[Prevention and treatment of postmenopausal osteoporosis in women treated for cancer]. / Prévention et traitement de l'ostéoporose postménopausique chez la femme traitée pour cancer.

Among 50-year-old women, about 30%, will suffer from osteoporosis resulting in vertebral compression, pain, and possible disablement; this represents a cost of over 4 billion French franco, and therefore necessitates a prevention policy. It has been established that estrogens applied in a dose-dependent manner have a preventive action against bone loss during the treatment period. The action of nor-steroid progestatives and anti-estrogens is likely, although this has not been fully demonstrated. Estrogens, when administered alone, increase the risk of endometrial cancer; however, this risk seems to be reduced by the addition of progestatives over a minimal period of time. Regarding breast cancer, it seems that substitutional hormone treatments for menopause only increase the risk of the above cancer after a prolonged period of over 10 years. The role of progestatives in breast-cancer risk remains uncertain, and is a subject of controversy. It therefore seems justified to prescribe substitutional hormone treatments combining estrogens and progestatives for young women in whom treatment for non hormone-dependent cancers of the cervix, ovary, etc has resulted in castration. For women who have been treated for breast or endometrial cancer, we are of the opinion that the treatment of choice should consist of non-hormonal treatments for prevention of osteoporosis.

[Human papillomaviruses in uterine cervix pathology: clinical implications, detection and type]. / Les papillomavirus humains (HPV) en pathologie cervicale utérine: implications cliniques, indications du typage.

Recently, intense interest has been focused on the relation between HPV infection and the precancerous and cancerous lesions of the uterine cervix, as documented in numerous publications on the subject. We carried out a prospective anatomoclinical study on 224 women (HPV positive) in the René Huguenin Centre, from April 1984 to December 1988. Among these patients, cytology, colposcopy and biopsy, where necessary, were performed, concurrently with the detection of HPV on cervical smears using a molecular hybridization method (G Orth). We analysed the anatomo-clinical results and propose practical implications, in taking the evolution of the patients into account. These patients were followed up and treated when necessary for cervical intra-epithelial neoplasia (CIN) or carcinoma, associated or unassociated with HPVs (oncogene in 70% of cases). 24% of the patients where infected by an HPV, without any lesion. This virus disappeared spontaneously during the follow-up period. It can be concluded therefore that HPV infection, even oncogene, does not necessarily carry on CIN. Among CIN 1-2, associated or unassociated with HPV, the adequate treatment cured the patients and the virus disappeared. In some cases, a simple follow-up showed spontaneous regression of the lesion and the virus--CIN 3 was removed when necessary with a systematic pathological examination of the endocervix and the surgical sample limits. In a few cases, the virus persisted without lesion. HPV infection did not modify our protocol in the invasive carcinoma. These observations are available in a Centre with a well-trained anatomo-clinical team. In our opinion, the major priority involved in the recognition of cervical HPV infection is to perform a more systematic colposcopy (even for normal smears with subtle atypia), allowing the detection of early precancerous lesion, clinically occult. On the other hand, the oncogene HPV notion has caused us to take more aggressive action regarding treatment of some CIN 1-2, but may not be of benefit to the patient. We remain convinced that the CIN, with or without HPV, or not oncogene with HPV, must only be treated based on the clinical extension and the pathological gravity of the lesions.

[Human papillomavirus infections of the cervix uteri. Clinical implications, indications of typing]. / Les infections à papillomavirus humains (HPV) du col utérin. Implications cliniques, indications due typage.

Recently, intense interest has focused on the relation between HPV infection and precancerous and cancerous lesions of the uterine cervix, as witnessed by the numerous publications on the subject. We carried out a prospective anatomo-clinical study on 224 HPV positive women followed in the Rene Huguenin Centre, from April 1984 to December 1988. Among these patients, cytology, colposcopy and biopsy were performed, when necessary, concurrently with the detection of HPV on cervical smears using a molecular hybridization method (G. ORTH). This study analysed the anatomo-clinical results and suggested the practical implications, taking into account the progress of the patients. These patients were followed up and treated when necessary for cervical intra-epithelial neoplasia (CIN) or carcinoma, associated or not with HPVs (oncogene in 70% of cases). 24% of this population was infected by an HPV, without any lesion. This virus disappeared spontaneously during follow-up; therefore, HPV infection even oncogene, did not necessarily carry onto CIN. Among CIN 1-2, associated or not with HPV, adequate treatment cured the patients with the virus disappearing. In some cases, a simple follow-up showed a spontaneous resolution of the lesion and of the virus. CIN 3 was removed when necessary with systematic pathological examination of the endocervix and of the surgical sample limits. In a few cases, the virus persisted without lesion. HPV infection did not modify our protocol for invasive carcinoma.(ABSTRACT TRUNCATED AT 250 WORDS)

[Human papillomaviruses in the epithelial cells of the cervix uteri: frequency of types 16 and 18. Preliminary results of a clinical, cytologic and viral study]. / Recherche de papillomavirus humains dans des cellules épithéliales du col utérin: fréquence des types 16 et 18. Résultats préliminaires d'une étude clinique, cytologique et virologique.

Between April 1 and June 30 1984, cervical scrapes were taken from 381 women attending the Gynecology Department of the Anticancer Center René-Huguenin. The scrapes were examined for the presence of human papillomavirus (HPV) DNA, by a molecular hybridization method, at the Pasteur Institute. The four HPV types involved in genital pathology, HPV 6, HPV 11, HPV 16 and HPV 18, were studied. Twenty four specimens (6.3%) were found positive: 19 for HPV 16, 3 for HPV 18, 2 for HPV 6 or HPV 11. Results of molecular hybridization were compared with cytological findings. HPV 6 or HPV 11 were detected in cases of mild dysplasia. HPV 16 or HPV 18 were mainly detected in cases diagnosed as severe dysplasia or carcinoma in situ (9 out of 14, i.e. 64.3%), and invasive carcinoma (3 out of 5 cases). The results were further confirmed when virological data obtained with cervical scrapes were compared with the histological diagnosis on biopsies: 14 out of 15 cases of severe dysplasia or carcinoma in situ (93%) and 3 out of 6 cases of invasive squamous carcinoma had been found positive for HPV 16 or HPV 18. Interestingly, four "normal" women (1.3%) with a negative cytology were found positive for HPV 16 or HPV 18. The data obtained by this sensitive and reliable method are useful to the clinician to identify women presenting a high risk of subsequent cervical intraepithelial neoplasia or invasive carcinoma, and, thus, to adapt the treatment and the follow-up of these patients.