Contraception Methods and Cervical Cancer Prevention: Opportunities or Unintended Consequences?

Abstract

Background: Patients may seek sexual and reproductive health care for a range of clinical services, including cervical cancer prevention through human papillomavirus (HPV) vaccination or screening with Pap and/or HPV testing, or pregnancy prevention through initiation or continuation of contraceptive methods. Recommendations for frequency of cervical cancer screening are clearly defined, but clinical surveillance for contraception varies significantly between methods. Despite the opportunities presented to complete preventive health care during clinical encounters for contraception, there are no existing analyses that explicitly consider the associations between contraceptive services and cervical cancer prevention and screening.Methods: A secondary data analysis of the 2015-2019 National Survey of Family Growth (NSFG) was completed to investigate the association between past and current contraception use and (a) awareness of cervical cancer screening recommendations, (b) history of HPV vaccination, (c) maintenance of current cervical cancer screening, and (d) Pap testing interval. Special populations, including sexual minority women and rural residents, were also considered. Univariate and bivariate statistics were calculated and logistic regression was used to estimate odds ratios (OR) using STATA 17.0, guided by a theory-based model. Results: Use of provider-surveilled contraception methods was associated with higher rates of HPV vaccination, increased odds of Pap testing prior to age 21, higher odds of current Pap testing, and lower odds of a >12 month Pap testing interval. There were no significant differences among contraception users in awareness of screening recommendations, nor were there differences in maintenance of current screening according to sexual orientation or place of residence. Significance: While provider-surveilled contraception use was associated with protective behaviors, individuals may undergo excessive cervical cancer screening that could increase risk for physical, emotional, or financial consequences, while not providing additional protection against cervical cancer. Clinical interactions should emphasize evidence-based cervical cancer prevention counseling and screening, while public health campaigns and health policy enhance awareness of these measures and reimbursement for services, respectively. Further research is necessary to understand the consequences of excessive screening while developing interventions to reach those at risk for delayed screening.