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Researchers at the National Cancer Institute’s Montefiore Einstein Cancer Center (MECC) have introduced a test to identify a type of cervical cancer that is often overlooked by Pap tests, marking a significant advancement in cervical cancer screening. The study’s results were recently published in the Journal of the National Cancer Institute (JNCI).
Dr. Howard Strickler, co-senior author of the JNCI paper and a member of MECC, stated, “Our innovative test demonstrates sensitivity in detecting cervical adenocarcinoma [ADC], which now constitutes up to 25 percent of cervical cancer cases, along with its precursor lesions, adenocarcinoma in situ [AIS], that frequently progress into ADCs. Because ADCs are frequently missed by current screening methods, they have higher mortality rates compared to the more common cervical squamous cell cancer.” Dr. Strickler also holds positions as a professor and head of the division of epidemiology and the Harold and Muriel Block Chair in Epidemiology and Population Health at Albert Einstein College of Medicine.
While the widespread adoption of the Pap test has significantly reduced the incidence of cervical squamous cell cancer over the past six decades, the prevalence of ADC has remained unchanged due to the Pap test’s limited effectiveness in detecting it. In recent years, HPV testing, which identifies human papillomaviruses responsible for nearly all cases of cervical cancer, has become a standard screening tool alongside the Pap test. However, current HPV tests cover only specific HPV types associated with cervical cancer, leaving some women at risk. The MECC-developed HPV test specifically assessed HPV 16, 18, and 45 by examining methylation levels, providing a more accurate detection method.
Methylation, the addition of methyl (CH3) groups to DNA, is a common process in both viral and human DNA and plays a crucial role in modifying gene expression. The study, conducted in collaboration with the NCI, examined methylation levels in cervical tissue samples from 1,400 women who had undergone cervical cancer screening.
The researchers evaluated methylation percentages for 35 different viral-genome sites, assigning a final “methylation score” based on the average percentage across all sites. Women with scores in the top 25 percent had significantly increased odds of developing either ADC or AIS.
Dr. Robert D. Burk, co-leader of the study and a professor at Einstein, emphasized, “Our findings, pending confirmation through clinical trials, suggest that women with a high methylation score may benefit from additional evaluation beyond a Pap test, potentially leading to early diagnosis and treatment for ADC or removal of AIS lesions before they progress to ADC.”
The new HPV methylation test, due to its potentially simplified equipment, holds promise for wider implementation, particularly in resource-limited regions. Cervical cancer remains a significant global health concern, particularly in lower- and middle-income countries and areas with high rates of HIV-HPV co-infections. Addressing this issue requires more frequent and effective screening.
Dr. Strickler expressed hope that the new HPV methylation test could ideally be administered every three to five years, potentially enhancing cervical cancer screening accessibility and equity in the United States.
