Preventing Invasive Cervical Cancer: The Importance of Expectant Management in Young Women With High-grade Pre-cancerous Lesions
Preventing Invasive Cervical Cancer: The Importance of Expectant Management in Young Women With High-grade Pre-cancerous Lesions
Lesions classified as "High Grade Squamous Intra-epithelial Lesions" (HSIL) are pre-cervical
 lesions of the cervix, induced by infection with the Human Papilloma Virus (HPV). The
 detection and proper management of these lesions greatly reduces the incidence of invasive
 cervical cancer.

 Pap smear remains the most effective tool for early detection of low and high-grade cervical
 lesions. In Belgium, screening for cervical cancer is recommended every 3 years for women
 between 25 and 65 years old.

 HPV is a virus who possesses certain oncogenic genes who have the ability to inactivate tumor
 suppressor genes in the host cell. This promotes a tumorigenesis process within the tissues
 affected by the virus. The majority of human papillomavirus infections are transient and
 spontaneously cleared by host defense mechanisms, especially in the first two years after
 exposure. However, 10-20% of infections persist latently and may eventually lead to
 progression to invasive cervical cancer.

 Even high-grade lesions kan naturally be cleared, even more so if the patient is young and
 immuno-competent. Therefore, the management of HSIL lesions in young women has been modified
 and consists of adopting mainly a conservative attitude, with controls every 6 months for 2
 years. This management makes it possible to avoid unnecessary conizations of the cervix
 which, in young nulliparous patients, are not devoid of heavy obstetric consequences during
 subsequent pregnancies (premature birth, perinatal mortality). Cervical conization will only
 be considered for lesions that progress during follow-up or that persist beyond 2 years.
 However, this type of follow-up requires that patients be compliant.

 Our study has two main objectives:

 -  to determine the compliance of CHU Brugmann Hospital patients who have been proposed a
 conservative strategy for the management of HSIL lesions.

 -  to identify the predictive factors for the persistence and / or progression of
 high-grade pre-cancerous dysplastic lesions.
Inclusion Criteria:

 -  Patients followed within the CHU Brugmann Hospital (no private practices).

 -  HSIL lesions confirmed by anatomopathologic analysis on cervical biopsies or cone
 specimen without evidence of invasive lesions

 Exclusion Criteria:

 -  Invasive lesions