A new cervical screening test could predict cell changes years in advance

University College London (UCL) and University of Innsbruck researchers have developed a swab test that identifies potentially harmful cervical cell changes four years before they occur.

According to the study published in Genome Medicine, the new cervical screening method can detect advanced cell changes and cervical cancer more reliably than other tests.

Moreover, 55% of women with HPV infection without visible cell changes under a microscope but who went on to develop advanced cell changes within 4 years could be predicted by the test. As part of a more extensive program, the test will be designed to predict the future risk of four cancers: breast, womb, cervical, and ovarian.

The development is hoped to allow earlier treatment of those predicted to suffer from the disease.

Professor Martin Widschwendter (UCL EGA Institute for Women’s Health and European Translational Oncology Prevention and Screening Institute at the University of Innsbruck) and his team developed the swab test.

DNA methylation, a modification “on top” of DNA, is assessed in cervical cells. Specific changes can increase the risk of certain diseases, such as cancer.

Using 1,254 cervical screening samples stored at the Karolinska Centre for Cervical Cancer Elimination (Stockholm, Sweden), researchers evaluated the reliability of the test. These included representatives from women with early cervical cancer (CIN1) to advanced cervical cancer (CIN3), women with HPV but no cervical cell changes, and samples from women without cervical cell changes who developed CIN3 within four years.

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This new method of analysis outperformed cytology and other molecular tests in development for detecting cancer and CIN3.

Vaccination against cervical cancer causes is now widely implemented and is causing changes in the amount and types of the viruses circulating in the community, said Professor Widschwendter. As a result, cervical screening programs must adapt to continue to deliver benefits.

In addition, our other work has shown that testing the same cervical sample can reveal a woman’s risk for three significant cancers: breast, ovarian, and womb.

By combining existing, effective cervical sample collection with new, holistic, risk-predictive screening programs, we can prevent cervical cancer in the future.”

Cervical cancer is the 14th most common cancer among women in the UK, with around 3,200 new cases yearly.

Women and people with cervixes are currently invited to have a cervical screening appointment every three years in England, but Scotland and Wales are moving to five-yearly screenings.

For cervical screenings, a soft brush is used to collect a sample from the cervix. This sample is tested for high-risk Human Papillomavirus (HPV) causes 99.8% of cervical cancers.

It is called cytology to examine the cells under a microscope for signs of changes that could lead to cancer if left untreated when high-risk HPV is present. Those with Cervical Intraepithelial Neoplasia (CIN), which is an abnormal growth of cells on the cervix, are then referred to another appointment to see a specialist examine the cervix closely with a colposcope. This instrument magnifies the view of the cervix.

A person with early cell changes (CIN1-2) will be screened more frequently until the cells are back to normal or treatment is needed. Those with advanced cell changes (CIN3) will be treated with a procedure called LLETZ (“Large loop excision of the transformation zone”), which removes the abnormal cells before they turn into cancer.

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The Eve Appeal’s CEO, Athena Lamnisos, said: “We are delighted to see screening tools and predictive tests becoming more effective. We want to prevent cancer, and cervical cancer is something that can be treated early.”

The new method is more specific and will not lead to overtreatment, which is excellent news for cervical cancer prevention and for everyone who needs to be screened.”

They will now test the new technology on screening samples from women who have been vaccinated against HPV, as well as on self-sampled vaginal swabs.

Research has been funded by the EU’s Horizon 2020 and European Research Council programs, a genealogical cancer charity, The Eve Appeal, and the Swedish Foundation for Strategic Research.