Title thesis: Innovative molecular markers for diagnosis and prognosis in cervical neoplasia

Boers described in her thesis improvements of the current cervical cancer screening program and treatment of cervical cancer patients. A wide variety of methylation markers has been explored for cervical cancer screening, but so far no methylation markers are validated for optimal detection of (pre)malignant cervical neoplasia in a population based screening program.

In a review an overview is shown of the markers known in literature and the best methylation markers for cervical cancer screening reported so far. Furthermore, Boers describes an innovative genome-wide methylation analysis to identify new methylation markers that can differentiate between normal cervices and CIN2 or higher lesions.

Detection of hrHPV in self-obtained cervico-vaginal samples is feasible, while cytological assessment of self-sampler material is not reliable. Optimizing triage of HPV positive women is necessary, because of its specificity. DNA methylation analysis with a 4-gene panel C13ORF18, JAM3, EPB41L3 and TERT as a triage test was performed directly on Evalyn Brush specimens. Boers concluded that DNA methylation is feasible directly on the Evalyn Brush and showed good correlation with matched physician-taken samples.

Apart from optimizing screening strategies for cervical cancer, possible improvements of the current standard of care of cervical cancer patients were described in this thesis. Boers studied in cervical cancer the role of ATG13-mediated autophagy in response to irradiation.