Ghana braces for possible first Marburg virus outbreak

by Alex Whiting

HPV prevention and vaccines help reduce the number of women dying from cervical cancer but new portable screening tools and new types of laboratory tests will improve early diagnosis and treatment of the disease.

New advances in cervical cancer screening — the fourth most common cancer among women — have the potential to save many women’s lives, their developers say.

While outcomes for women with cervical cancer have improved overall in recent years, the mortality rate from the disease is still too high. Despite the fact that cervical cancer is highly treatable if diagnosed early enough, more than 340,000 women died from the disease in 2020.

The majority of deaths occur in low- and middle-income countries where women often have limited access to screening services, according to the World Health Organization.

Even when women are tested, there may be a delay of several months before they get the results and, if they test positive, another delay before they receive treatment.
‘If you have advanced cancer, these months can be the difference between life and death,’ says Olivier Degomme, coordinator of a project called ELEVATE, which is developing a portable screening tool to take to deprived areas.

‘We really wanted to reduce this month’s interval to an ideally 24 hour interval,’ he said.

Mobile device

The ELEVATE mobile kit is designed for use in communities with limited access to medical care. The health worker will explain the importance of screening, then offer the test and be able to give the results to the woman within a day.

This kit requires a little training to use. The women collected the samples themselves, which health workers ran through a battery-powered analysis unit. This unit uses DNA testing to check for high-risk human papillomavirus (HPV) infection, which can cause cervical cancer. Results are returned within minutes.

The researchers aim to start using the toolkit in mountain villages and deprived urban areas in Ecuador and Brazil. They also want to use it with hard-to-reach women in Belgium and Portugal.

Initially, the researchers focused on migrants and other marginalized communities who have difficulty accessing medical care or who may not know about the importance of screening.

Too busy

But they also found that highly educated career women were not screened because they were too busy. So, apart from bringing a test kit to a community in need, it can also come in handy in a busy office, for example.

‘On a global level, the benefits will be much higher by focusing on hard-to-reach women in poor communities. But a nice side effect (of this project) is that we can also use this in a group of highly educated women,’ said Prof. Degomme, who is a professor in the faculty of medicine and health sciences at the University of Ghent, Belgium.

Screening programs vary between countries. Some invite all women of eligible age to be tested. Some offer opportunistic screening where the patient is informed about and offers screening when he or she visits the clinic. Some countries don’t filter at all.

WHO has set a 2030 target to reduce cervical cancer rates worldwide. One is that 70% of women should be screened for high performance tests at 35 years of age, and again at 45 years of age.

Prof Degomme hopes the ELEVATE portable kit will help countries meet WHO targets. This remains to be tested in the field, and assessed for acceptability, feasibility and cost-effectiveness for low-income countries.

‘What’s important is to make sure that it will reach women who can’t be reached in any other way. And we can actually save lives, hopefully many lives’, he said.

Ramen analysis

The HPV virus has more than 100 different strains, 14 of which are considered to be at high risk for cervical cancer. Increasingly, countries with screening programs are testing for high-risk HPV infection.

Researchers have recently designed a test that can distinguish between infections that will clear up on their own and infections that will become chronic and possibly lead to cancer.

They used Raman spectroscopy to examine changes in the molecular makeup of cervical cells taken during a smear test.

Ramen spectroscopy is a scanning technique to identify the chemical composition of materials by measuring their vibrational response to laser light. The research involved shining light on cells to make their molecules vibrate.

The resulting ‘fingerprint’ vibration gives an indication of whether the cell contents have been altered by the virus.

Cell specialist

Currently, if a person tests positive for a high-risk HPV infection, their cervical cells are examined through a microscope. This examination is performed by a cell specialist, called a cytologist.

Cells may look fine under a microscope, but Raman spectroscopy can pick up changes at the molecular level that are invisible to the human eye, according to Prof Fiona Lyng, coordinator of a project called ARC-HPV.

The project, which ended in 2018, concluded that Raman spectroscopy could be used to test for infections that can cause cancer. His findings have now been patented.

Since 2018, researchers have tested this method on larger samples and found that it is at least 91% accurate in distinguishing between cells of concern and cells likely to recover from infection.

The next step is to test the accuracy of Raman spectroscopy across the screened population.

Vaccination success

Another important form of prevention is vaccination. The available vaccines are highly effective, but do not protect against all forms of high-risk HPV.

‘The vaccine will actually reduce pre-cancer and cervical cancer, which is amazing.’ But its success poses problems for the screening program, said Prof Lyng, head of the Center for Radiation and Environmental Science at Dublin University of Technology.

With fewer cases of pre-cancerous and cancerous cells appearing in the population, cytologists will not be used to dealing with these disorders, meaning their ability to recognize them may decrease. ‘That’s why people are interested in developing new methods (such as Raman spectroscopy) that are more objective,’ says Prof Lyng.

There are ‘horrific stories about young women who died of this disease. That shouldn’t happen because it’s very treatable – if it’s detected in the early stages of pre-cancer,’ says Prof Lyng.

The results so far have shown that Raman spectroscopy is more accurate than cytology.

‘All tests have false positives and false negatives, and Raman isn’t 100% accurate either. But it does have a higher sensitivity than cytology, so we thought it would improve outcomes for women by detecting cancer, or pre-cancer, earlier,” said Prof Lyng.

The research in this article was funded by the European Union. This article was originally publishedon HorizonEuropean Union Research and Innovation Magazine.

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