DNA anticipates cancer diagnosis in ten years and has already replaced pap smear in the interior of SP

The pap smear is already passed in Indaiatuba, in the interior of São Paulo. Instead, women who seek health centers in the municipality, 98 km from SP, began to be analyzed through a more assertive DNA test in the screening of HPV, the virus responsible for causing cervical cancer. The method also makes it possible to advance a more serious diagnosis of the disease in years, according to experts.

The so-called DNA-HPV has been applied in the city since 2017 — in partnership between Unicamp, pharmaceutical company Roche and the City of Indaiatuba. The result of the initiative was published in the scientific journal The Lancet.

Unicamp provided the knowledge of its researchers to implement the program and to analyze the samples. The city hall, in turn, started to apply it to its patients. The test is already approved in Brazil, as well as in the United States, Australia, England and Sweden and other countries.

Pharmaceutical Roche supplied inputs, the machine for analyzing the material and also developed the software that is linked to the public system to issue alerts to the doctor when the test results are ready.

Anyone who receives a negative diagnosis for HPV (86.8% of patients in Indaiatuba, according to the Unicamp survey between 2017 and 2020, with a DNA test) can repeat the test in five years since, in this period, the virus does not develop, according to doctors.

Those who test positive undergo follow-up until they are discharged. The target audience is women between 25 and 64 years old.

Cervical cancer, as it is also called, can be devastating. According to the World Health Organization, 604,127 women worldwide were diagnosed with the disease in 2020. In the same period, 341,831 died, mostly in poor countries.

According to the Atlas of Mortality by INCA (National Cancer Institute), an auxiliary body of the Ministry of Health, 6,596 deaths from the disease were recorded in 2019 in Brazil. In the Southeast alone, there were 2,100.

But this type of cancer is preventable and can be eradicated with organized public policies, according to Júlio Cesar Teixeira, lead researcher on the DNA-HPV study and director of oncology at Unicamp’s Hospital da Mulher.

“This can happen with the combination of vaccination actions up to the age of 15 and adequate tracking”, says Teixeira.

In Indaiatuba, the only city in Latin America to replace the pap smear with the new test in the public network, 18,700 women have already undergone DNA-HPV by December 2021, according to the city hall.

“With the beginning of the program, pap smears were no longer collected”, declares Túlio José Tomass do Couto, gynecologist responsible for women’s health care programs and deputy mayor of the municipality.

Businesswoman Tania Albertini, 48, had a positive diagnosis through the new test. She says that she had the pap smear every six months through the health plan and the result was always negative.

With the pandemic, in 2020, she lost her job and sought care in the public network. That’s when she discovered the DNA-HPV which, then, showed damage.

“It’s a consequence of life to have HPV. I treated it in my own office.” In the same year that she received the diagnosis, Tania took her daughter, then 14, to a health center to have the HPV vaccine.

The deputy mayor explains that, normally, a woman takes a Pap smear every two or three years in the public network.

“It is still an important test in Brazil and in the world. We collect the material on a slide that is evaluated by professionals. The results take up to six months and false negatives can occur.”

With DNA testing, the process is more accurate because it does not depend on human evaluation. “With a cotton swab, we collect the material from the cervix, dissolved in a liquid that comes out with a bar code, sent to a modern machine at Unicamp. The result comes out, on average, in up to 40 days”, says Couto.

Another patient diagnosed with this method was pensioner Neuza Maria Jesus Ribeiro, 66. She says that she used to have a pap smear every year since she was 45 years old and never had a positive one. “I feel privileged, because if it took too long, it could be fatal.”

Results

Of 16,384 women tested with DNA-HPV in Indaiatuba, between October 2017 and March 2020, according to Unicamp, 21 of them were diagnosed with cervical cancer, with a mean age of 39.6 years, 67% of which were in stage. initial.

The university reported that, with the pap smear, only 12 patients had cervical cancer detected with a higher average age, 49.3 years, and only one case in an early stage, in a survey carried out between October 2014 and March 2017, with 20,284 women.

According to the university, with the DNA-HPV test it is possible to anticipate the diagnosis of cervical cancer by ten years, compared to the traditional method, which explains more initial cases.

​But for the program to work, according to Teixeira, it is not enough to implement a modern test in the SUS, if there is no data management.

“It is necessary to interconnect the system. Currently, there is no control over who does the exams in the public network. Whoever arrives, does it. There is a waste of resources, because the woman goes outside the age or the exam window.”

The researcher explains that two-thirds of women who will have advanced cancers one day are out of the system. “We can’t summon them because we don’t know who they are. They’re usually poorer.”

Flávia Miranda Corrêa, a medical researcher at INCA’s Early Detection Division, agrees. “Just implementing a more effective test in the system does not change mortality at all. You have to institute an organized screening.”

The INCA doctor says that since 2019 there has been a movement involving specialists and the government to incorporate the test into the Unified Health System. It’s not a simple process.”

Carlos Martins, president of Roche Diagnostica in Brazil, recalls that a woman dies of cervical cancer every 90 minutes. “It’s totally curable.” What joined the pharmaceutical company to the project, according to him, was to carry out a representative study that reaches the health authorities. “We can bet on it, because we know it will save many lives.”

According to Roche calculations, which take into account exam costs and quality of life, there are long-term savings. In the group of women who had only the Pap smear, says the pharmacist, the costs were higher and the quality of life was lower than in the group that used the DNA-HPV technology.

This is due, according to Roche, to the early identification of cancer precursor lesions, which reduces the need for advanced stage procedures.

Each DNA-HPV test has a reference value of US$ 30 (about R$ 170). Pap smears, R$70, according to Teixeira. “When you produce DNA on a large scale, the value goes down, and that means saving lives, which is priceless, priceless.”

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