[Molecular diagnosis of cervical neoplasia: future potential or academic playground?]

Despite major progress in the reduction of incidence and mortality of cervical carcinoma through systematic screening by cytology, there are areas which deserve further improvement, one of them being the obvious overtreatment of CIN 3 which has to be removed in all patients although the invasive potential is limited to a minority of those lesions. Based on new knowledge of cervical carcinogenesis uncovered in the last few years, new potential targets for an individualized determination of prognostic behaviour may become possible. Infection by high-risk HPV types has been recognized as an essential step in the development of cervical carcinoma. In virally induced cervical carcinogenesis, dysregulation of the cell cycle is induced by an overexpression of the oncogenes E6 and E7. Direct determination of these oncogenes may become possible by mRNA measurements. Other biomarkers of cell cycle dysregulation such as p16 may serve in the future to determine the invasive potential of the precursors of cervical carcinoma. Further discoveries in molecular carcinogenesis may possibly allow to develop new diagnostic markers and possibly therapeutic agents in the future.