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You can find the current article at its original source at https://www.theguardian.com/society/2019/nov/04/cervical-cancer-self-tests-may-be-key-smear-alternative-study
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| Cervical cancer self-tests may be key smear alternative – study | Cervical cancer self-tests may be key smear alternative – study |
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| Swabs or urine self-sampling could be less invasive at identifying high-risk women | Swabs or urine self-sampling could be less invasive at identifying high-risk women |
| Swabs or urine samples taken at home could be as effective at identifying women at high risk of cervical cancer as traditional smear tests, according to new research. | Swabs or urine samples taken at home could be as effective at identifying women at high risk of cervical cancer as traditional smear tests, according to new research. |
| Cervical cancer is the fourth most common cancer in women globally. In the UK, women aged between 25 and 64 are invited for cervical screening every three years. | Cervical cancer is the fourth most common cancer in women globally. In the UK, women aged between 25 and 64 are invited for cervical screening every three years. |
| While cervical screening can save lives, many women find having a clinician take a swab of their cervix unpleasant, embarrassing or are worried it will hurt, with recent figures from Public Health England (PHE) revealing a quarter of women do not attend their appointment. | While cervical screening can save lives, many women find having a clinician take a swab of their cervix unpleasant, embarrassing or are worried it will hurt, with recent figures from Public Health England (PHE) revealing a quarter of women do not attend their appointment. |
| At present, swabs are carried out by medical professionals to see if there are any abnormal cells in the cervix, which would mean a referral for further investigation. Sometimes, if the changes are borderline, the sample is also tested for types of human papilloma virus (HPV) that are high risk for cervical cancer. | At present, swabs are carried out by medical professionals to see if there are any abnormal cells in the cervix, which would mean a referral for further investigation. Sometimes, if the changes are borderline, the sample is also tested for types of human papilloma virus (HPV) that are high risk for cervical cancer. |
| Screening to look for HPV first is in the process of being rolled out, raising the possibility of self-collection of samples. PHE has already begun a pilot for a home smear test, while research has shown that HPV can also be detected in urine, meaning a less invasive approach might also be possible. | Screening to look for HPV first is in the process of being rolled out, raising the possibility of self-collection of samples. PHE has already begun a pilot for a home smear test, while research has shown that HPV can also be detected in urine, meaning a less invasive approach might also be possible. |
| However, self-tests have a drawback – they do not provide cervical cells that can be examined should HPV be found. | However, self-tests have a drawback – they do not provide cervical cells that can be examined should HPV be found. |
| Now researchers say a new type of test based on DNA within self-collected urine or swab samples might provide an accurate way to determine whether an HPV-positive woman is likely to have precancerous or cancerous cells. | Now researchers say a new type of test based on DNA within self-collected urine or swab samples might provide an accurate way to determine whether an HPV-positive woman is likely to have precancerous or cancerous cells. |
| The study, which is being presented at the National Cancer Research Institute conference in Glasgow and has not yet been published or peer reviewed, involved a test called S5. This detects whether DNA from four types of HPV linked to increased risk of cervical cancer has been modified through a process known as methylation. The test also looks at whether one particular human gene has undergone such changes. | The study, which is being presented at the National Cancer Research Institute conference in Glasgow and has not yet been published or peer reviewed, involved a test called S5. This detects whether DNA from four types of HPV linked to increased risk of cervical cancer has been modified through a process known as methylation. The test also looks at whether one particular human gene has undergone such changes. |
| Previous work has shown high levels of methylation at specific sites in such DNA indicates a greater risk of a woman having cells that could turn into cervical cancer, or the presence of cancer itself. | Previous work has shown high levels of methylation at specific sites in such DNA indicates a greater risk of a woman having cells that could turn into cervical cancer, or the presence of cancer itself. |
| “Some HPV infections will resolve naturally, but the ones that are methylated are less likely to do so,” said Prof Jack Cuzick of Queen Mary University, part of the team behind the work. | “Some HPV infections will resolve naturally, but the ones that are methylated are less likely to do so,” said Prof Jack Cuzick of Queen Mary University, part of the team behind the work. |
| To explore the potential of the test, the team focused on 600 women who had already been found to have unusual cells and/or HPV, and had gone to a colposcopy clinic to have their cervix examined. | To explore the potential of the test, the team focused on 600 women who had already been found to have unusual cells and/or HPV, and had gone to a colposcopy clinic to have their cervix examined. |
| Each woman was tested for HPV and provided a vaginal swab she had taken herself. Just over 500 of the women also provided a urine sample. DNA was then extracted from the samples and analysed to give an average score for the degree of methylation. | Each woman was tested for HPV and provided a vaginal swab she had taken herself. Just over 500 of the women also provided a urine sample. DNA was then extracted from the samples and analysed to give an average score for the degree of methylation. |
| The results reveal that for both urine and vaginal swabs from the women, the S5 test had about a 73% chance of correctly spotting women with advanced abnormal cells as diagnosed by colposcopy – putting it on a par with the standard test for high-risk HPV. But when the S5 test was used on HPV positive women, the figure rose to 96%. | The results reveal that for both urine and vaginal swabs from the women, the S5 test had about a 73% chance of correctly spotting women with advanced abnormal cells as diagnosed by colposcopy – putting it on a par with the standard test for high-risk HPV. But when the S5 test was used on HPV positive women, the figure rose to 96%. |
| “This methylation test has been used on clinical samples and then shown to help identify those women with HPV [who also] really have serious disease,” said Cuzik. “This is the first time we have suggested that the same can be done on a self sample.” | “This methylation test has been used on clinical samples and then shown to help identify those women with HPV [who also] really have serious disease,” said Cuzik. “This is the first time we have suggested that the same can be done on a self sample.” |
| Dr Belinda Nedjai, another member of the team, said the findings suggest it might be possibly to use home samples both to spot those with HPV and identify those who are likely to have precancerous or cancerous cells and hence need to be referred for colposcopy investigations. That could mean an end to clinic-based cervical smears, although she said such an approach should first be used for women who do not attend screening appointments. | |
| Nedjai added the S5 test could also be valuable in countries without a screening programme in place. |