Determinants of precancerous cervical lesions: A case-control study

Abstract

Introduction Development of cervical cancer is almost precedent by cervical precancerous lesion. Lesions evolutions maybe happen by regression or aggravation. These evolutions are closely related to human papillomavirus (HPV) infection and other determinants. Our objective was to describe the determinants distribution of the cervical cancer according to presence or absence of cervical precancerous lesion in Morocco. Methods The population of our study was nested in a control population of a national case-control study on cervical cancer [1] : 108 women were selected (27 cervical precancerous lesion cases and 81 controls). The controls were selected using an individual age-matching (± 2 years). The population was included between November 2009 April 2012 in different centers of Morocco: in primary healthcare centers (in Rabat, Casa and Fes) and in gynecological public hospital (in Rabat). The target population was represented by all women's outpatient consultants for pathologies others than gynecological pathologies (gynecological infection, menstruation disorders, etc.) as well as women consultants in the context of pregnancy monitoring. The women benefited from a gynecological examination with sampling for the cervical vaginal smear and for genotype of HPV. Data were collected by a questionnaire that included socio-demographic characteristics, sexual behaviours, reproductive and contraceptive history and history of sexually transmitted diseases. Results The mean age of cases was 54.5 ± 11.2 years while the age of controls was 55.0 ± 10.6 (P = 0.8). The lesions type in the study was distributed as follows: 51.9% were low cervical precancerous lesion, 25.9% were atypical squamous cells of Undetermined Significance (ASC-US), 14.8% were malpigian cell atypia of undermined significance and 4.7% were atypical Squamous Cell evocating High-grade lesion (ASC-H). The HPV infection was positive for 11.1% cases against 13.5% for controls (the oncogenic HPV infection was identified for 11.1% of the cases against 4.9% for the controls). The multiple HPV infection was detected for the three cases while the controls had one multiple infection and eleven single infection (63.6% with HPV 33 and 27.3% with HPV 16). Most cases and controls were married (76.0%, 61.7%, respectively); 66.7% of cases were illiterate against 61.5% of controls. Concerning the reproductive characteristics 52.4% of cases had an age of menarche ≤ 12 against 40.5% of controls and 47.2% of cases had an age of menarche > 12 against 59.4% of controls. Sixty-three percent of cases used the oral contraceptives against 52.5% of controls. The duration of uses of oral contraceptives was Conclusion Only 11.1% of women with cervical precancerous lesion HPV had a positive HPV infection, while some controls had an infection with oncogenic HPV type. These results raise the importance of looking for other factors associated to appearance and/or development of cervical precancerous lesion witch will be the subject of our future research work.