Epidemiology of uterine cervical cancer.

Squamous cell carcinoma of the uterine cervix is one of the most common cancers among women. Correlation between human papilloma virus (HPV) infection of the uterine cervix and the development of cervical neoplasia has been established. More recent studies have shown the presence and expression of integrated HPV types 16 and 18 DNA sequences in 70-80% of cervical tumours and tumour cell lines. It has been suggested that, in addition to HPVs, other agents such as hormones and tobacco products act as cofactors in cervical neoplasia (for review see ref. 15). The presence and expression of a glucocorticoid-responsive element in HPV-16 has been reported. Here we provide evidence for the oncogenic transformation of primary cells with a combination of HPV-16 DNA, but not HPV-11 DNA, and the activated form of the human Ha-ras oncogene only in the presence of the glucocorticoid hormone dexamethasone.

Glucocorticoid-dependent oncogenic transformation by type 16 but not type 11 human papilloma virus DNA.

Contraceptive use--efficacy study utilizing medroxyprogesterone acetate administered as an intramuscular injection once every 90 days.

The most widely used longterm injectable female contraceptive is depot medroxyprogesterone acetate. Its advantages as a contraceptive its history of use its present legal status in Australia and its mode of action are discussed. The major concern is that involving interpretation of animal toxicology data related to various carcinogenic side effects of the drug. Of the great amount of human data so far gathered none has shown any evidence of human risk with medroxyprogesterone acetate. There is continuing controversy regarding the size duration and type of studies which must be undertaken in order to exclude all hint of risk. A thorough review of the literature from studies with medroxyprogesterone acetate is presented. Injectable contraceptives do seem to cause a greater amount of menstrual disorders including amenorrhea than other types of contraception. They can however be used during lactation without effect of the lactating factor. Studies must be undertaken to assess whether they do carry risks to the baby through the milk. Few metabolic changes have been confirmed. The relationship which has been shown to exist either negative or positive between medroxyprogesterone acetate and cervical breast endometrial or liver cancer is discussed in detail.

A comprehensive review of injectable contraception with special emphasis on depot medroxyprogesterone acetate.

A review of the extensive literature on the subject indicates that sex hormones have been associated with a wide varietyof adverse clinical conditions following usage during pregnancy. About 230 cases of female pseudohermaphroditism have been reported following use of hormones with androgenic potency but masculinization observed with estrogens in a few females may represent only adrenal-stimulated pseudohermaphroditism. Feminization of males mostly by progestogens in some 45 cases is unproven at present. Realizing the limitations of the published studies when all present data are considered there seems no justification for undue concern over the induction of nongenital congenital malformations through hormone use in pregnancy. The available data on the association to cardiac limb and CNS defects and to several malformative syndromes are not convincing; the effects appear to be remarkably nonspecific the studies are contradicted by a large number of negative reports and an increased incidence of defects with increased usage has not materialized. A possible exception are the CNS malformations associated with the use of the antifertility agent clomiphene and careful surveillance is warranted at present. While a reasonable interpretation from this review would be that hormones present no major teratogenic hazard elimination of hormonal exposure whenever possible during pregnancy is suggested. (authors)

R.J. Seymour

Papers

Effects of depo-medroxyprogesterone acetate as a contraceptive agent.