HPV and Cervical Cancer

Advances in the Laboratory Diagnosis of HPV

The second most common cancer among women.
HPV is its main cause.
HPV is present in 99.7% of cervical cancers.
One of the most preventable human cancers.

How can you prevent HPV infection?

Being informed is your best defense

HPV infection is the most common sexually transmitted infection.
It infects sexually active women and men.
Condoms do not protect against HPV infection.

Warning

Although most infections are asymptomatic, a significant minority of infected women may develop persistent cervical infections, putting them at risk of developing cervical cancer.

- A woman infected with HPV is 300 times more likely than a woman who is not infected to develop cervical cancer.
- About 70% of sexually active women come into contact with HPV.
- About 25% of these women are between the ages of 18 and 30*.

_{*HPV testing is not performed before age 30 because the majority (80%) of infections are transient.}

What should you do?

See your gynecologist regularly.
Get regular screenings to detect HPV infection and determine whether it persists.
If persistent, identify high-risk genotypes.
If persistent and high-risk, characterize the integration into the genome.

How is the diagnosis made in the clinical pathology laboratory?

Hybrid capture test

This test allows for initial screening (usually in conjunction with cytology for women over 30 years of age).

It has proven clinical sensitivity (94%) adjusted for cervical cancer (CIN2+).
It is a screening test to identify clinically relevant hrHPV infections.
It does not identify individual genotypes.

Genotyping Test

It allows for the identification of high-risk genotypes in cases of persistent infections.

It has high analytical sensitivity.
It has lower clinical sensitivity than Hybrid Capture.
It has higher specificity, as it allows for the identification of high-risk genotypes.
It detects persistent hrHPV infections and co-infections.
It allows for different therapeutic approaches.

What information do we obtain from genotyping?

70% of cervical cancer cases are associated with persistent HPV 16 and 18 infections.
All other genotypes are associated with only 30% of cervical cancer cases.
The oncogenic potential is increased in co-infections.

e6/e7 mRNA test

This test characterizes persistent infections in terms of:

Integration into the genome of cervical epithelial cells.
Persistence of viral DNA; Viral DNA replication.
E6/E7-induced chromosomal instability, which causes changes in the host cell’s DNA.
It has high potential as a marker of oncogenic transformation.
It has high clinical sensitivity (≈Hybrid Capture).
It has high specificity for CIN2+/CIN3+.
It allows for superior differentiation between transient infections and persistent infections with oncogenic potential.

Can any HPV cause cancer?

Only high-risk HPV (hrHPV) genotypes 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68.
The infection must become chronic and persistent.
HPV must integrate into the cellular genome.
And cause cellular changes and uncontrolled cell growth.

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