ArticlePloS one2016
The Influence of Hormonal Factors on the Risk of Developing Cervical Cancer and Pre-Cancer: Results from the EPIC Cohort.
Article in PloS one, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 70 papers, 4 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
70 citing papers in PubMed, 4 syntheses or guidelines pooled it, 209 citations in OpenAlex.
- Association of cervical cancer and intrauterine device use: a narrative review.BMC women's health · 2025Pooled it
- The effect of hormone replacement therapy on cervical cancer risk in perimenopausal women: a systematic review and meta-analysis of observational studies.Frontiers in oncology · 2025Pooled it
- Non-Genetic Factors and Risk of Cervical Cancer: An Umbrella Review of Systematic Reviews and Meta-Analyses of Observational Studies.International journal of public health · 2023Pooled it
- The relationship between hormonal contraception and cervical dysplasia/cancer controlling for human papillomavirus infection: A systematic review.Contraception · 2022Pooled it
- Global burden trends and menopause timing associations for gynecological and breast cancers in postmenopausal women.iScience · 2026Article
- Article
- Review
- When Estrogen Signaling Refuses to Die: Receptor Rewiring, Compartmentalization, and Endocrine Plasticity in Gynecological Cancers.International journal of molecular sciences · 2026Review
- Cervical Cancer Epidemiology: Global Incidence, Mortality, Survival, Risk Factors, and Equity in HPV Screening and Vaccination.Journal of clinical medicine · 2026Review
- Blood metabolites, mitochondrial biofunction, and cervical cancer: a bidirectional Mendelian randomization study.BMC women's health · 2025Article
- Human Papillomavirus and Other Relevant Issues in Cervical Cancer Pathogenesis.International journal of molecular sciences · 2025Review
- The clinicopathological features of breast cancer in Peutz-Jeghers syndrome: results from an international survey.Familial cancer · 2025Article
- The role of co-infections and hormonal contraceptives in cervical intraepithelial neoplasia prevalence among women referred to a tertiary hospital in Western Kenya.Infectious agents and cancer · 2025Article
- Incidence of cervical intraepithelial neoplasia and cervical cancer in transmasculine and gender diverse individuals using testosterone: a retrospective, single-centre cohort study.EClinicalMedicine · 2025Article
- Anti-Estrogen Therapy Achieves Complete Remission and Stability in Recurrent Cervical Cancer: A Case Study.The American journal of case reports · 2025Article
- Distinct cervical microbiome and metabolite profiles before and after menopause: implications for cervical cancer progression.Frontiers in cellular and infection microbiology · 2025Article
- Human Papillomavirus (HPV) Vaccination: Progress, Challenges, and Future Directions in Global Immunization Strategies.Vaccines · 2024Review
- Associations of clinical and modifiable behavioral risk factors with the histological progression of squamous intraepithelial lesions.Molecular and clinical oncology · 2024Article
- Risk factors of uterine perforation when using contraceptive intrauterine devices.BMC women's health · 2024Article
- Cervical cancer: Challenges and prevention strategies: A narrative review.Health science reports · 2024Review
10 more citing papers are in PubMed but not listed here.
Corrections and comments
- Erratum issued
Authors and funding
49 authors at 20 institutions in 14 countries.
Funding
Abstract
backgroundIn addition to HPV, high parity and hormonal contraceptives have been associated with cervical cancer (CC). However, most of the evidence comes from retrospective case-control studies. The aim of this study is to prospectively evaluate associations between hormonal factors and risk of developing cervical intraepithelial neoplasia grade 3 (CIN3)/carcinoma in situ (CIS) and invasive cervical cancer (ICC). METHODS AND
findingsWe followed a cohort of 308,036 women recruited in the European Prospective Investigation into Cancer and Nutrition (EPIC) Study. At enrollment, participants completed a questionnaire and provided serum. After a 9-year median follow-up, 261 ICC and 804 CIN3/CIS cases were reported. In a nested case-control study, the sera from 609 cases and 1,218 matched controls were tested for L1 antibodies against HPV types 11,16,18,31,33,35,45,52,58, and antibodies against Chlamydia trachomatis and Human herpesvirus 2. Multivariate analyses were performed to estimate hazard ratios (HR), odds ratios (OR) and corresponding 95% confidence intervals (CI). The cohort analysis showed that number of full-term pregnancies was positively associated with CIN3/CIS risk (p-trend = 0.03). Duration of oral contraceptives use was associated with a significantly increased risk of both CIN3/CIS and ICC (HR = 1.6 and HR = 1.8 respectively for ≥ 15 years versus never use). Ever use of menopausal hormone therapy was associated with a reduced risk of ICC (HR = 0.5, 95%CI: 0.4-0.8). A non-significant reduced risk of ICC with ever use of intrauterine devices (IUD) was found in the nested case-control analysis (OR = 0.6). Analyses restricted to all cases and HPV seropositive controls yielded similar results, revealing a significant inverse association with IUD for combined CIN3/CIS and ICC (OR = 0.7).
conclusionsEven though HPV is the necessary cause of CC, our results suggest that several hormonal factors are risk factors for cervical carcinogenesis. Adherence to current cervical cancer screening guidelines should minimize the increased risk of CC associated with these hormonal risk factors.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.