by Alex Merlan
HPV prevention and vaccine are helping reduce the number of women dying from cervical cancer, but new wearable screening kits and new types of lab tests will improve earlier diagnosis and treatment of cervical cancer. disease.
New advances in screening for cervical cancer – the fourth most common cancer in women – have the potential to save many women’s lives, according to their developers.
While outcomes for women with cervical cancer have generally improved in recent years, the number of deaths from the disease is still too high. Despite the fact that cervical cancer is highly treatable if diagnosed early enough, over 340,000 women died from the disease in 2020.
The majority of deaths occur in low- and middle-income countries where women often have limited access to testing services, according to the World Health Organization.
Even when women do get tested, there can be a delay of several months before they get the result and, if they test positive, another delay before they receive treatment.
“If you already have an advanced stage of cancer, these months can mean the difference between life and death,” says Olivier Degomme, coordinator of a project called ELEVATE, which is developing a portable screening kit to take to deprived areas. .
“We really want to reduce that interval of months to a 24-hour interval ideally,” he says.
ELEVATE’s mobile kit is designed for use in communities with limited access to medical care. Health workers would explain the importance of getting tested, then offer the test and be able to give women the results within the day.
The kit requires little training to use. The women collect a sample themselves, which health workers run through the battery-powered analysis unit. The unit uses DNA testing to check for high-risk human papillomavirus (HPV) infections, which can lead to cervical cancer. Results are returned within minutes.
The researchers aim to start using the toolkit in mountain villages and deprived urban areas in Ecuador and Brazil. They also want to use it with hard to reach women in Belgium and Portugal.
Initially, the researchers focused on migrants and other marginalized communities who have difficulty accessing medical care or who may not know the importance of testing.
But they also found that highly educated career women didn’t show up for screening because they were too busy. So, in addition to bringing the test kit to disadvantaged communities, it could also be useful in busy offices, for example.
“Globally, the gains will be much greater by focusing on hard-to-reach women in the poorest communities. But a nice side effect (of the project) is that we could also use it in groups of highly educated women,” says Professor Degomme, associate professor at the Faculty of Medicine and Health Sciences at Ghent University. , in Belgium.
Screening programs vary from country to country. Some invite all women of age to be tested. Some offer opportunistic testing where a patient is informed and offered testing when she visits a clinic. Some countries do not test at all.
The WHO has set targets for 2030 to reduce cervical cancer rates worldwide. One of them is that 70% of women are screened with a high performance test at 35 and then at 45.
Professor Degomme hopes ELEVATE’s wearable kit will help countries meet the WHO target. It still needs to be field-tested and evaluated for its acceptability, feasibility and cost-effectiveness for low-income countries.
“The important thing is to make sure it reaches women who otherwise might not. And we can actually save lives, hopefully many lives,” he said.
The HPV virus has over 100 different strains, 14 of which are considered high risk for cervical cancer. Increasingly, countries with screening programs are testing for high-risk HPV infections.
Researchers recently designed a test that can distinguish between an infection that will resolve on its own and one that will become chronic and possibly lead to cancer.
They use Raman spectroscopy to check for changes in the molecular composition of cervical cells taken during a Pap smear.
Ramen spectroscopy is a scanning technique for identifying the chemical composition of materials by measuring their vibrational response to laser light. Research consists of lighting cells to make their molecules vibrate.
The resulting vibration ‘fingerprint’ indicates whether the contents of the cell have been altered by the virus.
Currently, if a person tests positive for a high-risk HPV infection, their cervical cells are examined under a microscope. These checks are carried out by a cell specialist, called a cytologist.
The cell may look beautiful under a microscope, but Raman spectroscopy can detect changes at the molecular level that are invisible to the human eye, according to Professor Fiona Lyng, coordinator of a project called ARC-HPV.
The project, which ended in 2018, concluded that Raman spectroscopy could be used to test for infections that could lead to cancer. His discoveries are now patented.
Since 2018, researchers have tested the method on larger samples and found it to be at least 91% accurate in differentiating cells of concern from those that are likely to recover from infection.
The next step will be to test the accuracy of Raman spectroscopy in an entire population being screened.
Another important form of prevention is vaccination. Available vaccines are very effective, but they do not protect against all high-risk forms of HPV.
“The vaccine will really reduce pre-cancers and cervical cancers, which is great.” But its success raises a problem for screening programs, said Professor Lyng, who heads the Radiation and Environmental Science Center at Technological University Dublin.
With fewer cases of precancerous and cancerous cells present in the population, cytologists will not be so used to encountering these abnormalities, which means their ability to spot them could decrease. ‘That’s why people are interested in developing new methods (like Raman spectroscopy) that are more objective,’ Professor Lyng said.
There are “horrible stories of young women dying of this disease”. It shouldn’t happen because it’s so treatable – if detected at this early stage of pre-cancer,” Professor Lyng said.
Results so far indicate that Raman spectroscopy is more accurate than cytology.
“All tests have false positives and false negatives, and Raman is also not 100% accurate. But it has a higher sensitivity than cytology, so we believe it would improve outcomes for women by detecting cancers or pre-cancers earlier,” Professor Lyng said.
The research in this article was funded by the EU. This article was originally publishedin Skylinethe european magazine for research and innovation.