The Japanese challenge: Can urine be the solution in the fight against cervical cancer?

Detecting cervical cancer in its initial stages allows for treatment to begin sooner and can dramatically increase chances of survival. However, symptoms of the disease are not always evident, making detection challenging.

Cervical cancer, the fourth most common cancer type in women globally, is primarily caused by the Human Papilloma Virus (HPV), a common sexually transmitted infection (STI) affecting both men and women. Most HPV infections present no symptoms and disappear naturally overtime. However, several genotypes like HPV16 and 18 are a major cause for cervical cancer development (1).

Regular examinations to monitor healthy individuals are recommended in many countries. In Japan for instance, all women over the age of 20 are recommended every two years for cytology-based HPV screening for cervical cancer. However, participation is low, with only 22.2% of women in the age group attending screening programs. As a result, cervical cancer mortality is continuously increasing every year in Japan (2).

Some reasons for poor uptake include the methods are clinician dependent and perceived relatively invasive. In addition, some women are often reluctant to have a pelvic examination (3).

Alongside screening, vaccination is important in the fight against cervical cancer. As the HPV vaccine, which prevents infection against several HPV types, including HPV16 and 18, is currently suspended from use in Japan, good and regular screening is even more critical in this region (2). 

Over the last few years, urine has shown great promise and can potentially offer a solution to increase participation for cervical cancer screening. Colli-Pee®, an innovative medical device developed by Novosanis, NV (Belgium), a subsidiary of OraSure Technologies, Inc. (NASDAQ: OSUR), enables first-void urine collection in a simple manner. Its unique design creates an easy and standardized way to capture the first 20 mL.

Initial urine flow contains higher concentrations of HPV DNA and several studies have shown the benefits of first-void urine in HPV detection (4). Further, a urine sample can easily be taken at home, is non-invasive and can be performed independently, addressing many of the concerns with the current cytology-based methods. 

This new approach could be game-changing in the way cervical cancer is diagnosed in the future.

References:

1.WHO website, HPV and cervical cancer - https://www.who.int/news-room/fact-sheets/detail/human-papillomavirus-(hpv)-and-cervical-cancer

2.Ikeda S, Ueda Y, Yagi A, Matsuzaki S, Kobayashi E, Kimura T, Miyagi E, Sekine M, Enomoto T, Kudoh K. HPV vaccination in Japan: what is happening in Japan?. Expert Rev Vaccines. 2019 Apr;18(4):323-325. doi: 10.1080/14760584.2019.1584040. Epub 2019 Feb 22. PubMed PMID: 30768373.

3.Racey CS, Withrow DR, Gesink D. Self-collected HPV testing improves participation in cervical cancer screening: a systematic review and meta-analysis. Can J Public Health. 2013 Feb 11;104(2):e159-66. Review. PubMed PMID: 23618210.

4.Pattyn J, Van Keer S, Biesmans S, Ieven M, Vanderborght C, Beyers K, Vankerckhoven V, Bruyndonckx R, Van Damme P, Vorsters A. Human papillomavirus detection in urine: Effect of a first-void urine collection device and timing of collection. J Virol Methods. 2019 Feb;264:23-30. doi: 10.1016/j.jviromet.2018.11.008. Epub 2018 Nov 16. PubMed PMID: 30452931.