The test is part of the FORECEE programme which is developing one screening test to predict the future risk of four cancers: breast, womb, cervical and ovarian.
The new test, in the early stages of development by Prof Martin Widschwendter and his team at University of Innsbruck and UCL, looks at the DNA Methylation of cervical cells. DNA Methylation sits on top of DNA and tells cells which parts of the genetic code to read. It can be affected by environmental and lifestyle factors, and some changes can increase the risk of certain diseases such as cancer. The researchers are using it as a tool to not only detect pre-cancerous cell changes, but to predict the future risk of cancer.
https://youtu.be/9O_uQO-HeTI
Currently in England, as part of the cervical screening programme, women and people with cervixes are invited to attend their screening appointment every three years. This interval has been moved to five-yearly in Scotland and Wales, with plans for England to follow.
When invited for cervical screening, a sample is taken from the cervix using a soft brush. This sample is then tested for the presence of high-risk Human Papillomavirus (HPV), the common virus which causes 99.8% of cervical cancers. If high-risk HPV is present, the cells are looked at under a microscope for the presence of changes that could lead to cancer if left untreated – this secondary testing is called cytology. Anyone who is found to have abnormal cells on the cervix, called Cervical Intraepithelial Neoplasia (CIN), is then referred on for a further appointment, where the cervix is looked at closely by a specialist with a colposcope, an instrument that magnifies the view of the cervix.
Anyone with early cell changes (which are graded as CIN1-2) will be screened more regularly, until the cells have turned back to normal, or treatment is needed. Those with advanced cell changes (CIN3) will be treated using a procedure called LLETZ (“Large loop excision of the transformation zone”), where the abnormal cells are removed before they turn into a cancer. Prof Widschwendter says: “Vaccination against the virus that causes cervical cancer, HPV, is now widely implemented and is leading to changes in the amount and types of the virus circulating in the community. In turn, our approaches to cervical screening must adapt so that programmes continue to deliver benefit.”
The researchers tested 1,254 cervical screening samples from women with cell changes ranging from CIN1 to CIN3, women with HPV but no cervical cell changes, and samples from women without any cervical cell changes who went on to develop CIN3 within 4 years. The new method of analysis out-performed cytology for detecting those with CIN3.
The new test could lead to a step change in moving screening towards being predictive as it identified 55% of women who had an HPV infection but no visible cell changes under the microscope and who went on to develop advanced cell changes within the following four years. “Building new, holistic, risk-predictive screening programmes around existing, effective cervical sample collection offers real potential for cancer prevention in the future.” says Widschwendter. CEO of The Eve Appeal, Athena Lamnisos, says: “We want to prevent cancer – and we know with cervical cancer that we can intervene at an early stage. This new method is more specific which is good news for cervical cancer prevention and great news for everyone who needs to be screened.”
The research team is moving into the next stage of study, where they will test the new technology on screening samples from women who have been vaccinated against HPV, and from samples taken from vaginal swabs.
This study was funded by EU’s Horizon 2020, the European Research Council programmes and The Eve Appeal. It was led out of the University of Innsbruck and UCL’s Department of Women’s Cancer, Institute for Women’s Health. The samples were collected by the Karolinska Center for Cervical Cancer Elimination. You can read the paper in full on this link.