The Emergence of Molecular Biology in the Diagnosis of Cervical Cancer: A Network Perspective by Daniele Rotolo, Michael Hopkins, Ismael Rafols and Stuart Hogarth

The development of molecular biology (since the 1980s) has changed both the research landscape and clinical practices around cervical cancer. Its rise has helped to address the ongoing problems with cytology-based diagnostic technologies (including the Pap test), in particular their well-documented low sensitivity (the Pap test may report 15-50% of false negative cases). In the context of these developments it is important to consider the influence that actors have upon the direction of such emerging technologies. The composition of the network can be crucial in supporting the system of innovation, and in distributing power and control of the network proportionally.

A recent paper presented by Rotolo, Hopkins, Rafols and Hogarth examines the inter-organisational networks in the emergence of molecular biology in the diagnosis of cervical cancer. It draws attention to four different phases of its emergence; exploration, development, adoption, and growth. The sources of innovation are not limited to any one actor, and they are often in the ‘interstices between firms, universities, research laboratories, suppliers and customer’ (Powell 1990: 118). While some configurations favour interaction, others concentrate power among the few (Burt 1992). Some organisations can act as a coordinator (mediating between actors in the same institutional group) or as a gatekeeper (screening and gathering knowledge from another group and distributing it among its own group) -

Cervical cancer’s viral origins have been heavily researched as far back as 1842 by Domenico Rigoni-Stern, which highlighted the link between koilocytes and condylomas and the development of cervical cancer. Later research highlighted that a persistent infection (developing through four stages may eventually evolve into cervical cancer (Schiffman, Castle, Jeronimo, Rodriguez & Wacholder 2007). During initial stage (Cervical Intraepithelial Neoplasia-CIN1), the virus is sexually transmitted, in the second stage (CIN2) lesions are cleared within the first 12 months (however less than 10% are successfully cleared), in the third stage (CIN3) abnormal cells duplicate and thus replace the full thickness of the cervical epithelium, and in the final stage the infection transforms into an invasion where the HPV genome is integrated into the host’s genome.

Using 4,722 scientific articles, and drawing upon the work of Blume (1992), Casper & Clarke (1998), and Hogarth et al. (2012), the paper identified four key stages of the emergence of molecular diagnostic technologies in the cervical cancer screening domain; 1) exploration- 1980-89, 2) development- 1990-99, 3) adoption- 2000-5, and 4) growth- 2006-11. These were all examined through the terms of the bridging roles that different institutional groups played, and then were classified into one of five different institutional groups. These included; Research & Higher Education, Governmental, Hospitals & Care, Industry, Non-governmental, and Other.

The paper concludes that the overall number of ties increases for each group (although they do decrease for the GOV, IND and NGO groups in the last few years). The number of organisations taking on a brokerage role (typically those actors contributing to the diagnosis domain of cervical cancer research), increases in the adoption and growth phases, but decreases in the last three years of observation.

In general it appears that the process of tie formation between groups, and it develops throughout the different phases of emergence. Typically RHE organisations are more active in creating intra-group ties, while GOV, IND and NGOs collaborate more frequently with actors in differing groups.  RHE groups are more likely to take on a brokerage role and to act as a gatekeeper. GOV groups are likely to act as broker in the emergence phase, but as gatekeeper in the adoption and growth phases. The HC, IND, and NGO groups are more active in itinerant broker, and liaison roles than intra-group coordination. These findings are incredibly useful in the development of policies designed to stimulate and support innovation. Using such complex inter-organisational networks will be crucial in this development. 

To read the full paper, click here.