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Int J Epidemiol. 1991 Dec;20(4):865-70.

Invasive cervical cancer and intrauterine device use.

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Department of Preventive Medicine and Biometrics, University of Colorado Health Sciences Center, Denver.


Although the hypothesis that intrauterine device (IUD) use might promote cervical cancer has been considered since the introduction of IUDs in the early 1900s, previous studies are inconclusive. Data collected in interviews with 481 invasive cervical cancer cases and 801 general population controls from Birmingham, Chicago, Denver, Miami and Philadelphia were used to address this issue. These data were analysed to determine the relationship between IUD use and the risk of cervical cancer, with consideration of the type of IUD (copper and inert) and duration of use. A non-significant reduced risk of cervical cancer was associated with copper IUD use, indicated by an adjusted odds ratio (OR) of 0.6 (95% Cl: 0.3-1.2), but virtually no effect was found for inert IUD use (OR = 1.1, 95% Cl: 0.9-1.7). Decreased risk with increased duration of copper IUD use supports a possible protective effect of copper IUD use on the development of invasive cervical cancer.


The hypothesis that IUD use increases the risk of invasive cervical cancer was investigated in a case-control study conducted in 1982-84 in 5 metropolitan US centers--Birmingham, Chicago, Denver, Miama, Philadelphia. The study population consisted of 481 cases with invasive cervical tumors and 801 age- and race-matched controls selected by random digit dialing. 13% of cases and 20% of controls selected by random digit dialing. 13% of cases and 20% of controls reported a history of IUD use. The crude odds ratio for the association between IUD use and invasive cervical cancer was 0.6 (0.4-0.8, 95% confidence interval). Adjustment for all possible confounding factors (i.e., age, race, number of sexual partners, age at first intercourse, parity, cigarette smoking, number of marriages, previous genital or venereal infections, income, interval since last Papsmear, and use of oral and barrier contraception) resulted in an odds ration of 0.8 (0.5-1.2). The odds ratio was unaffected when study subjects were categorized according to duration of IUD use. On the other hand, the presence or absence of copper in the IUD did exert a significant effect on the degree of cervical cancer risk. A protective effect against invasive cervical cancer was observed for copper-containing IUDs (adjusted odds ratio of 0.6, 95% confidence interval 0.3-1.2) but not for inert devices (adjusted odds ration 1.1, 95% confidence interval 0.9-1.7). The reduced risk associated with copper IUDs increased with increased duration of use. Although prior studies have also failed to detect any association between IUD use and an increased risk of invasive cervical cancer, this is the first to suggest the possibility of a protective effect of copper IUDs on this risk.

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