Relative Risk of Cervical Neoplasms Among Copper and Levonorgestrel-Releasing Intrauterine System Users

• Published in: Obstetrics and gynecology (New York. 1953) Vol. 135; no. 2; pp. 319 - 327
• Main Authors: Spotnitz, Matthew E, Natarajan, Karthik, Ryan, Patrick B, Westhoff, Carolyn L
• Format: Journal Article
• Language: English
• Published: United States by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved 01.02.2020; Lippincott Williams & Wilkins
• Subjects: Adolescent; Adult; Child; Contents; Contraceptive Agents, Female - administration & dosage; Databases, Factual; Female; Humans; Intrauterine Devices, Copper - adverse effects; Intrauterine Devices, Copper - statistics & numerical data; Intrauterine Devices, Medicated - adverse effects; Intrauterine Devices, Medicated - statistics & numerical data; Kaplan-Meier Estimate; Levonorgestrel - administration & dosage; Middle Aged; New York - epidemiology; Original Research; Propensity Score; Retrospective Studies; Risk Assessment; Uterine Cervical Neoplasms - epidemiology; Young Adult; New York
• ISSN: 0029-7844; 1873-233X
• DOI: 10.1097/AOG.0000000000003656

OBJECTIVE:To evaluate the relative risk of cervical neoplasms among copper intrauterine device (Cu IUD) and levonorgestrel-releasing intrauterine system (LNG-IUS) users. METHODS:We performed a retrospective cohort analysis of 10,674 patients who received IUDs at Columbia University Medical Center. Our data were transformed to a common data model and are part of the Observational Health Data Sciences and Informatics network. The cohort patients and outcomes were identified by a combination of procedure codes, condition codes, and medication exposures in billing and claims data. We adjusted for confounding with propensity score stratification and propensity score 1:1 matching. RESULTS:Before propensity score adjustment, the Cu IUD cohort included 8,274 patients and the LNG-IUS cohort included 2,400 patients. The median age for both cohorts was 29 years at IUD placement. More than 95% of the LNG-IUS cohort used a device with 52 mg LNG. Before propensity score adjustment, we identified 114 cervical neoplasm outcomes. Seventy-seven (0.9%) cervical neoplasms were in the Cu IUD cohort and 37 (1.5%) were in the LNG-IUS cohort. The propensity score matching analysis identified 7,114 Cu IUD and 2,174 LNG-IUS users, with covariate balance achieved over 16,827 covariates. The diagnosis of high-grade cervical neoplasia was 0.7% in the Cu IUD cohort and 1.8% in the LNG-IUS cohort (2.4 [95% CI 1.5–4.0] cases/1,000 person-years and 5.2 [95% CI 3.7–7.1] cases/1,000 person-years, respectively). The relative risk of high-grade cervical neoplasms among Cu IUD users was 0.38 (95% CI 0.16–0.78, P<.02) compared with LNG-IUS users. By inspection, the Kaplan-Meier curves for each cohort diverged over time. CONCLUSION:Copper IUD users have a lower risk of high-grade cervical neoplasms compared with LNG-IUS users. The relative risk of cervical neoplasms of LNG-IUS users compared with the general population is unknown.