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According to a study published in the journal Obstetrics and Gynecology, postmenopausal women who reported recent sexual activity while not married or not living as married were at increased risk of developing high-grade precancerous changes to the cervix.

The most important cause of cervical cancer is infection with a high-risk type of human papillomavirus (HPV). Human papillomaviruses consist of a group of more than 100 different viruses. Some types of HPV cause warts on the hands or feet; others cause genital warts; and some have been linked with cancer, most notably cervical cancer. The types of HPV most commonly linked with cervical cancer are HPV 16 and HPV 18, but several other high-risk types contribute to cancer as well.

The types of HPV that cause cervical cancer or genital warts are transmitted sexually. Although most infections resolve on their own, some persist and can lead to precancerous or cancerous changes to the cervix, vulva, vagina, penis, and anus.

To explore the frequency and predictors of cervical abnormalities among postmenopausal women, researchers evaluated information from the Women’s Health Initiative study of estrogen plus progestin. The study enrolled more than 16,000 postmenopausal women who were assigned to receive postmenopausal hormone therapy consisting of estrogen plus progestin, or a placebo.

Previous results from this study indicate the women who take estrogen plus progestin have an increased risk of heart disease, breast cancer, stroke, and blood clots, but a decreased risk of fractures and colorectal cancer.

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Enrollment in the study was restricted to women who had a normal or mildly abnormal Pap test result. At the start of the study (baseline), 98% of study participants had a normal Pap test result and 2% had a Pap test indicating a low-grade cervical abnormality (low-grade squamous intraepithelial lesion, or LSIL).

  • During six years of follow-up, 54 study participants developed a high-grade cervical abnormality. Forty-six of these cases occurred among women with a normal baseline Pap test result, and eight occurred among women with an abnormal baseline Pap test result. A total of 10 cases of cervical cancer were diagnosed.
  • Compared to women who took a placebo, women who took estrogen plus progestin were more likely to develop a cervical abnormality. This appeared to be explained largely by an increase in low-grade cervical abnormalities. Use of postmenopausal hormone therapy did not increase the risk of developing a high-grade cervical abnormality or cancer.
  • The risk of developing a high-grade cervical abnormality was increased among women who were sexually active and who were not married or were not living as married. Compared to women who were married or living as married, the risk of HSIL among sexually active women who were not married or not living as married was more than three times higher. This increased risk may be the result of exposure to a new sexual partner and a new HPV infection.

The researchers conclude “Sexually active older women who are not married or living as married may benefit from continued cervical cancer screening.”

Women of all ages may wish to talk with their doctor about the cervical cancer screening strategy that is best for them.

Reference: Yasmeen S, Romano PS, Pettinger M et al. Incidence of Cervical Cytological Abnormalities with Aging in the Women’s Health Initiative: A Randomized Controlled Trial. Obstetrics and Gynecology. 2006;108:410-419.