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Feature


EXPLORING THE SECONDARY PREVENTION OF CERVICAL CANCER




MOLECULAR TESTS, SAMPLING, CYTOLOGIC TECHNIQUES, VISUAL ASSESSMENT AND PRECANCER
TREATMENT PLAY A CRITICAL TOOL IN THE SECONDARY PREVENTION OF CERVICAL CANCER.

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By
 * Veronica Salib, Associate Editor

Published: 25 Nov 2024

The American Cancer Society estimates that 13,820 new cervical cancer cases will
be diagnosed across the United States in 2024, and 4,360 women in America will
die of cervical cancer in the same year. Cervical cancer is most often diagnosed
in women between the ages of 25 and 44; however, anyone with a cervix might be
at risk of cervical cancer.



Despite the potential risk of cervical cancer, it is a very treatable form of
cancer if diagnosed and treated early, which is why many healthcare
professionals and researchers have emphasized new diagnostic tools for cervical
cancer and precancerous lesions.

One of the most notable screening tools for cervical cancer and precancerous
lesions is a pap smear. This procedure, called cervical cytology, collects cells
from the cervix during a pelvic exam and examines them for cancerous or
precancerous characteristics.

Although pap smears are the most recognized screening tool for cervical cancer
and precancerous cervical cells, they are not the only available option.

In September 2023, Unitaid published a report on new screening and treatment
tools for precancerous lesions as a form of secondary prevention of cervical
cancer. The 90-page document details the importance of identifying and treating
precancerous cervical lesions and covers several screening and treatment
categories. This article will explore these components and highlight ongoing
research in this field.


CERVICAL CANCER AND PRECANCEROUS CELLS

According to the report, cervical cancer is one of the most preventable types of
cancer and can be easily cured when detected and treated early. Although there
are many available tools for the early detection and treatment of cervical
cancer, it is still one of the leading causes of cancer death in women globally.
More specifically, it is the fourth most common cancer among all women and the
second most common cancer in women over 45.

Cervical cancer risk and causes can vary from patient to patient; however, the
most common cause of cervical cancer is HPV infection.

Of the 200 HPV genotypes, 12 have been classified as carcinogenetic to humans by
the International Agency for Research on Cancer, including HPV 16, 18, 33, 31,
35, 39, 45, 51, 52, 56, 58, and 59. HPV 16 and 18 have been linked to 70% of all
cervical cancers worldwide.

This association between HPV and cervical cancer has positioned prophylactic HPV
vaccination as the primary prevention mechanism against cervical cancer. The HPV
vaccine provides 98%-100% prevention against HPV infections, including HPV 16
and 18.

In addition to primary prevention through the HPV vaccine, secondary prevention
through the detection of precancerous lesions is also vital. There are several
types of cervical cancer screening, including primary and triage screenings.
According to Unitaid, the WHO recommends HPV DNA detection as the primary
screening technique; however, several other primary screening tools exist.

Unitaid outlined several kinds of primary cervical screening tests, including
HPV DNA, HPV mRNA, cytology, visual inspection with acetic acid (VIA), and
AI-based tools.

Beyond these screening tests, Unitaid divides cervical cancer screening and
treatment-related products by technology type, including molecular tests,
sampling, cytologic techniques, visual assessment and precancer treatment.


MOLECULAR TESTS

Molecular tests for cervical screening include HPV tests -- such as HPV DNA and
mRNA screening -- methylation and other protein biomarkers.

As mentioned, HPV infections are one of the greatest contributors to cervical
cancer, which makes HPV screening a vital tool for diagnosing cervical cancer.
These tests amplify nucleic material to determine the presence of HPV infection.

DNA-based HPV tests are the primary screening test the WHO recommends for the
general population. HPV DNA nucleic acid amplification tests (NAATs) are
recommended as the primary screening tool starting at age 30 for the general
global population; however, in women living with HIV, these screenings can begin
at age 25.

HPV DNA NAATs should be done in five- to 10-year screening intervals for most
women, with shorter screening intervals, i.e., three to five years, for women
living with HIV.

One of the greatest benefits of HPV DNA NAATs over HPV mRNA NAATs is that the
samples can be collected by a healthcare provider or self-collected.

Compared to HPV DNA NAATs, HPV mRNA NAATs are the alternative primary screening
test for the general population starting at age 30; however, Unitaid does not
offer a screening recommendation for HPV mRNA NAATs in women living with HIV due
to insufficient evidence. Unlike the variable range for HPV DNA NAATs, HPV mRNA
NAATs are recommended every five years for the general population.

Beyond HPV mRNA and DNA NAATs, other molecular tests can be useful, including
HPV partial and extended genotyping tests. According to Unitaid, most HPV tests
can also be used for partial genotyping, which helps providers identify
high-risk HPV strains.

Additionally, protein-based biomarker testing is another molecular testing tool
that detects levels of oncoproteins or HPV antibodies to identify cancerous or
precancerous lesions.


SAMPLE COLLECTION AND SELF-COLLECTION

Another category explored by Unitaid is the sample collection and new
self-collection mechanisms for HPV and cervical cancer. Unitaid acknowledges the
various components associated with sampling, including collection type,
regulatory approval, transport type, stability and cost.

Self-sampling is an emerging tool used for HPV and cervical screenings, allowing
women to collect their own vaginal samples, eliminating the need for a
gynecological visit to conduct the screening. This makes screening more
accessible, supporting new outreach models.

Unitaid states, "Self-care interventions have proven to [strengthen] health care
services and improve universal health coverage. Thus, there has been a global
effort to develop self-sampling solutions that are accurate, less invasive,
adaptable to different contexts, and compatible with HPV testing, helping to
overcome multiple barriers related to cervical screening. However, the products
listed in this horizon scan section are still under evaluation/validation and
not yet recommended and/or commercially available."


CYTOLOGY-BASED TESTING

Cytology-based testing, including pap smears, has been acknowledged as one of
the most valuable screening tools. This type of test is more specific than an
HPV test, so it might be a preferred option in some cases. However, these tests
are more expensive and resource-intensive, making them less accessible to
lower-income communities.

In addition to standard cytology, computer-assisted cytology techniques combine
technology and microscopy to analyze samples.

Another emerging cytology tool is dual-stain cytology, which measures the
presence of two proteins to identify precancerous lesions.


VISUAL ASSESSMENT TECHNIQUES

There are several visual assessment techniques for cervical cancer, including
colposcopy, VIA and enhanced visual assessment tools.

Colposcopy is used after a positive HPV test or abnormal cytology to assess
which treatment method is appropriate. This technique magnifies and illuminates
the vulva, vaginal wall and cervix with an acetic acid wash and a colposcope --
a light-illuminated, stereoscopic binocular microscope.

New technologies in colposcopy, such as digital imaging and enhanced
visualization techniques, assist in the more accurate identification of lesions
during follow-up examinations.

VIA is a low-cost method in which acetic acid is applied to the cervix, making
abnormal cells more visible to the naked eye. This is useful in low-resource or
low-income settings.

Enhanced visual assessment tools being explored include digital coloscopy,
AI-enhanced visual evaluation and optoelectrical tools.


TREATMENT OF PRECANCEROUS LESIONS

Although tools for screening and identifying HPV and precancerous lesions play a
critical role in cervical cancer prevention, they are only effective when
positive results are followed by appropriate and timely treatment, such as
cryotherapy, thermal ablation or large loop excision of the transformation zone.

Overall, the screening and treatment landscape of precancerous lesions for the
secondary prevention of cervical cancer is a diverse and developing field that
can provide critical healthcare tools and improve healthcare outcomes for
several communities.

Veronica Salib has covered news related to the pharmaceutical and life sciences
industry since 2022.



DIG DEEPER ON BIOTECHNOLOGY IN MEDICINE

 * USPSTF PROPOSES GUIDELINES FOR CERVICAL CANCER SCREENING
   
   
   By: Veronica Salib

 * FDA APPROVES ROCHE’S SELF-COLLECTED HPV TESTS
   
   
   By: Veronica Salib

 * UNDERSTANDING GAPS IN WOMEN’S HEALTH: GYNECOLOGICAL CANCER RESEARCH
   
   
   By: Veronica Salib

 * EXPLORING PREVALENT DISPARITIES IN GYNECOLOGICAL CANCERS
   
   
   By: Veronica Salib

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