An overview of innovative techniques to improve cervical cancer screening
Article type: Research Article
Authors: Nijhuis, Esther R.; | Reesink-Peters, Nathalie | Wisman, G. Bea A. | Nijman, Hans W. | van Zanden, Jelmer | Volders, Haukeline | Hollema, Harry | Suurmeijer, Albert J.H. | Schuuring, Ed | van der Zee, Ate G.J.;
Affiliations: Department of Gynecologic Oncology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands | Department of Pathology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
Note: [] E.R.N. and N.R.-P. contributed equally to this work.
Note: [] Corresponding author: Ate G.J. van der Zee, MD, PhD, Department of Gynecologic Oncology, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands. Tel.: +31 50 3613152; Fax: +31 50 3611806; E-mail: a.g.j.van.der.zee@og.umcg.nl.
Abstract: Although current cytomorphology-based cervical cancer screening has reduced the incidence of cervical cancer, Pap-smears are associated with high false positive and false negative rates. This has spurred the search for new technologies to improve current screening. New methodologies are automation of Pap-smear analysis, addition of new biological or molecular markers to traditional cytology or using these new markers to replace the current screening method. In this overview we will summarize data on cervical cancer epidemiology and etiology and the current cervical cancer screening approach. Available data on new screening approaches, such as quantitative cytochemistry, detection of loss of heterozygosity (LOH) and hypermethylation analysis will be reviewed. We discuss the potential of these approaches to replace or augment current screening. When available, data on cost–effectiveness of certain approaches will be provided. In short, Human Papillomavirus (HPV) DNA detection stands closest to implementation in nation-wide screening programs of all markers reviewed. However, specificity is low in women aged <35 years and the psychological effects of knowledge of HPV positivity in absence of cervical (pre) malignant disease are important drawbacks. In our opinion the results of large clinical trials should be awaited before proceeding to implement HPV DNA detection. New technologies based on molecular changes associated with cervical carcinogenesis might result in comparable sensitivity, but improved specificity. Hypermethylation analysis is likely to be more objective to identify patients with high grade squamous intra-epithelial lesions (HSIL) or invasive cancer with a higher specificity than current cytomorphology based screening.
Keywords: Biological marker, HPV, methylation, cervical cancer, cervical intraepithelial neoplasia, screening
Journal: Analytical Cellular Pathology, vol. 28, no. 5-6, pp. 233-246, 2006
