Costa Rica. Epidemiol Bull PAHO 1985;;6:10-13.
7 +
Rosero-Bixby L, Grimaldo-Vásquez C:  Epidemiología descriptiva del cancer de mama y de cuello de útero en Costa Rica. Bol Of Sanit Panam 1987;;102:483-493.
8 +
Rosero-Bixby L,  Asociación Demográfica Costarricense : Fecundidad y anticoncepción en Costa Rica 1981: Resultados de la segunda encuesta de prevalencia anticonceptiva . Columbia, Md, Westinghouse Health Systems, 1981;.
9 +
Garfield RM, Rodriguez PF:  Health and health services in Central America. JAMA 1985;;254:936-943.
10 +
Casas A, Vargas H:  The health system in Costa Rica: Toward a National Health Service. J Public Health Pol 1980;;1:258-279.
11 +
Oberle MW, Becker S, Morris L, et al: The Costa Rican Fertility and Health Survey, 1986: Final English Language Report . Atlanta, Centers for Disease Control, 1987;.
12 +
Lee NC, Rosero-Bixby L, Oberle MW, et al:  A case-control study of breast cancer and hormonal contraception in Costa Rica. JNCI 1987;;79:1247-1254.
13 +
Lee FK, Coleman RM, Pereira L, et al:  Detection of herpes simplex virus type 2—specific antibody with glycoprotein G. J Clin Microbiol 1985;;22:641-644.
14 +
Wang SP, Grayston JT, Alexander ER, et al:  Simplified microimmunofluorescence test with trachoma-lymphogranuloma venereum (Chlamydia trachomatis) antigens for use as a screening test for antibody. J Clin Microbiol 1975;;1:250-255.
15 +
Cox PM, Logan LC, Norins LC:  Automated, quantitative microhemagglutination assay for Treponema pallidum antibodies. Appl Microbiol 1969;;18:485-489.
16 +
Cramer DW:  Uterine cervix , in Schottenfeld D, Fraumeni JF (eds): Cancer Epidemiology and Prevention . Philadelphia, WB Saunders Co, 1982;, pp 881-900.
17 +
Schlesselman JJ: Case-Control Studies: Design, Conduct, Analysis . New York, Oxford University Press, 1982;, pp 227-290.
18 +
Harrel FE: The Logist Procedure: SUGI Supplemental Library User's Guide . Cary, NC, SAS Institute, 1983;, pp 181-202.
19 +
La Vecchia C, Franceschi S, DeCarli A, et al:  Cigarette smoking and the risk of cervical neoplasia. Am J Epidemiol 1986;;123:22-29.
20 +
Stern E, Forsythe AB, Youkeles L, et al:  Steroid contraceptive use and cervical dysplasia: Increased risk of progression. Science 1977;; 196:1460-1462.
21 +
Zur Hausen H:  Human genital cancer: Synergism between two virus infections or synergism between a virus infection and initiating events? Lancet 1982;;2:1370-1372.
22 +
Gall SA, Bourgeois CH, Maguire R:  The morphologic effects of oral contraceptive agents on the cervix. JAMA 1969;;207:2243-2247.
23 +
Maquero M, Azuela JC, Calderon JJ, et al:  Morphology of the cervix in women treated with synthetic progestins. Am J Obstet Gynecol 1966;;96:994-998.
24 +
Wied GL, Davis E, Frank R, et al:  Statistical evaluation of the effect of hormonal contraceptives on the cytologic smear pattern. Obstet Gynecol 1966;;27:327-334.
25 +
Coulter A, Vessey M, McPherson K:  The ability of women to recall their oral contraceptive histories. Contraception 1986;;33:127-137.
26 +
Skegg DCG, Corwin PA, Paul C, et al:  Importance of the male factor in cancer of the cervix. Lancet 1982;;2:581-583.
27 +
Reid R, Crum CP, Herschman BR, et al:  Genital warts and cervical cancer: III. Subclinical papillomaviral infection and cervical neoplasia are linked by a spectrum of continuous morphologic and biologic change. Cancer 1984;;53:943-953.
28 +
Swan SH, Brown WL:  Oral contraceptive use, sexual activity, and cervical carcinoma. Am J Obstet Gynecol 1980;;139:52-57.
29 +
Vessey MP, Lawless M, McPherson K, et al:  Neoplasia of the cervix uteri and contraception: A possible adverse effect of the pill. Lancet 1983;;2:930-934.
30 +
Harris RWC, Brinton LA, Cowdell RH, et al:  Characteristics of women with dysplasia or carcinoma in situ of the cervix uteri. Br J Cancer 1980;;42:359-369.

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Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Piper JM:  Oral contraceptives and cervical cancer. Gynecol Oncol 1985;;22:1-14.
2 +
Brinton LA, Huggins GR, Lehman HF, et al:  Long-term use of oral contraceptives and risk of invasive cervical cancer. Int J Cancer 1986;;38:339-344.
3 +
 WHO Collaborative Study of Neoplasia and Steroid Contraceptives: Invasive cervical cancer and combined oral contraceptives. Br Med J 1985;;290:961-965.
4 +
Reeves WC, Brinton LA, Brenes MM, et al:  Case control study of cervical cancer in Herrera Province, Republic of Panama. Int J Cancer 1985;;36:55-60.
5 +
Swan SH, Petitti DB:  A review of problems of bias and confounding in epidemiologic studies of cervical neoplasia and oral contraceptive use. Am J Epidemiol 1982;;115:10-18.
6 +
De Bermudez DG:  The National Tumor Registry in Costa Rica. Epidemiol Bull PAHO 1985;;6:10-13.
7 +
Rosero-Bixby L, Grimaldo-Vásquez C:  Epidemiología descriptiva del cancer de mama y de cuello de útero en Costa Rica. Bol Of Sanit Panam 1987;;102:483-493.
8 +
Rosero-Bixby L,  Asociación Demográfica Costarricense : Fecundidad y anticoncepción en Costa Rica 1981: Resultados de la segunda encuesta de prevalencia anticonceptiva . Columbia, Md, Westinghouse Health Systems, 1981;.
9 +
Garfield RM, Rodriguez PF:  Health and health services in Central America. JAMA 1985;;254:936-943.
10 +
Casas A, Vargas H:  The health system in Costa Rica: Toward a National Health Service. J Public Health Pol 1980;;1:258-279.
11 +
Oberle MW, Becker S, Morris L, et al: The Costa Rican Fertility and Health Survey, 1986: Final English Language Report . Atlanta, Centers for Disease Control, 1987;.
12 +
Lee NC, Rosero-Bixby L, Oberle MW, et al:  A case-control study of breast cancer and hormonal contraception in Costa Rica. JNCI 1987;;79:1247-1254.
13 +
Lee FK, Coleman RM, Pereira L, et al:  Detection of herpes simplex virus type 2—specific antibody with glycoprotein G. J Clin Microbiol 1985;;22:641-644.
14 +
Wang SP, Grayston JT, Alexander ER, et al:  Simplified microimmunofluorescence test with trachoma-lymphogranuloma venereum (Chlamydia trachomatis) antigens for use as a screening test for antibody. J Clin Microbiol 1975;;1:250-255.
15 +
Cox PM, Logan LC, Norins LC:  Automated, quantitative microhemagglutination assay for Treponema pallidum antibodies. Appl Microbiol 1969;;18:485-489.
16 +
Cramer DW:  Uterine cervix , in Schottenfeld D, Fraumeni JF (eds): Cancer Epidemiology and Prevention . Philadelphia, WB Saunders Co, 1982;, pp 881-900.
17 +
Schlesselman JJ: Case-Control Studies: Design, Conduct, Analysis . New York, Oxford University Press, 1982;, pp 227-290.
18 +
Harrel FE: The Logist Procedure: SUGI Supplemental Library User's Guide . Cary, NC, SAS Institute, 1983;, pp 181-202.
19 +
La Vecchia C, Franceschi S, DeCarli A, et al:  Cigarette smoking and the risk of cervical neoplasia. Am J Epidemiol 1986;;123:22-29.
20 +
Stern E, Forsythe AB, Youkeles L, et al:  Steroid contraceptive use and cervical dysplasia: Increased risk of progression. Science 1977;; 196:1460-1462.
21 +
Zur Hausen H:  Human genital cancer: Synergism between two virus infections or synergism between a virus infection and initiating events? Lancet 1982;;2:1370-1372.
22 +
Gall SA, Bourgeois CH, Maguire R:  The morphologic effects of oral contraceptive agents on the cervix. JAMA 1969;;207:2243-2247.
23 +
Maquero M, Azuela JC, Calderon JJ, et al:  Morphology of the cervix in women treated with synthetic progestins. Am J Obstet Gynecol 1966;;96:994-998.
24 +
Wied GL, Davis E, Frank R, et al:  Statistical evaluation of the effect of hormonal contraceptives on the cytologic smear pattern. Obstet Gynecol 1966;;27:327-334.
25 +
Coulter A, Vessey M, McPherson K:  The ability of women to recall their oral contraceptive histories. Contraception 1986;;33:127-137.
26 +
Skegg DCG, Corwin PA, Paul C, et al:  Importance of the male factor in cancer of the cervix. Lancet 1982;;2:581-583.
27 +
Reid R, Crum CP, Herschman BR, et al:  Genital warts and cervical cancer: III. Subclinical papillomaviral infection and cervical neoplasia are linked by a spectrum of continuous morphologic and biologic change. Cancer 1984;;53:943-953.
28 +
Swan SH, Brown WL:  Oral contraceptive use, sexual activity, and cervical carcinoma. Am J Obstet Gynecol 1980;;139:52-57.
29 +
Vessey MP, Lawless M, McPherson K, et al:  Neoplasia of the cervix uteri and contraception: A possible adverse effect of the pill. Lancet 1983;;2:930-934.
30 +
Harris RWC, Brinton LA, Cowdell RH, et al:  Characteristics of women with dysplasia or carcinoma in situ of the cervix uteri. Br J Cancer 1980;;42:359-369.

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