A 26-year-old woman has used a combined oral contraceptive pill continuously for 10 years. She asks whether this increases her risk of cervical cancer. The most accurate answer is:

• A No association exists between oral contraceptives and cervical cancer
• B Oral contraceptives protect against cervical cancer while increasing endometrial cancer risk
• C Long duration of use is associated with a modest increase in cervical cancer risk, which declines after cessation ✓
• D Risk increases only in women who also smoke

Explanation

The IARC classified combined oral contraceptives as increasing the risk of cervical cancer in HPV-positive women, with the effect emerging after around 5 years of use and being modest in magnitude. The excess risk falls toward baseline within about 10 years of stopping. Option D is incorrect because the association exists independently of smoking, although smoking compounds the risk. Protection against endometrial and ovarian cancer (option B) does not extend to the cervix.

Reference: Williams Gynecology, 4th ed.

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Written and medically reviewed by the StethoPrep medical team.