Advances in cervical cancer control and future perspectives.
The knowledge that the persistent infection with high-risk (HR) human papillomavirus (HPV) is the etiological factor in the development of cervical cancer has led to the development of the HPV DNA detection methods as well as the prophylactic vaccine against the most common HR-HPV types, HPV 16 and 18. Despite HPV vaccination, cervical cancer screening will remain the main preventive measure for both vaccinated and non-vaccinated women, but the nature of screening and management of women with cervical disease is being adapted to the new technologies. Although, HPV DNA detection is more sensitive that cytology, its specificity is lower, since most HPV infections are transient. Therefore, other methods are considered to improve the management of women with cervical disease. Typing of HPV DNA and viral load measurements are still used for research purposes only. Detection of viral oncogene E6/E7 transcripts, which is the marker of the productive infection, is a promising tool for follow-up of HPV DNA-positive women. The detection of p16INK4a over-expression, as an indirect test of E6/E7 expression, is used for confirmation of cervical neoplasia. Despite the lack of standardization, the detection of p16INK4a is useful in clinical settings, however its reproducibility in the management of low-grade and borderline cases is low. Future perspectives include the determination of the methylation status of several cellular genes that could predict the progression of the disease.
Grce
Magdalena
M
Laboratory of Molecular Virology and Bacteriology, Division of Molecular Medicine, "Rudjer Bosković" Institute, Zagreb, Croatia. grce@irb.hr
Matovina
Mihaela
M
Milutin-Gasperov
Nina
N
Sabol
Ivan
I
D000465:Algorithms; D044963:Biopsy, Fine-Needle / Q000379:methods; D001943:Breast Neoplasms / Q000473:pathology / Q000517:prevention & control; D003585:Cell Biology / Q000639:trends; D003362:Cost-Benefit Analysis; D003581:Cytodiagnosis; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000473:pathology / Q000517:prevention & control; D006801:Humans; D007249:Inflammation / Q000150:complications; D008175:Lung Neoplasms / Q000473:pathology / Q000517:prevention & control; D008198:Lymph Nodes / Q000473:pathology; D010353:Patient Education as Topic; D012106:Research / Q000639:trends; D013964:Thyroid Neoplasms / Q000473:pathology / Q000517:prevention & control; D002577:Uterine Cervical Diseases / Q000150:complications; D002583:Uterine Cervical Neoplasms / Q000191:economics / Q000453:epidemiology / Q000473:pathology / Q000517:prevention & control*