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World of Genomics: Cyprus

The next destination on our World of Genomics tour is the island nation of Cyprus. Kípros in Greek and Kıbrıs in Turkish, Cyprus is found in the eastern Mediterranean Sea. Geographically, the island is located in Asia, but Cyprus is actually part of Europe and shares cultural elements from both continents. Having been inhabited for more than 10 millennia, the country has soaked up the culture, languages and history of generations of conquerors, pilgrims and travellers.

Cyprus has long been celebrated for its mineral wealth, natural beauty, quality wines and produce. The poet, Leonidas Malenis, described Cyprus as a “golden-green leaf thrown into the Sea” and a land of “wild weather and volcanoes”. Today, the country is a popular tourist destination for many travellers from across Europe and further afield. As it is the legendary home of the Greek goddess of love, Aphrodite, Cyprus is a particularly popular spot for newlyweds on their honeymoon.

The population of Cyprus

Map of Cyprus (Source: Britannica)

Cyprus is the third largest island in the Mediterranean Sea, lying south of Turkey, west of Syria and southeast of mainland Greece. From 1925, Cyprus was a crown colony of Great Britain, until it gained independence in 1960 and became known as the Republic of Cyprus.

Two main ethnic groups – Greek and Turkish – make up the population of Cyprus. The Greek Cypriots make up approximately 80% of the total population. They are descended from the aboriginal inhabitants and the Peloponnese, who began colonising Cyprus in 1200 BC until the 16th century.

Around 20% of the population of Cyprus are Turkish Cypriots, descended from the Ottoman army that conquered the island is 1571. Turkish immigrants were also brought to Cyprus from Anatolia by the Sultan’s government. More recently, immigrants from Turkey have been brought to the island to work on undeveloped land and increase the labour force.

The languages of Cyprus reflect the population – the main language being Greek, followed by Turkish. As well as this, there are a small number of Arabic-speaking Maronite Christians and a population that speaks Armenian. These alternative languages total only a few thousand speakers, with most having Greek or Turkish as their second language. English is also widely spoken and understood on the island.

A long-standing conflict between the Greek Cypriot majority and the Turkish Cypriot minority led to an invasion of the island by Turkish forces in 1974. The result of this was the partition of the island and the establishment of the de facto Turkish Cypriot state in the north of Cyprus in 1975. In 1983, the Turkish Cypriot state declared independence under the name Turkish Republic of Northern Cyprus. This independence was only recognised internationally by Turkey.

Geographic and demographic information

Summary statistics

  • Land area: 9,251 km2
  • Gross domestic product (GDP):
    • Total: $28.41 billion (2021)
    • Per capita: $31,552 (2021)

Population statistics

  • Population size: 1,244,188 people (2023)
  • Birth rate: 11 per 1,000 people (2020)
  • Death rate: 7 per 1,000 people (2020)
  • Infant mortality rate: 2 per 1,000 live births (2020)
  • Average Life expectancy: 81 years (2021)
    • Male estimate: 79 years (2021)
    • Female estimate: 83 years (2021)
  • Ethnicities: Greek Cypriot (77%), Turkish (18%), Other (5%)

Healthcare system

In June 2019, Cyprus implemented the first phase of the new General Healthcare System. This aimed to unify the previously fragmented healthcare system that had a number of problems, including an imbalance of resources between public and private providers, very high out-of-pocket payments, large inequalities in access, long waiting lists and inefficiency of the health system overall.

State revenues and contributions from wages, incomes and pensions are used to fund the General Healthcare System. When the new system was implemented, some responsibilities of the Ministry of Health shifted to the Health Insurance Organisation. This now acts as the single purchaser of services from both public and private providers. Other responsibilities of the Ministry of Health were moved to the new State Healthcare Services Organisation, which is responsible for the development, management, control and supervision of hospitals and health centres in the public sector.

Despite the COVID-19 pandemic, the new healthcare system became fully operational on the 1st of June 2020. The COVID-19 response in Cyprus was centralised and coordinated at the highest levels of government. The response was led by the General Secretary and the Medical Services Directorate of the Ministry of Health, in coordination with the Scientific Advisory Committee, the Council of Ministers and the President of the Republic. The Scientific Advisory Committee consists of independent academics from universities and members of the Surveillance and Control of Communicable Diseases Unit.

On average, Cyprus spends less on healthcare than most EU countries. In 2019, the healthcare spend was €1,881 per capita, which is about half the average for the EU as a whole (€3,521 per capita). This translates to 7% of GDP, significantly lower than the total EU average of 9.9%. Additionally, only 8% of the government budget was spent on health, compared with a 14% EU average.

Health priorities

Despite mortality rates decreasing substantially over the past two decades, circulatory diseases remain the leading cause of death in Cyprus. In 2018, they were responsible for 30% of all deaths within the country. Specifically, ischaemic heart disease is the leading cause of mortality (11% of all deaths), followed by stroke and diabetes. In contrast to circulatory diseases, mortality rates from cancer have remained fairly stable, accounting for 24% of all deaths in 2018. Lung cancer remains the most frequent cause of death by cancer, followed by colorectal and breast cancer. However, the cancer mortality rate in Cyprus is lower than the EU average.

Around 35% of all deaths recorded in Cyprus in 2019 were attributed to behavioural risk factors such as tobacco smoking, dietary risks, alcohol consumption and low physical activity. Tobacco consumption remains a major public health concern in Cyprus, with more than one fifth of Cypriot adults reporting that they smoked daily in 2019. Higher smoking rates are seen among men (33%) compared to women (14%). Some tobacco control policies are in place, but they are relatively weak and poorly enforced.

Adult obesity rates in Cyprus are slightly lower than the EU average (14.6% in Cyprus, 16% EU average in 2019). However, obesity among children is a public health concern. In 2015-2017, 20% of children aged 6-9 years in Cyprus were obese – the highest rate among EU countries. Low physical activity and poor nutrition are important contributors to obesity. About 40% of adults in Cyprus did not meet the WHO recommendation of at least 2.5 hours of moderate physical activity per week in 2014, which is a higher share than the EU average. Cypriot adults also reported that they did not eat at least one portion of fruit (40%) or vegetables (52%) per day in 2019. However, these figures are still lower than those in most other EU countries.

Genomic medicine capabilities

The prevalence of thalassaemia, the collective name for a group of inherited conditions that affect haemoglobin in blood, is high in Cyprus. As such, the Thalassaemia Control Programme started in 1972 and the Cyprus Thalassaemia Centre opened in 1982. These operations are dedicated to the prevention of the disease in the Cypriot population and the Centre also offers medical care to those with thalassaemia.

Further genetic services were introduced in the 1980s at the Makarios Hospital in Nicosia. Laboratories were established to focus on cytogenetics, molecular diagnostics and biochemical genetics. In 1990, the Cyprus Institute of Neurology and Genetics was established with the aims of providing specialised medical care and state-of-the-art preventive programmes in collaboration with other local institutions and to promote research and postgraduate education.

Part of the Cyprus Institute of Neurology and Genetics, The Clinical Genetics Clinic was founded in 1994. The Clinical Genetics Clinic provides a diagnostic, management and genetic counselling service for individuals or families with, or at risk of, genetic disorders. Services are available to assess chromosomal abnormalities, single-gene disorders (such as cystic fibrosis), familial cancer or cancer pre-disposition syndromes and much more.

In 2016, the Clinical Genetics Clinic also became an official member of the European Reference Network, ERN-ITHACA, as the designated expert centre in Cyprus for rare congenital malformations and rare intellectual disability disorders.

The Cypriot neonatal metabolic screening program was started in 1988 by the Centre for Preventive Paediatrics. The program screens for congenital hypothyroidism and phenylketonuria. In 1990 systematic screening for inborn errors of metabolism (IEM) was also introduced at the Biochemical Genetics Laboratory (Cyprus Institute of Neurology and Genetics). This made it possible to offer a full investigation of patients suspected of having IEM.

Notable projects

Biobanking and the Cyprus Human Genome Project: This project is helping Cyprus significantly enhance its biobank repository and promote research to benefit its citizens and their healthcare delivery with two pillars: i) A contemporary Biobank research infrastructure that incorporates eHealth; ii) a state-of-the-art research facility to support the Cyprus Human Genome Project and drive translational research, focused on genetic diseases.

The Molecular Genetics Thalassaemia Department, Haemomics project: The project aims to identify new proteins involved in the regulation of γ-globin gene expression as suitable pharmacological targets for the treatment of β-haemoglobinopathies (β-thalassaemia and sickle cell disease).

The Molecular Genetics Thalassaemia Department, Hepat-omics project: This project aims to identify potential non-invasive, novel serum diagnostic biomarkers for different stages of liver disease (fibrosis and cirrhosis) in β-thalassaemia patients using combined data from proteomics, metabolomics and transcriptomics.

1+ Million Genomes (1+MG) Initiative: Cyprus joined the 1+MG initiative in 2018. The Europe-wide initiative aims to facilitate cross-border access to genomic data.

Notable organisations and companies

The Cyprus Society of Human Genetics (CSHG): The CSHG was founded with the main aim of promoting and developing the science of human genetics in Cyprus. The CSHG facilitates the networking of national and international biomedical professionals, organises the professional framework of geneticists in Cyprus and provides education and research in the diagnosis, treatment and prevention of inherited disorders.

Cyprus Biobank and Centre of Excellence for Research and Innovation: The Cyprus Biobank collects, analyses and preserves biological samples and health data in a state-of-the-art biobank and utilises them for scientific, diagnostic, and educational innovation.

The Cyprus Institute of Neurology and Genetics: The Cyprus Institute of Neurology and Genetics is an internationally recognised centre of excellence offering specialised services, translational research and postgraduate education in the fields of neurology, genetics, biomedical sciences and medical sciences.

The Clinical Genetics Clinic: The Clinical Genetics Clinic is part of the Cyprus Institute of Neurology and Genetics and provides a diagnostic, management and genetic counselling service for individuals or families with, or at risk of, disorders that may have a genetic basis. Individuals or families are referred by healthcare providers.

The University of Cyprus: The University of Cyprus is a research-led university established in 1992. Scientific research remains one of the pillars of the university, with laboratories focusing on epigenetics and gene regulation and molecular cell biology. The Molecular Medicine Research Centre in the University of Cyprus also covers molecular genetics and bioinformatics. 

Notable individuals

Professor Leonidas A. Phylactou: Professor Leonidas A. Phylactou is the Chief Executive Officer and Medical Director of the Cyprus Institute of Neurology and Genetics. Professor Phylactou has secured research funding from several local and international funding organisations and published extensively in the areas of molecular genetics, gene function and gene therapy.

Dr Violetta Christophidou-Anastasiadou: Dr Violetta Christophidou-Anastasiadou founded the Clinical Genetics Clinic in 1994. Dr Christophidou-Anastasiadou has been active in the field of rare diseases for the past 27 years both in Cyprus and internationally. She has represented Cyprus on various European committees as an expert in rare genetic conditions and in the establishment of the European Reference Networks.

Professor Constantinos Deltas: Professor Constantinos Deltas is the Director of the Cyprus Biobank and Centre of Excellence for Research and Innovation. Professor Deltas’ research interests include the genetics of inherited kidney conditions, inherited heart conditions and the search for biomarkers for use in disease diagnosis and prognosis.

Future genomics landscape

Along with the Haemomics and Hepat-omics projects detailed above, the Molecular Genetics Thalassaemia Department (Cyprus Institute of Neurology and Genetics) has continued research projects investigating thalassaemia. These include genotype/phenotype correlation, drug therapy, gene therapy and non-invasive prenatal diagnosis.

In November 2022, the Cyprus Biobank received extra investment with new facilities at the Centre of Excellence. The inauguration of the new facilities was attended by representatives from the University of Cyprus and the First Health Officer at the Ministry of Health. The biobank is expanding its research into personalised medicine by inviting healthy volunteers and individuals with any diagnosed diseases to enrol and provide samples.

The Cyprus Human Genome Project is running until 2026. The project intends to support studies focusing on cancer, cardiovascular conditions, kidney disorders, rheumatic diseases, psychiatric conditions, diabetes, autoimmune diseases and any other condition of interest to the medical community. It aims to enrol more than 16,000 donors within the first seven years to achieve operational sustainability, before expanding into the general population.

References

  1. Bowman J S, Wathen D, Hunt S, Gout H W. Cyprus. Encyclopaedia Britannica. Available at: https://www.britannica.com/place/Cyprus
  2. Cyprus. The World Bank. Available at: https://data.worldbank.org/country/cyprus
  3. Cyprus Population 2023. World Population Review. Available at: https://worldpopulationreview.com/countries/cyprus-population
  4. State of Health in the EU. Cyprus Country Health Profile 2021.
  5. Angastiniotis M & Middleton L. Genetic Services in Cyprus. Nature. 1997;5, 51-57.
  6. Skrinska V, Khneisser I, Schielen P, Loeber G. Introducing and Expanding Newborn Screening in the MENA Region. Int J Neonatal Screen. 2020; 6(1):12.