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Cervical cancer is one of the worst enemies of women worldwide. Statistics shows that it affects 500,000 women every year and it is the cause of death of 250,000 women worldwide. The data for Greece are about 580 new cases and 280 deaths per year.

So, prevention is more than pressing. A new discovery in this area has come from the obstetric clinic of the University of Ioannina, To Vima newspaper reports. It has already been applied at a testing level in various gynaecological clinics across Greece and constitutes a system for secondary prevention of cancer of the cervix. In fact, it "pre-screens" with great accuracy women belonging to the "zone of high risk" and those who, despite the alarming results of regular examinations, are not at risk of cancer.

The small progress of research in this field was presented by Professor Evangelos Paraskevaidis - President of the Greek Association of Colposcopy and Cervical Pathology at an international seminar held in Ioannina.

PAP (smear) and HPV DNA tests are not enough
 
Today's methods of diagnosis are the transformation of the standard liquid based PAP smear test and the new HPV DNA test that analyzes the genetic makeup of the HPV virus. According to doctors, however, their results have serious flaws. "90 out of every 100 women who undergo a PAP test obtain normal results and only 10 - pathological. But 20 to 30% of every 100 women with precancerous or invasive lesions get false negative results, although in actual fact they already have lesions of the cervix. The PAP test is subjective and depends on the skills of the professionals who take and perform the testing, and on the proper application of the preparative technique prior to testing.

At the same time, in 3 out of 10% of women who have abnormal results, the PAP test shows damage to the cervix, and minor damage in 7% of women. Half of the women of this percentage or 3% actually belong to the risk group and undergo immediate treatment. The rest, however, do not have any problem. In the women from the other 7%, it has been found that 80% actually have no serious pre-cancer lesions but things are serious for 20% of them, although their test results were relatively "mild"," the professor said.

On the other hand, the HPV DNA test, which in any case is more sensitive than the PAP test, has disadvantages too. According to Paraskevaidis, by identifying the HPV virus, it shows the cause of the damage, but not the disease. In some cases, this leads to over-diagnosis and excessive treatments.

To "scan" the probability
 
Knowing that there are human lives behind these statistics has led Paraskevaidis and his research group to develop an innovative system for forecasting the personal cumulative risk (a scoring system) for carcinogenesis of cervical cancer. According to the professor, "this is a globally unique method-algorithm", which the University of Ioannina has been developing for seven years and it seems to be able to fill the gaps in the existing system for forecasting.

The algorithm is based on specific biomarkers associated with HPV, and "the equation" also includes epidemiological and other data, medical history and the habits of each woman. For example, when her sexual contacts began, how many sexual partners she had, whether she is a smoker. The overall system includes 12 different parameters. Analyses are carried out after taking only one sample from the cervix. The procedure is painless, similar to that of the PAP test. The algorithm is complemented by colposcopy, HPV DNA test, viral load test, mRNA test, which detects specific viral proteins and others. So far, the system has been applied to about 8,000 women in various health centres in Greece, who had very good results from the PAP test.
 
The scoring system can forecast with high precision the group of women with a high risk of developing cervical cancer. "We are able to diagnose with almost absolute precision the degree of damage and the probabilities for its development, completely excluding the false negative results of conventional cytology. The system is effective even in women who have already undergone treatment for lesions of the cervix. "Every 10 out of 100 women who undergo a cone cervical amputation will need re-treatment at some point in their lives. This means that they should be subjected to tests until the end of their lives. The scoring system can be applied in this case: After applying it just once six months after the operation, we can identify those women at a high risk of relapse and separate them from the rest, who will simply undergo the tests other women undergo."

Doctors believe that the cost of the test will be about 150 euro and they urge health authorities to realize the long-term benefits from the implementation of the system. "In fact, we are talking about a way of screening that shows with absolute precision which women actually need to be monitored continuously or subjected to treatments and which – do not need that. Imagine how useful it would be for the women themselves and for the public finances as well," the teacher at the School of Medicine of the Aristotle University of Thessaloniki, Loufopoulos said.

Is the vaccine against the HPV virus effective?

Scientists from various Greek and foreign universities argue that primary prevention against the HPV virus, which is achieved through vaccination, is just one of the "weapons" in the fight against this type of cancer. "In order for the vaccine to be effective, 80% of women should be vaccinated. In Greece, despite the increase, which has recently been reported, that rate does not exceed 30%. But even if we reach the minimum required, the effect of the vaccine will be apparent after about 20 years. Therefore, the secondary prevention is very important, which the scoring system guarantees," the professor at the University of Ioannina and a member of the research group, Evripidis Biliarakis, stated.

Recently, world-known centres such as Imperial College - Hammersmith Hospital in London have joined their Greek counterparts in the development of the system.