Evidence for practice: oral contraception and risk of cervical cancer.
OBJECTIVE
The issue of continued oral contraceptive use among women with abnormal Pap smears may be controversial due to reported evidence of an increased risk of cervical cancer among long term oral contraceptive users. This article reviews the evidence concerning oral contraception and cervical cancer risk. The role of Human Papilloma virus (HPV) and proposed mechanisms for the development of cervical cancer are explained. Evidence from World Health Organization (WHO) studies and additional research evidence are discussed. Implications for clinical practice are included.


METHODS
WHO commissioned studies, additional relevant studies searchable from an EBSCO database, and texts that describe the natural history of HPV.


CONCLUSIONS
Epidemiological studies and biomedical research suggest a role for steroid hormones, such as oral contraceptives, in facilitating the action of HPV. However, a majority of HPV infections resolve spontaneously, despite widespread use of oral contraception. Oral contraception does not appear to increase incident HPV infection or persistence of HPV infection. The benefits of oral contraceptives appear to outweigh the risks associated with HPV facilitation.


CONCLUSIONS
NPs inform patients of abnormal Pap smears, manage the clinical care of women at risk of cervical cancer, and provide educational counseling regarding contraceptive choices. Ethical considerations include clear disclosure of potential risk. However, a risk-benefit analysis supports continued use of oral contraception among women who have abnormal Pap smears but also have access to clinical surveillance.
Bertram
Cathy Cramer
CC
Queen's Medical Center, University of Hawaii School of Nursing and Dental Hygiene, USA. ccramer@queens.org
D003043:Cocarcinogenesis; D003276:Contraceptives, Oral / Q000009:adverse effects*; D018450:Disease Progression; D016903:Drug Monitoring; D016021:Epidemiologic Studies; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007258:Informed Consent; D008403:Mass Screening; D009722:Nurse Practitioners; D024802:Nurse's Role; D009730:Nursing Assessment; D065006:Papanicolaou Test; D030361:Papillomavirus Infections / Q000150:complications / Q000635:transmission; D010353:Patient Education as Topic; D012107:Research Design / Q000592:standards; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000139:chemically induced* / Q000453:epidemiology / Q000473:pathology / Q000821:virology; D014626:Vaginal Smears; D014944:World Health Organization
D003276:Contraceptives, Oral