ORAL CONTRACEPTIVE USE AND MALIGNANCIES OF THE GENITAL TRACT: Results from The Royal College of General Practitioners' Oral Contraception Study

Abstract

Of 47 000 women followed since 1968, those who had used oral contraceptives (ever-users) had a significantly higher incidence rate of cervical cancer than never-users. After standardisation of rates by age, parity, smoking, social class, number of previously normal cervical smears, and history of sexually transmitted disease, the excess was 41 per 100 000 woman-years for carcinoma-in-situ and 8 per 100 000 woman-years for invasive cervical cancer. Incidence increased with increasing duration of use: the standardised incidence rate for cervical cancer in women who had taken the pill for more than 10 years was four times that in never-users. Ever-users had a lower incidence of other uterine cancers (deficit 5 per 100 000 woman-years); a lower incidence of ovarian cancer was also found (deficit 4 per 100 000), but was not statistically significant. Overall, ever-users had an excess incidence for genital tract cancers of 37 per 100 000 woman-years. This excess was mainly from carcinoma-in-situ of the cervix; the excess incidence of invasive cervical cancer was offset by the deficits in other uterine and ovarian cancers. Standardised mortality rates from genital cancer were similar in ever-users and never-users. Of relevance to clinical practice is the substantially different distribution of primary cancer sites: cervical cancer accounted for 75% of the invasive genital cancers and 74% of deaths from genital cancer in ever-users, but only 31% of the invasive cancers and 30% of deaths in never-users.