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FOLATE METABOLISM AND ITS ASSOCIATION WITH CERVICAL DISEASE
Abdusattorova Soxiba Anvarjon kizi
Andijan State Medical Institute
https://doi.org/10.5281/zenodo.14169294
Annotation.
Cervical cancer is one of the few cancers that can be prevented. When it is
diagnosed at an early stage, the disease is more amenable to effective treatment, which
increases overall and relapse-free survival, improves the quality of life of patients, and reduces
the cost of treatment. According to international guidelines, Human Papillomavirus (HPV) DNA
tests represent a valid alternative to Pap Test for primary cervical cancer screening, provided
that they guarantee balanced clinical sensitivity and specifcity for cervical intraepithelial
neoplasia grade 2 or more (CIN2+) lesions. The study aimed to assess whether HPV Selfy (Ulisse
BioMed – Trieste, Italy), a full-genotyping HPV DNA test that detects and diferentiates 14 high-
risk HPV (HR-HPV) types, meets the criteria for primary cervical cancer screening described in
the international guidelines, on clinician-collected as well as on self-collected samples.
Keywords
: diseases of the cervix, oncogenic types of HPV, folate metabolism.
Introduction.
Pathology of the cervix (CC) is one of the most common gynecological
diseases, especially in antenatal clinics - 25-45%. In gynecology and obstetrics, early diagnosis
and adequate treatment of background and precancerous diseases, as well as initial forms of
cervical cancer, remain one of the most important problems . Cervical cancer (CC) is a major
public health problem in Uzbekistan. According to the International Agency for Research on
Cancer IARC (IARC) estimates for 2018, cervical cancer is the second most common type of
cancer among women in Uzbekistan after breast cancer and the third most common cause of
death of women from cancer in Uzbekistan. According to estimates for 2021, the age-
standardized incidence and mortality rates are 5.3 and 2.9 per 100,000 women per year,
respectively. According to the national cancer registry, in 2021 in Uzbekistan, the number of
initially diagnosed cases of cervical cancer in the republic was 1827, 997 cases of death from
cervical cancer were registered with the following distribution of cases by stages: stage-I: 12%,
stage-II: 54, 1%, stage-III: 23.6%, stage-IV: 5.3%. Every year in Europe, more than 25,000 cases
of cervical cancer are diagnosed and about 12,000 deaths from this disease, which exceeds the
number of deaths from AIDS and hepatitis combined. The etiological link between persistent
HR-HPV infection and the development of high-grade cervical dysplasia and cervical cancer is
well established. The two oncogenic HPV types that most commonly cause cervical cancer are
types 16 and 18. Cervical cancer of the brand is one of the few forms of malignant neoplasms
that satisfy all the requirements of population screening, i.e. is an almost completely
preventable disease. The Regional Consultative and Diagnostic Center has accumulated 10
years of successfull experience in identifying, treating and monitoring patients with cervical
pathology, i.e. with background and precancerous processes.
Methods for early diagnosis and the introduction of new screening technologies for
diseases of the cervix open up additional opportunities for the prevention of cervical cancer,
which is the basis for reducing diseases in general and opens up prospects for maintaining
women's health.
Subjects and methods:
We evaluated 200 sexually active women aged <65 years in
Andijan region by using a questionnaire; the subjects were also screened using the CIN-DIAG
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cytologic test. Patients with abnormal CIN-DIAG results (other than glandular cell
abnormalities) who were willing to provide informed consent were further diagnosed using
colposcopy and histopathological examination. We investigated 247 cases of low-grade cervical
squamous intraepithelial lesions (LSIL), 125 cases of high-grade cervical squamous
intraepithelial lesions (HSIL) and 877 controls. A 24-item food frequency questionnaire was
filled out by the investigator to estimate the consumption of dietary folate. Positivity for hrHPV
from residual exfoliated cervical cells was tested; serum folate was also measured.
Results:
The hrHPV infection rate in HSIL patients (77.6%) was higher than that in LSIL
(33.2%) and control (32.0%) patients. Dietary folate intakes in controls, LSIL and HSIL were
306.9±176.6, 321.8±168.0 and 314.7±193.8 μg/kcal, respectively. The levels of serum folate in
controls, LSIL and HSIL were 18.2±7.9, 15.9±7.1 and 14.3±7.5 nmol/l, respectively. Increased
CIN correlated with higher rates of hrHPV infection and lower levels of serum folate.
Conclusions
: Low levels of serum folate may increase the risk of CIN progression.
