However, the risk was not statistically significant.Considering the duration of use, women who had used OC for 3 years or less did not have an increased risk of cervical cancer (OR 0.78).

Nevertheless,  the odds ratio of oral contraceptive pill use for more than 3 years was 2.57 which was statistically significant.

So, long-term use of oral contraceptives might be a cofactor that increases the risk of cervical carcinoma by up to four-fold in women who are positive for cervical HPV ^(55,56,57).  For this reason,many U.S.gynecologists refuse prescription of hormonal   contraceptives   in   women   without   cervical   cancer   screening ⁽⁵⁸⁾.

Although the World Health Organization does not recommend any change in oral contraceptive use   ⁽⁵⁹⁾. So,a risk-benefit analysis supports the continuation of contraceptive use among women who have abnormal smears but also, who have access   to   educational   counselling   and   clinical   surveillance ⁽⁶⁰⁾.

Cervical cytological   studies   reported   the   significantly   high   frequency   of   squamous intraepithelial lesions (SILs)  in the early stages of contraception with Norplant insertion,  but after 1 year a progressive decline of them was found and after 3 years no SIL was seen ⁽⁶¹⁾.

Data suggest that in adolescents and young women HPV infections and their sequalae,squamous intraepithelial lesions (SILs) occur more commonly among human immunodeficiency (HIV)-infected girls because of the HIV associated CD4+T-cell immunosuppression ⁽⁶²⁾. 

However, the risk of developing the HPV-associated precancer high-grade squamous intraepithelial lesion (HSIL)in HIV-infected adolescent is unknown.  It seems that the use of hormonal contraceptives,either combined oral contraceptives or intramuscolar MPA , high cervical mucous concentrations of interleukin-12, a positive HPV test, and   a   persistent   low-grade   squamous   intraepithelial   lesion (LSIL)  were significantly associated with the development of HSIL ⁽⁶³⁾. 

—
Rosa Sabatini and Giuseppe Loverro
Dept. Obstetrics and Gynecology,
General Hospital Policlinico-University of Bari, Italy
—

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