PhD defence A.J.M. (Meike) van de Sande

Brief summary: 

High-grade Cervical Intraepithelial Neoplasia (CIN 2-3), the precursor of cervical cancer, is caused by infection with Human Papilloma Virus (HPV). While national screening programs have reduced cervical cancer rates, screening has increased the number of women known to have CIN, primarily women of reproductive age. Surgical treatment, including Large Loop Excision of the Transformation Zone (LLETZ), is commonly used for CIN removal but increases the risk of premature birth in subsequent pregnancies, especially after multiple procedures. Additionally, a significant number of women (5%-22%) experience recurrent or residual CIN (rrCIN) after a surgical procedure, and women who have undergone a surgical procedure remain at higher risk of developing cervical cancer in comparison to women without previous treatment for CIN.

In an effort to reduce pregnancy-related risks we explored non-surgical approaches, with a primary focus on imiquimod, a cream with antiviral and antitumor properties. Despite its integration into Dutch CIN treatment guidelines, research on the efficacy of imiquimod in CIN and rrCIN is limited. Thus, the aims of this thesis were two-fold: (1) to review the efficacy of imiquimod in women with high-grade CIN, and (2) to investigate imiquimod as a possible alternative to a LLETZ procedure for women with rrCIN.