Master of Science
E. Christa Stern
The purpose of this study was to determine the relationship between specific oral contraceptive use and cervical intraepithelial neoplasia (CIN), and to determine if duration of use and content of oral contraceptives were related to CIN. The hypotheses tested in this study were: (1) norgestrel-containing oral contraceptives are associated with more severe levels of CIN, and (2) longer duration of oral contraceptive use is associated with more severe CIN.
Data was collected from 52 clinical records of clients who attended a colposcopy clinic during a four month period. Clients included in the study were utilizing one of five specific oral contraceptives for a minimum of six continuous months. During their initial clinic visit, all clients were interviewed by the colposcopy clinic nurse who recorded information concerning duration and type of oral contraceptive use on part one of an investigator-designed data collection form. From the data collection forms completed by the nurse, the investigator determined clinical record eligibility for inclusion in the study. The investigator utilized part two of the data collection form to record age, race and colposcopic diagnosis from the client clinical record.
The majority of study clients were black and younger than 26 years of age. The duration of oral contraceptive use ranged from six to 96 months. OrthoNovum 1/50 (ON 1/50) was the most frequently used, and LoOvral was the least frequently use, oral contraceptive. Mild/moderate dysplasia was the most frequent CIN diagnosis and carcinoma in situ (CIS) was the least frequent. Condyloma was the second most frequent CIN diagnosis.
OrthoNovum 1/35 (ON 1/35) users had the highest frequency of mild dysplasia, and the highest Estimate of Relative Risk (ERR) of mind/moderate dysplasia. Users of <= 35 mcg. estrogen oral contraceptives had a higher percentage and ERR of mild/moderate dysplasia than users of 50 mcg. Estrogen oral contraceptives. ON 1/35 and Loestrin users had no severe dysplasia/CIS diagnoses.
ON 1.50 and Ovral users (50 mcg. Estrogen oral contraceptives) had a higher percentage and ERR of severe dysplasia/CIS and condyloma than users of <= 35 mcg. estrogen oral contraceptives. Loestrin users had the highest overall percentage and ERR of condyloma, and LoOvral users had the lowest overall percentage and ERR of condyloma. Of those clients with 12 or more months of oral contraceptive use, the 50 mcg. estrogen oral contraceptive users had the highest percentage of condyloma. Of the study clients with 12 months or less oral contraceptive use, the 50 mcg. estrogen oral contraceptive users had the lowest percentage of condyloma. For all durations of oral contraceptive use, 50 mcg. estrogen users had the highest percentage of severe dysplasia/CIS. Users of oral contraceptives for 12 months or less had a higher percentage and ERR of severe dysplasia/CIS and condyloma than users of oral contraceptives for more than 12 months.
Users of norgestrel-containing oral contraceptives had a higher percentage and ERR of severe dysplasia/CIS and a lower percentage of condyloma and mild/moderate dysplasia than other oral contraceptive users in the study.
Fisher’s exact one-tail test and Analysis of variance (ANOVA) showed a statistically significant difference in the incidence of dysplasia between <=35 mcg. estrogen and 50 mcg. estrogen oral contraceptive users. Fisher’s exact one-tail test also showed statistically significant differences in the incidence of dysplasia between ON 1/35 and Ovral users. Differences in the incidence of condyloma between norgestrel-containing oral contraceptives and other oral contraceptive users were not statistically significant with Fisher’s exact one-tail test.
The investigator concluded that there were differences between specific oral contraceptives and the associated incidence of CIN. The investigator also concluded that these differences were not associated with duration of oral contraceptive use.
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