“The number of women participating in the cervical cancer population screening must be increased.” This was stated by Prof. Renske Steenbergen during her inaugural lecture on 6 October in which she officially accepted her appointment as professor of Experimental Pathology at Amsterdam UMC. She is working on tests that can detect cancers caused by the human papilloma virus at an early stage.

Renske  Steenbergen has been professor of Experimental Pathology at Cancer Center Amsterdam - Amsterdam UMC since December 1st 2019. In pathology, biopsies or cells from patients are examined to make a diagnosis and to investigate disease processes. Prof. Steenbergen has conducted extensive research in cancer biology, especially in the development of cancer diagnostics, over the past thirty years. The current focus of her research is early diagnosis: detecting subtle signs of the disease before obvious symptoms are present. She is mainly involved in the detection of cervical cancer and other cancers caused by the human papilloma virus (HPV).

A better balance is needed between avoiding unnecessary referrals and optimally detecting cervical cancer." Professor Renske Steenbergen.

More accurate referrals
Until a few years ago, the population-based cervical cancer  screening was performed by identifying abnormal cells from the cervix using a test called a Pap smear. Nowadays, the presence of HPV is first determined by molecular testing to identify infected women who are at a higher risk of developing cervical cancer. Closely monitoring infected women means cervical cancer can be detected at an earlier stage. But at the moment, many women are also unnecessarily referred to a gynecologist, says Prof. Steenbergen. This is because not all HPV infections are associated with a higher cancer risk, and the current triage methods lead to many unnecessary referrals.

“A better balance is needed between avoiding unnecessary referrals and optimally detecting cervical cancer. By investigating how HPV infection leads to cancer, we have developed new tests that can predict more accurately who is at risk for cancer.” These tests not only lead to improved detection of cervical cancer, importantly, they can prevent unnecessary referrals. Prof. Steenbergen is also developing tests for premalignant stages of vulvar cancer and anal cancer, which are also caused by HPV, using biomarkers that indicate who is at most risk for cancer and who needs to be treated.

Easier self-sampling
The professor also wants to ensure that more women participate in population screening for cervical cancer. The percentage of women who participate has been decreasing slowly in recent years. Thanks in part to the research of Amsterdam UMC, a self-sampling test was introduced in 2017 in order to increase participation by making it more convenient. With this self-test, women can take a sample themselves and mail it for testing in the laboratory. Unfortunately, the self-sampling kit did not significantly increase participation in screening; last year, only half of the invited women participated, compared to 56% in 2019. However, this test had to be requested by the participant. Recently, the Health Council advised that the self-sampling test should be offered to all women as an equivalent alternative to a Pap smear performed by a GP as a strategy to increase participation.

Detection in urine
In order to lower the threshold to participate in the population screening, various approaches should be implemented. Prof. Steenbergen: "That is why, in addition to the self-sampling kit, I want to develop another simple way to detect cervical cancer early, namely a urine test." Prof. Steenbergen is experienced in the development of urine tests for diagnostic purposes, and has promising results detecting other cancers in urine, such as uterine, bladder, colon and lung cancers.

Renske Steenbergen, professor of Experimental Pathology

For more information, read this announcement or contact: r.steenbergen@amsterdamumc.nl

Adapted by Esméé Joosten.

Source: ‘Urinetest moet deelname aan bevolkingsonderzoek baarmoederhalskanker verbeteren’, by Daniëla Cohen.