Digital representation of cervical cancer
Digital medical illustration: Perspective x-ray view of human cervix with tumor. Anatomically correct. Isolated on black.

Researchers at Sweden’s Karolinska Institute and colleagues at the University of Innsbruck, Austria say they have a developed new screening method for cervical cancer that is both simpler and more effective than the current method used today. Their findings, published this week in Nature Medicine, show that that the new test called WID-qCIN detects significantly more cancerous and precancerous conditions.

Current methods for screening are cytological analysis via a Pap smear, that collects cervical cells which are then analyzed to detect changes in the cell caused by the human papilloma virus (HPV) that may turn into cervical cancer. WID-qCIN automatically analyzes epigenetic changes in cells—changes that affect which genes are active and which are not. Epigenetic changes are influenced by a much wider range of risks that could influence cancer development such as the environment, lifestyle, diet, and aging.

For their research, the team enrolled 28,000 women over the age of 30 who underwent cervical cancer screening in Stockholm between January and March 2017. WID-qCIN was combined with a test for two high-risk HPV subtypes—HPV 16 and HPV 18—with results showing the ability to detect 100 per cent of all invasive cervical cancer and 93 per cent of all serious precancerous lesions that occurred within a year of sampling.

Further, the combination testing method was able to predict 69% of all cancers and cancerous lesions up to six years after the sample was taken, a significant improvement over the 18% that can be identified using current methods.

One potential benefit of the new test could be a large reduction to the number of invasive procedures for women to confirm current screening. Today, if changes are detected in the cells via a cervical cancer screening, the woman undergoes a colposcopy and examination of the woman’s cervix via a microscope that often leads to the collection of a tissue biopsy. Cervical biopsies can have a range of negative consequences including preterm delivery. The new screening method could reduce colposcopy examinations by as much as 40% the investigators contend.

“This would mean a significant improvement compared to today’s screening methods, which were introduced in the 1960s,” said study last author Martin Widschwendter, MD, professor at the University of Innsbruck and visiting professor at the department of women’s and children’s health, Karolinska Institute. “With its simplicity and objective assessment, the WID-qCIN test can improve the effectiveness of these programs and support the global strategy to eliminate cervical cancer.”

The authors note that current methods of screening for and preventing cervical cancer are already highly successful.

“Cervical cancer (CC) screening is among the most successful strategies for cancer prevention,” they investigators wrote. “In combination with high human papillomavirus (HPV) vaccination coverage, cervical screening with substantial uptake is an essential part of the global strategy to eventually eliminate CC.”

An understanding of the predictive and diagnostic capabilities of DNA methylation testing is not new. Research 20 years ago showed, in proof-of-principle research that epigenetic changes could identify cervical cancer and precancer. The WID-qCIN test focuses on methylation changes in across the regions of three different genes: DPP6, RALYL and GSX1.

Because the test relies on DNA and not cell samples, the investigators noted it is well-suited for self-sampling by women, obviating the need for an in-person screening. In addition, “High-performance molecular triaging strategies, such as the WID-qCIN test, which could be readily automated and do not require complex infrastructures, should further facilitate these efforts.”

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