Smoking habit, immune suppression, oral contraceptive use, and hormone replacement therapy use and cervical carcinogenesis: a review of the literature

Gynecol Endocrinol. 2011 Aug;27(8):597-604. doi: 10.3109/09513590.2011.558953. Epub 2011 Mar 25.


High-risk human papillomaviruses (HPVs) are involved in the etiopathogenesis of cervical intraepithelial neoplasia (CIN) and cervical cancer. After taking HPV into account, smoking habit appears to be the most significant environmental risk factor, and the risk of this malignancy increases significantly with intensity and duration of smoking. Women with human immunodeficiency virus (HIV) infection experience a higher incidence of CIN and invasive cervical cancer. Among HIV+ women, the highly active antiretroviral therapy increases the regression rate of CIN, but the majority of these lesions do not regress to normal. As far as oral contraceptives (OCs), a systematic review of 28 studies found that, compared with never pill users, the relative risk (RR) of cervical cancer increased with increasing duration of OC use. The results were similar for squamous cell carcinoma and adenocarcinoma, and the RRs decreased after pill discontinuation. However, by weighing risks and benefits, the World Health Organization does not recommend any change in OC practice. There is no correlation between hormone replacement therapy and cervical cancer. Experimental data have shown that estradiol and progesterone can modulate the host immune response to HPV16. Prophylactic vaccination in conjunction with cervical screening is the best prevention strategy for cervical cancer.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Cervical Intraepithelial Neoplasia / epidemiology
  • Cervical Intraepithelial Neoplasia / etiology*
  • Cervical Intraepithelial Neoplasia / pathology
  • Contraceptives, Oral / adverse effects*
  • Estrogen Replacement Therapy / adverse effects
  • Female
  • HIV Infections / physiopathology
  • Hormone Replacement Therapy / adverse effects*
  • Humans
  • Immunosuppression / adverse effects*
  • Neoplasm Invasiveness
  • Papillomavirus Infections / physiopathology
  • Risk Factors
  • Smoking / adverse effects*
  • Uterine Cervical Neoplasms / epidemiology
  • Uterine Cervical Neoplasms / etiology*
  • Uterine Cervical Neoplasms / pathology


  • Contraceptives, Oral