Human Papillomavirus and Cervical Dysplasia in Women With Cystic Fibrosis
Background The main risk factor for cervical cancer is the infection by human
papillomavirus (HPV), with several intermediate steps between HPV infection and cervical
cancer. Cervical screening with pap smear test and HPV vaccination are effective
preventions. A high frequency of HPV carriage and of cervical dysplasia have been
described in transplanted women.
The majority of women with cystic fibrosis reach adulthood and some will face
transplantation. Particular attention should therefore be paid to cervical screening.
However, low adherence to screening recommendations was noted. In addition, preliminary
data has found a high frequency of abnormal smears and of inflammatory aspect of the
cervix in women with cystic fibrosis.
Objectives of the study The main objective of the study is to determine the prevalence of
HPV carriage in a cohort of women with cystic fibrosis
The secondary objectives are:
- To study the factors associated with the prevalence of HPV (transplantation,
smoking, age at first intercourse, number of sexual partners in the year,
contraception, gravidity and parity, HPV vaccination)
- To describe and to compare with data in the general population, in hospital-based
population, (and with data in transplanted population for transplanted women)
1. the prevalence of HPV (and of different genotypes) infection, of cervical
dysplasia, of vulvar/vaginal/cervical condylomatosis
2. the rate of HPV persistence (> 12 months), the mean time of HPV clearance;
rates of spontaneous regression / persistence / worsening of cervical dysplasia
Study design:
The study will last 24 months. Includable patients are adult women, transplanted or not,
followed at Lyon CRCM. Included women will attend a consultation with a gynaecologist.
Pap smear test (liquid phase cytology) and genomic DNA microarray assay enabling the
detection of 35 different HPV genotypes will be performed.
Patients with an initial abnormal pap smear or a positive HPV test will be monitored:
- In case of an abnormal smear and / or positive HPV test, pap smear and HPV testing
will be renewed every 6 months during the study period
- In case of an abnormal smear:
Atypical squamous cells of undetermined significance (ASC-US) : the attitude will depend
on the result of the HPV test Atypical squamous cells - cannot exclude HSI L (ASC-H),
Low-grade squamous intraepithelial lesion (LSIL), High-grade squamous intraepithelial
lesion (HSIL), Atypical glandular cell of undetermined significance (AGUS) , Atypical
glandular cells (AGC) , Adenoma carcinoma in situ (AIS), carcinoma: a colposcopy will be
systematically performed
Expected results This study will help to determine the frequency of HPV infection and the
pathogenic power of HPV in non-transplanted and in transplanted women with cystic
fibrosis This data will help to sensitize health professionals on the importance of
gynecological care and regular cervical screening, and on the importance of HPV
vaccination.
In case of a high frequency of genital diseases linked to HPV, recommendations on
gynecological monitoring procedures for women with cystic fibrosis could evolve.