Molecular markers: how to apply in practice.

Predicting disease outcome is a major challenge in modern medicine. Concerning the prediction of HPV-associated cervical disease, several important issues are related both to the management of women with diagnosed cervical precancer and cancer. The detailed molecular mechanisms explaining the different oncogenic potential of the LR-HPVand HR-HPV have emerged only recently. Oncogenic HPVs are capable of contributing to the development of the malignant phenotype by several different mechanisms, most of which seem to be closely interrelated [1]. Because of the fact that these molecular interactions are mediated by proteins, the logical strategy to dissect the complex molecular pathways is to study these molecular markers, using a variety of research techniques [1,2]. Biomarkers are measurable indicators of exposure effects and susceptibility or disease state, and are used to understand the mechanisms of cancer progression. Considering the trend of increase in incidence rate of the cervical cancer and its high prevalence in developing countries, there is a need to identify and validate new markers for cervical cancer detection. Apart from predicting disease outcome and viral events, effective and specific molecular markers would not be susceptible to the many technical limitations of current cervical cancer technologies that rely primarily on the morphological interpretation of cells sampled from the uterine cervix. The accuracy of screening based on morphological interpretation of cytological samples, can be substantially hampered by low inter-observer reproducibility [3]. Molecular markers are therefore perceived as having the potential to confer an improved level of reproducibility as compared to conventional screening tools. This document is focused on issues related to the use of markers as potential screening tools in early detection of cervical cancer precursors.