The oral contraceptive pill and cervical neoplasia [editorial]

While it is generally accepted that the combined oral contraceptive (OC) is associated with a significant positive effect against ovarian and endometrial cancer the role of OC use in the development of cervical neoplasia is less easily discerned because of the confounding variable associated with cervical cancer. Such variables include sexual behavior nonuse of barrier methods and the increased number of cervical smear tests given to OC users. Smoking and the type of OC used are also considerations. Despite the problems associated with many of the early studies on OC use and risk of cervical cancer a consensus is building that the use of OCs is linked with a small but significant increase in the risk of cervical neoplasia and that this risk increases with duration of use from 1.3-1.8 at five years use to approximately 2.0 after 10 years use. It also appears that the increased risk for adenocarcinoma of the cervix associated with OC use is greater than that observed for squamous cell carcinoma. Regular cervical cytology is thus essential for all longterm users of combined OCs. This issue will remain unresolved until larger well-controlled studies are carried out.