Urine‐based detection of HPV for cervical cancer screening: Time for standardized tests

Abstract

Cervical cancer is preventable because it has an established etiology, mainly attributed to a detectable pathogen, human papillomavirus (HPV). In 2018, the world health organization issued an unprecedented call for global action to eliminate cervical cancer by 2030. The adaptation of regular screening programs is fundamental to achieve the goal of cervical cancer elimination. However, it is still difficult to achieve satisfactory coverage rates of screening in developing countries as well as in developed countries because many women are reluctant to participate in gynecologic examination. HPV detection in urine is a convenient, widely acceptable by women and relatively affordable without the necessity for clinical visits to improve the coverage rates of cervical cancer screening. Unfortunately, the clinical implementation of urine-based tests for HPV detection has been hindered by the lack of standardized tests. Further optimization of protocols and standardization of urinary HPV detection are expected to be realized. With the advantages of urine sampling to overcome cost, personal, and cultural barriers, time has come for the standardized tests to facilitate a wide clinical implementation of urinary HPV detection that will significantly contribute to the WHO's goal, that is, to eliminate the cervical cancer globally.

Advanced technologies towards improved HPV diagnostics

“…On the other hand, urine testing faces challenges such as lower HPV load, presence of PCR inhibitors and contaminating pathogens, and possible higher rate of false positives due to HPV infection of the urinary tract or the lower genital tract. Although many studies have shown correlation between HPV detection in cervix and urine, 195,197–203 they were often very discrepant due to diverse methodologies used during sampling, storage, sample preparation, and DNA extraction, and further optimization and standardization is required.…”

“…On the other hand, urine testing faces challenges such as lower HPV load, presence of PCR inhibitors and contaminating pathogens, and possible higher rate of false positives due to HPV infection of the urinary tract or the lower genital tract. Although many studies have shown correlation between HPV detection in cervix and urine,195,[197][198][199][200][201][202][203] they were often very discrepant due to diverse methodologies used during sampling, storage, sample preparation, and DNA extraction, and further optimization and standardization is required. Regarding the blood analysis, most authors focus on the role of HPV circulating DNA as a prognostic biomarker in blood of patients F I G U R E 3 Schematic illustration of the photoelectrochemical biosensor array (PEBA) platform.…”