A groundbreaking study led by the American Cancer Society (ACS) has unveiled a startling truth about the cancer epidemic in the United States:

Nearly half of all cancer cases and deaths in adults over 30 are linked to preventable causes.

This number translates to a staggering 713,340 cancer cases and 262,120 deaths in 2019 alone that could have potentially been avoided.

The Usual Suspects

The culprits? Everyday choices like the following:

• smoking
• excess weight
• alcohol consumption
• lack of exercise
• poor diet
• infections

This revelation underscores the urgent need for widespread lifestyle changes and offers a glimmer of hope.

By understanding and addressing these modifiable risk factors, we can empower ourselves to take control of our health and significantly reduce the burden of cancer in our society.

After reviewing the new study findings, I look forward to providing some tips for reducing your risk of ever developing (or dying from) cancer.

The New Study

Researchers recently took a deep dive into cancer causes.

Researchers calculated the contribution of various risk factors.

In this groundbreaking analysis, a team of researchers led by Dr. Farhad Islami of the American Cancer Society delved deep into the connection between lifestyle choices and cancer risk.

By meticulously analyzing the prevalence of known risk factors and their impact on cancer development, the team estimated the proportion of cancer cases attributed to these modifiable factors.

Study Details

This innovative approach allowed them to paint a vivid picture of the cancer landscape in the United States, revealing this:

We could potentially avoid a staggering number of cancer-related cases and deaths through lifestyle changes.

The risk factors under scrutiny included smoking, secondhand smoke, excess weight, alcohol consumption, red and processed meat intake, low fruit and vegetable consumption, lack of fiber and calcium in the diet, physical inactivity, exposure to ultraviolet light, and several cancer-associated infections.

By shedding light on the profound impact of these modifiable risk factors, this study empowers individuals to take charge of their health and make informed decisions to reduce their cancer risk.

Here are some of my takeaway messages from the new research.

Not Surprisingly, Smoking Leads the Bad Habits List

As a cancer doctor, I am not surprised to see that the leading risk factor — cigarette smoking — contributed to nearly one in five cancer cases.

Let me repeat that disturbing figure:

Cigarette smoking is linked to nearly one in five cancers. Moreover, the habit is linked to nearly three in 10 cancer-related deaths.

Yes, smoking has declined over the last several decades.

In 1991, 70 percent of teens reported having tried smoking. This percentage dropped to 18 percent in 2021.

Still, I am alarmed.

Other Modifiable Cancer Risk Factors

Besides smoking, other everyday habits and lifestyle choices like carrying extra weight, drinking alcohol, not getting enough exercise, eating an unhealthy diet, and certain infections also played a significant role in causing cancer and cancer-related deaths.

Don’t get me wrong: I know about these cancer risk factors as an oncologist.

But what surprises me is this:

Four out of 10 cancers (and 44 percent of cancer deaths) among U.S. adults 30 or older could be attributable to lifestyle-related risk factors.

However, the study reminds me of good actions for my cancer patients and others.

The Biggest Contributants to Cancer Risk

Here is a graphic representation of the relative contributions of lifestyle elements to cancer risk:

Cigarette smoking is the leading cancer risk factor, contributing to 19 percent of cancer cases and 28.5 percent of cancer deaths.

Here are other top risk factors:

• Excess body weight — contributes to nearly eight percent of cancer cases and seven percent of cancer-related deaths.
• Alcohol — contributes to 5.4 percent of cancer cases and four percent of cancer deaths.
• The top five cancer risk factors are UV radiation exposure and physical inactivity.

Cancer Types

The cancer types with the greatest number of cases attributable to potentially changeable risk factors include the following:

• Lung cancer — 201,660 cases
• Breast cancer — 83,840 cases
• Melanoma — 82,710 cases
• Colorectal cancer — 78,440 cases

What You Can Do

There is nothing I can do that guarantees I will not get cancer.

On the other hand, I can pursue some potential risk-reducing maneuvers.

1. I have had a hepatitis B virus vaccine, reducing my liver cancer risk.
2. I don’t smoke; if I did, I would quit. If I had a significant smoking history, I would get lung cancer screening with CT imaging.
3. I don’t drink. There may be no safe dose (when it comes to cancer), but if I drank, I would cap it at seven standard drinks weekly.
4. I maintain a healthy weight.
5. I try to eat a balanced diet.
6. I get regular physical activity.
7. I get sufficient sleep, aiming for seven to nine hours daily.
8. I wear sunscreen and avoid excessive sun exposure. I would never go to a tanning salon.
9. I have gotten better at listening to my body. I check in with my primary care provider if I have a concern.
10. I get appropriate cancer screening, including for colorectal and prostate cancer. If I were a woman, I would get screened for cervix cancer, breast cancer, and colorectal cancer.

Colorectal Cancer: Screening

www.uspreventiveservicestaskforce.org.

Prostate Cancer: Screening

www.uspreventiveservicestaskforce.org.

Breast Cancer: Screening

www.uspreventiveservicestaskforce.org.

Cervical Cancer: Screening

www.uspreventiveservicestaskforce.org.

One more thing: Young folks should consider vaccination against human papillomavirus (HPV):

HPV Vaccination: What Everyone Should Know | CDC

www.cdc.gov

The post Cancer Epidemic? Study Reveals Alarming Link to Daily Habits (and How to Break Free) appeared first on Medika Life.

Recurrent respiratory papillomatosis (RRP) is just one of those unexpected HPV-driven conditions. RRP is not a sexually transmitted disease and patients are not contagious. An estimated 15,000 to 20,000 people in the United States and more than 125,000 globally have RRP. This burdensome disease takes several forms and impacts people’s upper or lower respiratory tracts or presents as recurrent lesions on the vocal cords or adjacent tissues that require endless corrective surgeries. The treatment often results in permanent damage to a person’s voice.

RRP falls into two demographic subtypes: juvenile-onset (even toddlers) RRP and adult-onset RRP. Each presents unique medical management and lifestyle difficulties, and in addressing these challenges, patient advocacy—raising awareness and building a supportive community—is critically important.

Since it has no Food and Drug Administration (FDA)- approved treatment or cure, patients and scientists devote energy and resources to ensuring people with RRP have access to information. They are in the loop about clinical possibilities for this rare disease. No cure doesn’t mean there is no action!

Beyond the physical challenges of dealing with the disease – and the missed life events and career detours resulting from repeated surgeries, patients also face significant and demoralizing administrative challenges, such as battling payers to cover care using drugs not indicated by the Food and Drug Administration (FDA) for RRP or deemed “not sufficiently proven.”

The lack of treatment does not mean the RRP community is without hope. They are resilient and courageous and are making meaningful connections through the patient advocacy efforts of the Recurrent Respiratory Papillomatosis Foundation. They are reaching and inspiring researchers at the National Institutes of Health to pursue breakthrough research and oversee clinical trials. They also connect with scientists advancing possible therapies at discovery and clinical-stage biopharmaceutical companies like Precigen and encourage them to move forward by enrolling in clinical trials.

Collaboration Accelerates Change

When people unite, their presence creates energy. The Recurrent Respiratory Papillomatosis Foundation, biotech company Precigen, the National Cancer Institute (NCI), and RRP patients and their caregivers met on June 11th at the National Press Club for the Inaugural International Recurrent Respiratory Papillomatosis Awareness Day. This was an inflection point for those who follow the rare disease category.

The gathering wasn’t about hype or baseless optimism; it was a meeting that brought people together, prepared and ready to roll up their sleeves and get to work. It was a day that reaffirmed a commitment to transparency and a truthful assessment of the current situation and path forward.

Virginia Senator Mark Warner, chair of the powerful Senate Intelligence Committee, which oversees cybersecurity efforts that are key to healthcare and innovation data protection, kicked off RRP Awareness Day by expressing his support for people with rare diseases and his desire to help RRP patients find their voice. Senator Warner stated his desire to advance research and innovation and ensure access to care, an expression of determination that reflected his long-standing record on behalf of people seeking treatment options and improved outcomes.   

RRP Foundation President Kim McClellan also spoke as an advocate for the RRP community and as a patient. “We are here to raise awareness about RRP and bring together critical stakeholders in a dialogue on important aspects impacting individuals living with RRP,” she said. “We invite and encourage anyone living with RRP, either as a patient, family member or caregiver, to join us in spreading the word about RRP and participate in clinical trials and advocacy efforts.”

The date of this groundbreaking gathering has special meaning for the RRP community. June 11th (6/11) corresponds to HPV variants 6 and 11 associated with RRP. As the date symbolizes, the gathering united people with the disease, their family members, congressional leaders, and researchers from government agencies and corporate partners in a community united in a common cause.

The opportunity to share and hear multiple perspectives enriched discussions and underscored the importance of taking a comprehensive approach to tackling this condition. Panels of experts and patients sharing personal stories about their journeys gave attendees an unmatched opportunity to delve into the intricacies and impacts of RRP.

Helen Sabzevari, PhD, President and CEO of Precigen, expressed that she and her company were “proud to join forces with the RRP Foundation to establish the first global RRP Awareness Day to bring visibility to the many challenges experienced by RRP patients and to help forge connections among patients, clinicians and government officials.”

A former NCI team leader, Dr. Sabzevari’s commitment to RRP awareness and patient well-being as an animating principle is a model biopharma company C-Suite executives would be wise to emulate. For her and her Precigen colleagues, patients are the focal point of every decision, action, and investment.

RRP Awareness Day was an inspiring platform for discussing struggle, stigma, and science. Lunch was optional, but tissues were required as attendees in the filled-to-capacity room listened to a patient panel on how RRP impacts people and their families. They learned how some individuals living with RRP have needed hundreds of surgeries over the years, beginning when they were toddlers or young children in primary school.

Culture Drives Clinical Performance

Therapeutic innovations are needed to ensure that future generations living with RRP have options reviewed and indicated by the FDA for treating this viral condition.

During the event, a panel of representatives from advocacy and research reflected on how their collaborative approach centering around patients – from the design of clinical trials to allocating resources that have enabled patients to participate in those trials – has been vital in accelerating the R&D process toward identifying and developing viable treatments. The panel included James Gulley, MD., PhD., NIH, Senior Investigator, Center for Immuno-Oncology, Acting Co-Director, National Cancer Institute/Center for Cancer Research; Scott M. Norberg, DO., NIH, Associate Research Physician, Center for Immuno-Oncology; Helen Sabzevari, PhD, CEO, Precigen; and Kim McClellan, President, RRP Foundation.

Dr. Gulley, who is part of the NCI team and has been instrumental in advancing research on RRP and its connection to HPV, emphasized the pressing need for innovative therapies. In his panel comments, Dr. Gulley highlighted the importance of collaborative research efforts to explore potential immunotherapeutic approaches that could offer new hope for patients suffering from this debilitating condition.

No Disagreement – Harmony

Panelists Gulley, Norberg, and Sabzevari applauded the patient community, acknowledging the courage of their readiness to volunteer to participate in clinical trials to speed possible therapeutics forward. It was a reassuring presence and a reminder that public-private collaborations, particularly for rare diseases, do more than spark hope; they spur action. The patient-panel takeaways were: (1) Connect with the RRP Foundation, (2) Support ongoing clinical trial efforts, (3) Prevention through HPV vaccination is key.

While there is still no FDA-approved treatment to manage RRP, this community remains resilient and upbeat, inspiring everyone facing the challenge of rare conditions. The RRP Foundation, Precigen, and NCI are on the same page—science is essential. People living with RRP can remain hopeful that this collaboration will continue until actions result in better options for this patient community.

The post HPV Urban Legends – From Contagion to Symptoms to Risks to Prevention – There Are More Rare Concerns that Deserve Our Attention appeared first on Medika Life.

Even in the age of advanced diagnostics, proton beam and nanotechnology treatments, and more walkathons than we can count, cancer still kills roughly one-third of those in the U.S. diagnosed with it. The numbers for low-income countries are far more shocking.

The causes of many cancers aren’t some hidden mystery. In the U.S., we can prevent two of the most dangerous forms of skin cancer by 40-50 percent by wearing sunscreen, but it’s an expensive option, and only 13 percent say they protect themselves most of the time with SPF-rated lotions. People are 15-30 times more likely to get lung cancer if they smoke; nevertheless, 1 in 10 Americans still smoke cigarettes.

You Have Cancer – or Not

We continue to lose many of the battles we should win against cancer. Billions of dollars have been spent over the years to educate the public on how they can prevent cancer; billions more have gone into treating patients. And then there’s the emotional toll that comes from hearing those three words.

There is a massive bright spot in this story, however. While the chances of preventing many forms of cancer with known interventions are frequently below 50 percent, we have a way of preventing six forms of cancer with a 90 percent effectiveness rate. It doesn’t come from adhering to daily rituals or resisting tempting vices. These cancers can be prevented by going to a doctor’s office or a pharmacy* and getting vaccinated against Human Papilloma Virus (HPV).

The catch is that the greatest chance of preventing HPV-related cancers later in life comes from vaccinating kids between 9-14. That requires parents seeing the importance of preventing HPV and many don’t, especially in southern states, where the number of pre-teens and adolescents who are fully vaccinated against HPV frequently falls below 50 percent.

Anxiety Versus Information

Many parents cite the vaccine’s safety as a leading concern, which is not based on fact. In the 17 years since the HPV vaccine has been available, more than 160 studies in multiple countries have shown no major adverse events associated with the vaccine. Instead, safety concerns have been fueled by misinformation on the Internet and skepticism among key audiences, including some healthcare professionals (HCPs).

More strikingly, however, the roots of hesitancy to vaccinate against HPV may go back to how it has been presented to patients: as a vaccine for sexually transmitted infections (STIs), not cancer. This is a major reason many parents discount the importance of getting their 10-year-old child vaccinated. In the face of such resistance, many HCPs in chronically under-vaccinated communities do not proactively recommend HPV vaccination during annual well visits.

Need to Reinform the Link Between HPV and Cancer

Reorienting this trend requires a concerted effort to flip the script on HPV vaccination discussions from STI prevention to cancer prevention. In the past year, only 22 percent of online conversations linked HPV with cancer. And in research conducted last month, FINN Partners found that only 46 percent of HCPs surveyed discuss HPV as cancer prevention.

This presents an important opportunity to close one of our generation’s most important health gaps. Healthcare professionals rank among the most trusted people in the U.S. When doctors make a vaccine recommendation with authority; most parents follow that counsel.

Flipping the script on HPV conversations tackles several significant barriers for patients: many may have omission bias, which means they believe vaccinating puts their kids in greater danger than the disease it’s supposed to prevent. And since they can’t picture their children getting an STI, they discount HPV vaccination further as a priority. But presenting that same vaccine as cancer prevention could change the nature of the conversation. Most parents understand cancer and see it as a threat. And cancer doesn’t carry the same stigma among many patient communities as sexually transmitted diseases.

The Cancer Prevention Message is Long Neglected

It’s time to make cancer prevention the dominant message in HPV vaccination decisions. More than 135 million doses of the HPV vaccine have been administered in the U.S., and we have seen a dramatic correlation in the drop in HPV cases: the prevalence of four HPV strains has declined by 88 percent among women aged 14-19. If HCPs are provided with better resources and more people are educated on HPV vaccination as cancer prevention, we have a shot at addressing misinformation about vaccine safety and continuing the upward trend of HPV vaccination.

The stakes are high for us to get this right. Because the only thing possibly worse than being told “You have cancer” is hearing that your son or daughter has HPV-related cancer later in life when it could have been prevented by a simple, safe decision to vaccinate them against HPV as an adolescent.

*HPV vaccines can be administered to adolescents at pharmacies in 22 states. Most states allow pharmacists to administer HPV to older patients.

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Are you up to date on boosters for COVID-19? What about tetanus, diphtheria, and pertussis (whooping cough)? Then there are hepatitis A and influenza vaccines.

Today, I want to discuss three vaccinations: influenza (flu), pneumonia, and shingles. And yes, I am up to date. Full confession: The shingles vaccine caused moderately severe pain at the injection site for several days.

Sufficient sleep and vaccine effectiveness

Could a good night’s sleep improve the effectiveness of your COVID-19 (and other) vaccines? Short sleep the day after a jab may not be an important issue for most of us who don’t have compromised immune systems.

However, if you have some compromise in your immune system’s ability to fight infectious disease, getting an adequate sleep duration during the night after the vaccination may enhance your chances of getting an adequate response to vaccines.

One research investigation discovered that ten days after vaccination for seasonal influenza, antibody levels in individuals getting a jab after four consecutive days restricted to four hours had half of the antibody levels of those without short sleep.

A separate study showed sleep duration (measured with a device) associated with antibody responses to hepatitis B vaccination. Researchers examined 70 females, ages 40 to 60. All received a standard three-dose hepatitis B vaccination series.

The subjects wore devices to track sleep and completed sleep diaries. The researchers checked antibody levels before the second and third vaccinations. Finally, the study investigators checked antigen immunoglobulin status (to assess clinical protection status) at the six-month mark.

The lower antibody response associated with less sleep appeared independent of age, body mass index, sex, and response to initial immunization.

As measured by actigraphy devices, shorter sleep duration predicted a lower chance of being clinically protected from hepatitis B after the vaccination series. Subjective sleep quality did not prove a useful predictor of antibody response.

These studies hint that getting sufficient sleep during vaccination may boost immune system response, but there is no high-level evidence. The studies remind me to get a good night’s sleep around the time of my jabs.

Vaccination and time of day

Did you know that our immune systems have significant circadian rhythms? In this context, might the time of a vaccination affect efficacy?

Immune system basics

There is a circadian rhythm in the ability of immune system cells (lymphocytes) to enter and exit lymph nodes. Lymphocytes survey antigens by circulating through our bloodstream, and lymph nodes and lymph modulate our specific immune responses in nodes.

In layperson language, lymphocytes are a white blood cell type and are an important part of our immune system. Approximately 20 to 40 percent of the white blood cells are lymphocytes. Here is an explanation of what lymphocytes do, courtesy of WebMD:

Lymphocytes are created in your bone marrow. We have B lymphocytes (B-cells) designed to make antibodies. Antibodies take out foreign substances or mark them for an attack. On the other hand, T-cells are lymphocytes that destroy any cells that cancers or viruses have invaded.

Natural killer cells are another lymphocyte type. NK cells can destroy tumor cells without any previous activation. In contradistinction, T-cells only attack a cell if another immune cell has tagged it.

Lymphocytes have memory, able to remember antigens — a toxin or other foreign substances that provoke our immune system to respond. Once the lymphocyte encounters an antigen, some become memory cells. The memory lymphocytes quickly respond when an antigen comes around for a second time. We take advantage of this immune response when we use vaccines.

Vaccination time during the day

Critical components of the immune system oscillate in humans and mice with opposite phases according to their inverted rest-activity times; I mean that circulating immune cells known as leukocytes are high during the rest periods — the night for humans and the day for mice.

One study of influenza and hepatitis A vaccination discovered that administering the vaccines in the morning (and not the afternoon) led to an almost two-fold higher immune system response in men (but not women), as measured by antibody levels four weeks later.

I do not believe we have anything actionable here, but interesting to learn about circadian rhythmicity and immune system function.

Influenza (flu) vaccination

Influenza vaccines can help protect us against the four influenza viruses that research suggests will be the most common during the upcoming flu season. While most receive a jab (typically in the upper arm), there are also nasal flu vaccines.

Flu is relatively common. 20average:

• Five to 20 percent of the U.S. population will get the flu, on average, each year.
• 200,000 Americans are hospitalized annually because of illness-related complications.
• 8,200 to 20,000 people who die each year from flu-related causes in the United States.

The United States Centers for Disease Control (CDC) explains that:

“All flu vaccines for the 2022–2023 season are quadrivalent vaccines, designed to protect against four different flu viruses, including two influenza A viruses and two influenza B viruses. Different vaccines are licensed for use in different age groups, and some vaccines are not recommended for some groups of people.”

To learn more, please check out the CDC site:

Seasonal Flu Vaccines

Influenza (flu) vaccines (often called “flu shots”) are vaccines that protect against the four influenza viruses.

www.cdc.gov

The CDC recommends that all six months and older in the USA get an influenza (flu) shot each season, with rare exceptions. Vaccination to prevent flu (and its potential associated complications) is especially important for those at higher risk of developing serious flu-related problems.

Is there a preferred type of flu shot? For some individuals, yes. For the upcoming 2022 to 2023 flu season, three types of flu vaccine are available for those at least 65.

The preferred vaccine types for those 65 or older are Fluzone High-Dose Quadrivalent vaccine, Flublok Quadrivalent recombinant flu vaccine, or Fluad Quadrivalent adjuvanted flu vaccine. These vaccines may be more effective for this age group than regular flu vaccines. There is no preferential recommendation for people younger than 65 years.

How effective are flu shots?

When scientists get the vaccine right for any given flu season, the vaccine can drop the risk of having to go to the doctor because of flu by up to half or more (40 to 60 percent lower chance).

Moreover, the flu shot can drop influenza complication severity. A 2021 study revealed that among adults hospitalized with flu, vaccinated patients had a one-quarter lower chance of intensive care unit (ICU) admission and a nearly one-third lower risk of death from flu compared to the unvaccinated.

Flu vaccination is also associated with lower rates of some cardiac events among people with heart disease, particularly for those who have had a cardiac event in the past year. Flu can also reduce flu-related worsening of chronic lung diseases such as COPD (chronic obstructive pulmonary disease).

Honestly, I believe I am healthy enough to weather a flu infection. One of the primary reasons I will get the jab is to protect those around me, particularly those with a higher risk of serious flu-related complications.

My flu shot should help young children, older folks, and those with certain chronic health conditions around me. Fortunately, life-threatening allergic reactions to flu shots are quite rare.

Allergic to eggs?

The CDC explains that individuals who have an egg allergy are candidates to receive an age-appropriate flu vaccine that is otherwise appropriate.

Those with a history of a severe reaction to eggs should receive their vaccine in a medical center, with appropriate health professional oversight. Finally, there are two completely egg-free vaccine options: Flublok Quadrivalent recombinant flu vaccine and Flucelvax Quadrivalent cell-based flu shot.

Pneumonia vaccination

Why consider a pneumonia vaccine? While imperfect, the pneumonia vaccine can lower your chances of catching the disease. In addition, even if you get pneumonia, having had the vaccine can help drop its severity.

For the older amongst us or those who have health issues, a lung infection that makes it harder to breathe could be particularly problematic.

Here are some groups that should strongly consider pneumonia vaccination, according to WebMD:

• Weakened immune systems. If you have heart disease, diabetes, emphysema, COPD, or asthma, you are more likely to have a weakened immune system, which makes you more likely to get pneumonia. Those who received an organ transplant, those with HIV or AIDS, and people receiving chemotherapy fit into this category.
• People over 65
• Smokers
• Heavy drinkers of alcohol
• Individuals getting over surgery or a severe illness. If you were in the hospital intensive care unit and needed a ventilator to help you breathe, you have a higher risk of getting pneumonia. Those recovering from major surgery or a serious injury also have a higher risk.

Who shouldn’t get a pneumonia vaccine?

Not everyone needs to get a pneumonia vaccine. You can probably skip the vaccine if you’re a healthy adult between 18 and 50. Also, you shouldn’t get it if you’re allergic to what’s in the vaccine. Not sure? Ask your doctor.

The United States Centers for Disease Control (CDC) recommends pneumococcal vaccination for all children under five years and all adults at least 65. In certain situations, others should get the vaccine. Learn more here:

Pneumococcal Vaccination: What Everyone Should Know

Pneumococcal disease is common in young children, but older adults are at the greatest risk of serious illness and deat.

www.cdc.gov

Shingles vaccination

Shingles is a viral infection that can result in a painful (on occasion, extraordinarily so) rash. This skin rash can happen anywhere on your body and often manifests as a single stripe of blisters that wrap around your torso’s right or left side.

Varicella-zoster virus causes shingles — the same virus that leads to chickenpox. Once you’ve had chickenpox, the virus lingers in us for the rest of our lives. Years later, the virus may reactivate and result in shingles.

The most common complication is postherpetic neuralgia — A painful condition that causes pain for a long time after the blisters have cleared.

The US Centers for Disease Control (CDC) recommends the shingles vaccine (Shingrix) for adults age 50 and older, whether you have had shingles or not.

Those who have had the Zostavax vaccine (or had a chickenpox vaccine or don’t remember if you had chickenpox) in the past for shingles risk reduction may also consider Shingrix. For those who have had shingles, the CDC offers this guidance:

“If you had shingles in the past, Shingrix can help prevent future occurrences of the disease. There is no specific length of time that you need to wait after having shingles before you can receive Shingrix, but generally you should make sure the shingles rash has gone away before getting vaccinated.”

You should not get Shingrix if you:

• You have had a severe allergic reaction to any vaccine component or after a dose of Shingrix.
• Currently have shingles.
• Are pregnant. Women who are pregnant should wait to get Shingrix.

If you have a minor illness (for example, a cold), you may get Shingrix. But if you have a moderate or severe illness, with or without fever, you should usually wait until you recover before getting the vaccine.

Shingrix is a non-living vaccine composed of a virus component. Shingrix is given in two doses, with two to six months between the administrations. Protection against shingles with Shingrix may extend beyond five years.

Shingrix side effects

In general, the vaccine is quite safe and provides good protection against shingles. Temporary side effects are not uncommon but may affect your ability to do normal daily activities for two to three days. I made sure to get my vaccine on Friday so that I could have the weekend to recover.

Most individuals report a sore arm (for me, it was moderately severe, tolerable, and associated with swelling at the injection site). Some report generalized fatigue, a headache, fever, shivering, nausea, or stomach pain. Side effects appear to be more common among younger people.

Some who suffer from side effects choose to take over-the-counter pain medicines such as acetaminophen or ibuprofen. Shingrix rarely causes major medical problems, including a serious nervous system disorder known as Guillain-Barré syndrome (GBS).

Please check in with your health care provider if you have ever had an allergic reaction to any component of Shingrix. Those who have had a stem cell transplant, are pregnant (or trying to become pregnant), or have a weakened immune system secondary to a condition or medicine should talk to their health care provider.

Finally, insurance may or may not cover your Shingrix vaccine. Please check your plan.

Effectiveness of Shingrix

The Cleveland Clinic (USA) offers that the shingles vaccine is 97 percent effective in preventing shingles for those ages 50 to 79. It is 91 percent effective in people ages 70 years and older.

Thank you for joining me today for this (non-COVID-19 vaccination roundup). Oh, one more thing:

One More Reason to Get a Flu Shot

Flu vaccination is associated with a 40 percent drop in the risk of getting Alzheimer’s disease.

medium.com.

The post Vaccination Roundup — What You Should Know appeared first on Medika Life.

The British introduced human papillomavirus (HPV) immunization in 2008, with routine vaccination offered to girls aged 12 to13 years with a catch-up program for females aged 14 to 18 years in 2008–10.

The jabs carry the potential of lowering certain cancers.

Did you know that the human papillomavirus is the most common sexually transmitted disease in the USA? Of the over 150 virus types, about 40 spread via direct oral or genital contact.

Most individuals who have been sexually active will contract HPV at some point. That’s right, most of us will carry human papillomavirus at some point in our lives. Human papillomavirus quickly spreads through sexual contact.

HPV basics

We may conveniently divide HPV strains into two categories: Low-risk versus high-risk.

Low-risk HPV

This type of genital human papillomavirus strain doesn’t lead to symptoms. The HPV vanishes as your body develops immunity to the virus. While low-risk HPV is not associated with cancer, the virus can cause genital warts.

Some low-risk HPV strains can cause abnormalities of a woman’s cervix, but these types (unlike their high-risk counterparts) don’t become cancer.

High-risk HPV

Unlike its low-risk counterpart, high-risk human papillomavirus can lead to troublesome changes (including cancer) in cervix cells. While there are more than a dozen strains of high-risk HPV, types 16 and 18 lead to most HPV-related cancers.

High-risk human papillomavirus can cause cancer of the following:

• cervix, vagina, and vulva (women)
• penis (men)
• oropharynx (throat, back of the tongue, and tonsils)

HPV vaccination slashes infection rates

A new study shows that the human papillomavirus vaccine has been extraordinarily effective, nearly eliminating the prevalence of the two most dangerous viral strains in young women by 2016.

Moreover, the vaccine didn’t just help the young women who got the HPV vaccine. The vaccinations led to herd immunity, with prevalence rates dropping among the unvaccinated as the virus could not circulate freely.

Look at these remarkable results:

Among women 18 to 26 years old, the prevalence of high-risk strains of HPV before the introduction of the vaccines was 15.2 percent. In the 2015 to 2016 period, this percentage declined to 3.3 percent among the unvaccinated and one percent among the vaccinated. By ten years, the rate dropped to zero for those at the younger vaccinated women.

We can do better. The vaccine is available for boys and girls in the United States from age nine through early adulthood. From 2015 to 2016, approximately 55 percent of women aged 18 to 20 had received a jab, 52 percent of those aged 21 to 23, and 50 percent of those aged 24 to 26.

While our vaccination rates are not yet optimal (with the researchers pointing to an 80 percent target), the results are quite encouraging. We may someday eliminate HPV infections. Today, I celebrate that cancer incidence rates have dropped substantially among those less than 25 years.Cervical Cancer Rates Have Dropped Among Young Women in the United StatesHuman papillomavirus (HPV) is a common sexually transmitted infection. Nearly all men and women in the United States…www.cdc.gov

One researcher notes that the reasons for not getting the vaccine are driven largely by unfounded safety concerns from parents. The United States has lower vaccination rates in the Midwest and Southeast. Not surprisingly, HPV-associated cancer incidence remains relatively high in those states.

Among states with the lowest vaccination rates are those in the Midwest and Southeast, and HPV-associated cancer incidence remains high in those states, Deshmukh said.

And no, there is no good evidence that the vaccination somehow serves as a license for more sexual activity. Can we catch Australia, which aims to eliminate cervical cancer by 2035? And what about the rest of the world, where cervix cancer is rising? Can we more equitably distribute vaccines?

One caveat: The great success of the vaccine has not yet eliminated the need for appropriate cervix cancer screening. Thank you for joining me in this look at the remarkable success of the HPV vaccine.

The post This Vaccine Has Been Wildly Successful appeared first on Medika Life.

More than 13,000 US women are diagnosed with cervical cancer each year. In most cases, cervical cancer can be prevented through vaccination and proper cervical screening.

Despite screening programs, 4,000 US women die from HPV-related cervical cancer each year.

What is the point of a pap smear?

A pap (Papanicolaou) smear is a screening test for cervical cancer. The cervix is the opening of the uterus located at the back of the vagina. During a pap smear, doctors place a device called a speculum into the vagina.

The speculum opens the walls of the vagina allowing visualization of the cervix. Cervical cells are then collected using a small brush. These cells are sent to a lab for analysis.

The cells are processed under a microscope to evaluate for precancerous changes called cervical dysplasia. The goal of pap screening is to detect abnormal cervical changes so we can intervene long before cervical cancer develops.

Do I need an HPV test with my pap?

In addition to analyzing the cervical cells, doctors often perform an HPV test. HPV testing recommendations vary depending on your age. HPV testing is recommended for standard screening in women over 30.

HPV testing is also triggered when an abnormal pap smear is found in women under 30. Cervical dysplasia (precancerous cells of the cervix) are linked to the Human papillomavirus (HPV).

Statistically, 80% of Americans will contract HPV, making it the most common sexually transmitted infection. This means more of us will contract this STI than those who do not. HPV “co-testing” during pap smear helps guide the management steps when an abnormality occurs.

Around 40 of the known 130 known strains of HPV affect the genital tract. In men and women, HPV causes genital warts, and persistent strains can lead to cervical, penile, vaginal, anal, mouth, throat, and neck cancer. Approximately 20,000 women and 12,000 men develop cancer caused by HPV every year in the United States.

Who is at risk for HPV?

Anyone sexually active is at risk. The virus may stay dormant for years. Symptoms may not appear until long after you have sex with someone previously infected. It is rarely possible to know when you first became infected. You can not play the blame game with HPV.

Sexually transmitted HPV types fall into two groups, low risk and high risk.

• Low-risk HPVs mostly cause no disease. However, a few low-risk HPV types can cause warts on or around the genitals, anus, mouth, or throat.
• High-risk HPVs can cause several types of cancer. There are about 14 high-risk HPV types. Two of these, HPV16 and HPV18, are responsible for most HPV-related cancers.

Long-lasting infections with high-risk HPVs can cause cancer in parts of the body where HPV infects cells, such as in the cervix, mouth, throat, anus, rectum, penis, vagina, and vulva. 

The HPV vaccine and keeping your pap smears up to date are our best tools to impact cervical disease and HPV.

There is no cure or medication for HPV. The most effective way to protect yourself from HPV infection is to get vaccinated. The HPV vaccine is FDA approved for men and women age 9–45. The Center for Disease Control recommends that the vaccine be given as early as 11 or 12.

HPV vaccination is recommended by the Centers for Disease Control and Prevention (CDC)’s Advisory Committee on Immunizations Practices (ACIP) to prevent new HPV infections and HPV-associated diseases, including some cancers.

The vaccine is most effective when given before initiating sexual activity. It is still useful for those already sexually active as very few have already been exposed to the nine strains of HPV covered in the vaccine.

The most recent recommendations extended the age from 26 to 45, but insurance coverage for those in this age group is lagging.

Pap smears allow for early detection of disease

When a pap smear comes back abnormal, there is no reason to hit the panic button. The next step is a microscope exam called a colposcopy procedure. A colposcopy is an office procedure that allows your doctor to visualize the cervix more closely using a microscope. The colposcope identifies abnormal cervical tissue that cannot be seen with the naked eye.

This office procedure helps determine where on the cervix the abnormal cells are coming from and how severe the abnormality is.

If an area of the cervix appears concerning or precancerous, the doctor can sample the area with a biopsy during the exam.

If the biopsy shows a precancerous lesion, your healthcare provider may recommend a LEEP (loop electrosurgical excision procedure.)

A few minutes of discomfort can save your life

Pap smears save lives. Period. No one likes to get this test, but the benefits of early detection and prevention outweigh the risks of avoiding it.

If it is time for you to update you pap smear, it is well worth your time to do it. A pap smear could save your life.

The post Pap smears Aren’t Fun But Can Save Your Life by Preventing Cervical Cancer appeared first on Medika Life.

Cervical cancer is a disease in which malignant (cancer) cells form in the cervix. The cervix is the lower, narrow end of the uterus (the hollow, pear-shaped organ where a fetus grows). The cervix connects the uterus to the vagina (birth canal). Cervical cancer usually develops slowly over time. Before cancer appears in the cervix, the cells of the cervix go through a series of changes in which cells that are not normal begin to appear in the cervical tissue.

When cells change from being normal cells to abnormal cells, it is called dysplasia. The abnormal cervical cells may go away without treatment, stay the same, or turn into cancer cells over many years.

The Importance of Cervical Cancer Screening

What is cervical cancer screening?

Cervical cancer screening is an essential part of a woman’s routine health care. Nearly all cases of cervical cancer are caused by infection with sexually transmitted oncogenic, or high-risk, types of human papillomavirus, or HPV. The primary goal of screening is to identify precancerous lesions caused by HPV so they can be removed to prevent invasive cancers from developing.

A secondary goal is to find cervical cancers at an early stage when they can usually be treated successfully. Routine cervical screening has been shown to greatly reduce both the number of cervical cancer cases and deaths from the disease.

For many years, cytology-based screening, known as the Pap test or Pap smear, was the only method of screening. Its use reduced cervical cancer incidence and deaths in countries where screening is common.

However, with the advent of the ability to test for HPV, cervical cancer screening now includes three approaches: HPV testing, which looks for the presence of high-risk HPV types in cervical cells; Pap testing; and HPV/Pap cotesting, which checks the same cell sample for both high-risk HPV types and cervical cell changes.

How is cervical cancer screening done?

Cervical cancer screening can be done in a medical office, a clinic, or a community health center. It is often done during a pelvic examination.

While a woman lies on an exam table, a health care professional inserts an instrument called a speculum into her vagina to widen it so that the upper portion of the vagina and the cervix can be seen. This procedure also allows the health care professional to take a sample of cervical cells. The cells are taken with a wooden or plastic scraper and/or a cervical brush and placed in a vial of liquid preservative.

The slide or vial is then sent to a laboratory where the cells are tested for the presence of high-risk types of HPV and/or examined under a microscope with an automated liquid-based Pap cytology test. When both tests are done using the same sample, this is referred to as “cotesting.” 

Researchers have found that screening may be less effective for obese women, possibly because of challenges in visualizing the cervix and obtaining a cell sample. Approaches to improve cervical visualization in obese women, including the use of larger speculum, may be helpful.

When should a woman begin cervical cancer screening, and how often should she be screened?

Women should talk with their doctor about when to start screening and how often to be screened. In August 2018, updated screening guidelines were released by the United States Preventive Services Task Force. The updated guidelines are as follows:

• Women ages 21 through 29 should be screened with a Pap test every 3 years
• Women ages 30 through 65 should be screened with any of three tests:
  • every 5 years with high-risk HPV testing alone
  • every 5 years with Pap and high-risk HPV cotesting
  • every 3 years with a Pap test alone
• Women with certain risk factors may need to have more frequent screening or to continue screening beyond age 65. These risk factors include:
  • being infected with the human immunodeficiency virus (HIV)
  • being immunosuppressed
  • having been exposed to diethylstilbestrol before birth
  • having been treated for a precancerous cervical lesion or cervical cancer
• Screening for cervical cancer is not recommended for:
  • women younger than 21 years
  • women older than 65 years who have had adequate prior screening, with normal results, and who are not otherwise at high risk for cervical cancer
  • women who have had a total hysterectomy (surgery to remove the uterus and cervix) and have no history of high-grade cervical lesions or cervical cancer

A joint statement released by the American College of Obstetricians and Gynecologists, American Society for Colposcopy and Cervical Pathology, and the Society of Gynecologic Oncology noted that the updated guidelines are largely in line with their clinical guidance, with some differences in the details.

The screening intervals in the 2018 guidelines reflect scientists’ evolving understanding of the natural history of HPV infection and cervical cancer. Although HPV infection of the cervix is very common, most infections will be controlled by the immune system over the course of 1 to 2 years. Because most HPV infections are transient and produce only temporary changes in cervical cells, overly frequent screening could detect HPV infections or cell changes that would never cause cancer.

Treating abnormalities that would have gone away on their own can cause needless psychological stress. Follow-up tests and treatments can also be uncomfortable, and the removal of cervical tissue has the potential to weaken the cervix and may affect fertility or slightly increase the rate of premature delivery, depending on how much tissue is removed.

These screening intervals also limit false-negative results that would delay the diagnosis and treatment of a precancerous condition or cancer. With these intervals, if an HPV infection or cell changes are missed at one screening exam, chances are good that those changes will be detected at the next one, when they can still be treated successfully.

The success of cervical cancer screening is due, in part, to the repeat testing that women typically undergo over many years. A study of a large population of women receiving routine screening showed that women with a history of negative HPV/Pap cotest results have a very low risk of developing precancer or cancer even if a subsequent screening test reveals a new HPV infection or abnormal cervical cells.

How do the three testing options compare?

For women age 30 or older, both HPV/Pap cotesting and HPV testing alone are more sensitive than Pap testing alone. Therefore, a woman with a negative HPV test and normal Pap test—or just a negative HPV test—has a very low risk of developing precancerous cervical lesions over the next several years.

It is for that reason that, when Pap and HPV cotesting or HPV testing alone are used, the  recommended screening interval is 5 years: this longer interval (compared with 3 years for women receiving Pap testing alone) still allows abnormalities to be detected in time to treat them while  reducing the detection of HPV infections that would be successfully controlled by the immune system.

Both Pap and HPV cotesting and HPV testing alone may also improve the detection of glandular cell abnormalities, including adenocarcinoma of the cervix (cancer of the glandular cells of the cervix). Glandular cells are mucus-producing cells found in the endocervical canal (the opening in the center of the cervix) or in the lining of the uterus. Glandular cell abnormalities and adenocarcinoma of the cervix are less common than squamous cell abnormalities and squamous cell carcinoma. Pap testing is not as good at detecting adenocarcinoma and glandular cell abnormalities as it is at detecting squamous cell abnormalities and cancers.

What do the results of cervical cancer screening tests mean?

A health care provider may simply describe Pap test results to a patient as “normal” or “abnormal.”

Likewise, HPV test results can either be “positive,” meaning that a patient’s cervical cells are infected with one or more of a group of high-risk HPV types (which is what most commercially available HPV tests detect), or “negative,” indicating that none of the high-risk HPV types were found. Several HPV tests are specific for HPV16 and HPV18—the types that cause most cervical cancers.

A woman may want to ask her provider for specific information about her Pap and HPV test results and what these results mean.

Most laboratories in the United States use a standard set of terms, called the Bethesda System, to report Pap test results. Under the Bethesda System, samples that have no cell abnormalities are reported as “negative for intraepithelial lesion or malignancy.” A negative Pap test report may also note certain benign findings, such as common infections or inflammation. Pap test results also indicate whether the specimen was satisfactory or unsatisfactory for examination. Guidelines committees are re-evaluating how results of cervical screening tests are reported, based on the most up-to-date research on the natural history of HPV infections.

The Bethesda System considers abnormalities of squamous cells and glandular cells separately. Squamous cell abnormalities are divided into the following categories, ranging from the mildest to the most severe.

• Atypical squamous cells (ASC) are the most common abnormal finding in Pap tests. The Bethesda System divides this category into two groups, ASC-US and ASC-H:
  • ASC-US: atypical squamous cells of undetermined significance. The cells do not appear completely normal, but the cause is unclear. The changes may be related to an HPV infection, but they can also be caused by other factors.
  • ASC-H: atypical squamous cells, cannot exclude a high-grade squamous intraepithelial lesion. ASC-H lesions may be at higher risk of being precancerous than ASC-US lesions.
• Low-grade squamous intraepithelial lesions (LSILs) are considered mild abnormalities caused by HPV infection. LSILs often return to normal as the immune system controls the infection, especially in younger women.
• High-grade squamous intraepithelial lesions (HSILs) are more severe abnormalities that have a higher likelihood of progressing to cancer if left untreated. 
• Carcinoma in situ (CIS) refers to severely abnormal cells that resemble cancer cells but remain on the surface of the cervix and have not invaded more deeply or spread beyond the cervix. 
• Squamous cell carcinoma is cervical cancer. The abnormal squamous cells have invaded more deeply into the cervix or into other tissues or organs. In a well-screened population, such as that in the United States, a finding of cancer during cervical screening is extremely rare.

Glandular cell abnormalities describe abnormal changes that occur in the glandular tissues of the cervix. The Bethesda system divides these abnormalities into the following categories:

• Atypical glandular cells (AGC), meaning the glandular cells do not appear normal, but doctors are uncertain about what the cell changes mean.
• Endocervical adenocarcinoma in situ (AIS), meaning that severely abnormal cells are found but have not spread beyond the glandular tissue of the cervix.
• Adenocarcinoma includes not only cancer of the endocervical canal itself but also, in some cases, endometrial, extrauterine, and other cancers.

What follow-up tests are done if cervical cancer screening results are abnormal?

Depending on the test results, a woman may be recommended to have repeat screening in a year because some abnormalities, especially more minor ones (ASC-US), will go away on their own as the immune system controls the HPV infection. If a woman has more severe cell changes (ASC-H or HSIL) and/or evidence of HPV16 or HPV18, she may be recommended to have a colposcopy, a procedure that involves the use of an instrument  (called a colposcope) to examine the cervix.

During a colposcopy, the provider inserts a speculum into the vagina to widen it and may apply a dilute vinegar solution to the cervix, which causes areas of HPV infection, inflammation, precancer, or other cell changes to turn white. The provider then uses the colposcope (which remains outside the body) to examine the cervix. When a provider performs colposcopy, he or she will usually remove cells or tissues from one or more concerning areas for examination under a microscope, a procedure called a biopsy.

Can an HPV infection come back after a negative test? 

Yes. Sometimes, after many years of negative HPV tests, an infection that the immune system had previously controlled can become active again, resulting in an HPV-positive test result. Such reactivation of an old, previously undetectable HPV infection can happen due to age-related changes in the immune system.

There is no way to tell whether a newly positive HPV result is a sign of a new infection or represents a reactivation of an old infection. It is also not yet known whether reactivated HPV infections can cause cell changes that lead to precancer and cancer.

Do women who have been vaccinated against HPV still need to be screened for cervical cancer?

Yes. Current HPV vaccines do not protect against all HPV types that cause cervical cancer, so it is important for vaccinated women to continue to undergo routine cervical cancer screening. 

Cervical Cancer Prevention

Key Points

• Avoiding risk factors and increasing protective factors may help prevent cancer.
• The following are risk factors for cervical cancer:
  • HPV infection
  • DES
• In women who are infected with HPV, other risk factors add to the increased risk of cervical cancer:
  • Giving birth to many children
  • Using oral contraceptives for a long time
  • Smoking cigarettes
• The following increase the risk of HPV infection:
  • Having a weakened immune system
  • Being sexually active at a young age or having many sexual partners
• The following protective factors decrease the risk of cervical cancer:
  • Avoiding sexual activity
  • Getting an HPV vaccine
  • Using barrier protection during sexual activity
• Cancer prevention clinical trials are used to study ways to prevent cancer.
• New ways to prevent cervical cancer are being studied in clinical trials.

Avoiding risk factors and increasing protective factors may help prevent cancer.

Avoiding cancer risk factors may help prevent certain cancers. Risk factors include smoking, being overweight, and not getting enough exercise. Increasing protective factors such as quitting smoking and exercising may also help prevent some cancers. Talk to your doctor or other health care professional about how you might lower your risk of cancer.

The following are risk factors for cervical cancer:

HPV infection

Cervical cancer is almost always caused by human papillomavirus (HPV) infection that is spread through sexual contact. There are more than 80 types of human papillomavirus and about 30 of these can infect the cervix. HPV types 16 and 18 are most often linked to cervical cancer.

Most of the time, the body’s immune system can fight the HPV infection before cancer forms. Only a very small number of women infected with HPV develop cervical cancer.

DES

Being exposed to a drug called diethylstilbestrol (DES) while in the mother’s womb increases the risk of cervical dysplasia and clear cell adenocarcinoma of the vagina and cervix. Between 1940 and 1971, DES was given to some pregnant women in the United States to prevent miscarriage (premature birth of a fetus that cannot survive) and premature labor.

In women who are infected with HPV, other risk factors add to the increased risk of cervical cancer:

Giving birth to many children

Among women who are infected with HPV, those who have had 7 or more full-term pregnancies have an increased risk of cervical cancer.

Using oral contraceptives for a long time

Among women who are infected with HPV, those who have used oral contraceptives (“the Pill”) for 5 to 9 years have a risk of cervical cancer that is 3 times greater than that of women who have never used oral contraceptives. The risk is 4 times greater after 10 or more years of use. In women who stop taking oral contraceptives, over a 10 year period, the risk of cervical cancer returns to that of women who never used oral contraceptives.

Smoking cigarettes

Among women who are infected with HPV, those who either smoke cigarettes or breathe in secondhand smoke have an increased risk of cervical cancer. The risk increases with the number of cigarettes smoked per day and how long the woman has smoked. Current and former smokers have 2 to 3 times the risk of cervical dysplasia and invasive cervical cancer.

The following increase the risk of HPV infection:

Having a weakened immune system

Having a weakened immune system caused by immunosuppression increases the risk of HPV infection and cervical cancer. Immunosuppression weakens the body’s ability to fight infection and other diseases.

Immunosuppression can be caused by these and other conditions:

• Human immunodeficiency virus (HIV). This virus causes AIDS and weakens the body’s immune system.
• Medicine given to prevent organ rejection after transplant. Women who have an organ transplant are given medicine to weaken the body’s immune system and help prevent organ rejection.

Women who are infected with the HIV virus or who take medicine to prevent organ rejection after transplant are less able to fight HPV infection and are at increased risk of cervical cancer.

Being sexually active at a young age or having many sexual partners

The risk of HPV infection is higher in women who become sexually active before age 18 and in women who have had 6 or more sexual partners.

The following protective factors decrease the risk of cervical cancer:

Note: Screening with the Pap test and the HPV DNA test reduces the number of new cases of cervical cancer.

Avoiding sexual activity

Nearly all cases of cervical cancer are caused by HPV infection, which is spread through sexual activity. Women who are not sexually active have almost no risk of cervical cancer.

Getting an HPV vaccine

Vaccines that protect against HPV infection greatly reduce the risk of cervical cancer. These vaccines do not protect women who are already infected with HPV.

Several HPV vaccines have been approved by the U.S. Food and Drug Administration (FDA). These vaccines have been shown to prevent infection with the types of HPV that cause most cervical cancers. Protection against HPV infection lasts for 6 to 8 years. It is not known if the protection lasts longer.

Harms of HPV vaccines include dizziness, feeling faint, headache, fever, and redness, tenderness, or warmth at the place of injection. Allergic reactions are rare. Getting the HPV vaccine while pregnant does not have a harmful effect on the pregnancy.

Using barrier protection during sexual activity

Some methods used to prevent sexually transmitted diseases (STDs) decrease the risk of HPV infection. The use of a barrier method of birth control, such as a condom or diaphragm, helps protect against HPV infection.

Drugs approved for Cervical Cancer

Drugs Approved to Prevent Cervical Cancer

• Cervarix (Recombinant HPV Bivalent Vaccine)
• Gardasil (Recombinant HPV Quadrivalent Vaccine)
• Gardasil 9 (Recombinant HPV Nonavalent Vaccine)
• Recombinant Human Papillomavirus (HPV) Bivalent Vaccine
• Recombinant Human Papillomavirus (HPV) Nonavalent Vaccine
• Recombinant Human Papillomavirus (HPV) Quadrivalent Vaccine

Drugs Approved to Treat Cervical Cancer

• Avastin (Bevacizumab)
• Bevacizumab
• Bleomycin Sulfate
• Hycamtin (Topotecan Hydrochloride)
• Keytruda (Pembrolizumab)
• Mvasi (Bevacizumab)
• Pembrolizumab
• Topotecan Hydrochloride

Drug Combinations Used in Cervical Cancer

• Gemcitabine-Cisplatin

The post Cervical Cancer appeared first on Medika Life.

HPV is a group of more than 200 related viruses, some of which are spread through vaginal, anal, or oral sex.

Sexually transmitted HPV types fall into two groups, low risk and high risk.

• Low-risk HPVs mostly cause no disease. However, a few low-risk HPV types can cause warts on or around the genitals, anus, mouth, or throat.
• High-risk HPVs can cause several types of cancer. There are about 14 high-risk HPV types. Two of these, HPV16 and HPV18, are responsible for most HPV-related cancers.

HPV infection is common: Nearly all sexually active people are infected with HPV almost immediately once they become sexually active. Around half of these infections are with a high-risk HPV type.

Most HPV infections don’t cause cancer: Your immune system usually controls HPV infections so they don’t cause cancer.

High-risk HPV infections that persist can cause cancer: Sometimes HPV infections are not successfully controlled by your immune system. When a high-risk HPV infection persists for many years, it can lead to cell changes that, if untreated, may get worse over time and become cancer.

HPV vaccination can prevent cancer: HPV vaccines can prevent infection with disease-causing HPV types, preventing many HPV-related cancers and cases of genital warts.

Cancers Caused by HPV Infection

Long-lasting infections with high-risk HPVs can cause cancer in parts of the body where HPV infects cells, such as in the cervix, oropharynx (the part of the throat at the back of the mouth, including the soft palate, the base of the tongue, and the tonsils), anus, rectum, penis, vagina, and vulva. 

HPV infects the squamous cells that line the inner surfaces of these organs. For this reason, most HPV-related cancers are a type of cancer called squamous cell carcinoma. Some cervical cancers come from HPV infection of gland cells in the cervix and are called adenocarcinomas.

HPV-related cancers include:

• Cervical cancer: Virtually all cervical cancers are caused by HPV. Routine screening can prevent most cervical cancers by allowing health care providers to find and remove precancerous cells before they develop into cancer. As a result, cervical cancer incidence rates in the United States are decreasing.
• Oropharyngeal cancers: Most oropharyngeal cancers (70%) in the United States are caused by HPV. The number of new cases is increasing each year, and oropharyngeal cancers are now the most common HPV-related cancer in the United States.
• Anal cancer: Over 90% of anal cancers are caused by HPV. The number of new cases and deaths from anal cancer are increasing each year.
• Penile cancer: Most penile cancers (over 60%) are caused by HPV.
• Vaginal cancer: Most vaginal cancers (75%) are caused by HPV.
• Vulvar cancer: Most vulvar cancers (70%) are caused by HPV.

In the United States, high-risk HPVs cause 3% of all cancers in women and 2% of all cancers in men. There are about 44,000 new cases of cancer in parts of the body where HPV is often found, and HPV is estimated to cause about 34,000 cancers each year, according to the latest statistics from the Centers for Disease Control.

Worldwide, the burden of HPV-related cancers is much greater. High-risk HPVs cause about 5% of all cancers worldwide, with an estimated 570,000 women and an estimated 60,000 men getting an HPV-related cancer each year. Cervical cancer is among the most common cancers and a leading cause of cancer-related deaths in low- and middle-income countries, where screening tests and treatment of early cervical cell changes are not readily available.

How is HPV Transmitted?

HPV is transmitted through vaginal intercourse, anal and oral sex, and other intimate, skin-to-skin contact. The infection passes easily between sexual partners. Condoms and dental dams can reduce the likelihood of HPV transmission but do not completely prevent it.

Does HPV Infection Cause Symptoms?

No, infection with high-risk HPV does not cause symptoms. The precancerous cell changes caused by a persistent HPV infection at the cervix also do not cause symptoms. However, precancerous lesions at other sites in the body may cause symptoms. And if an HPV infection develops into cancer, the cancer may cause symptoms.

HPV Vaccination: Preventing HPV Infection

The HPV vaccine Gardasil 9® protects against infection with nine HPV types: the two low-risk HPV types that cause most genital warts, plus the seven high-risk HPV types that cause most HPV-related cancers.

HPV vaccination is recommended by the Centers for Disease Control and Prevention (CDC)’s Advisory Committee on Immunizations Practices (ACIP) to prevent new HPV infections and HPV-associated diseases, including some cancers.

HPV vaccination provides strong protection against new HPV infections, but the vaccine does not cure, and is not used to treat, HPV infections or diseases caused by HPV. HPV vaccination offers the most protection when given before someone is exposed to the virus. 

Who should get the HPV vaccine?

The HPV vaccine series is recommended for girls and boys at the age of 11 or 12; the series can be started at age 9. Children who start the series before age 15 need two doses to be protected. For young people who didn’t get vaccinated on time, HPV vaccination is recommended up to age 45; those who receive their first dose at age 15 or older need three doses to be protected. A fair warning, many insurance companies only cover it up to age 26 reflecting the older guidelines.

Can the HPV vaccine be given at older ages?

Yes, the vaccine can be given to adults between the ages of 27 and 45 who didn’t receive all vaccine doses earlier. In fact, it is now recommended. Adults in this age group benefit less from the vaccine because they are more likely to have been exposed to HPV already. But if you are concerned that you are at risk for new HPV infections, you should talk with your health care provider about whether the vaccine may be right for you. 

Screening for HPV and Cell Changes Caused by HPV

Screening tests are tests used to check for disease when there are no symptoms. The goal of screening for cervical cancer is to find precancerous cell changes at an early stage, even before they become cancer and when treatment can work to prevent cancer from ever happening. Currently, cervical cancer is the only HPV-caused cancer for which FDA-approved screening tests are available.

Screening for Cervical Cancer

Cervical cancer screening tests:

• the HPV test checks cervical cells for high-risk HPV
• the Pap test checks for cervical cell changes that can be caused by high-risk HPV
• the HPV/Pap cotest checks for both high-risk HPV and cervical cell changes

These screening ages and intervals apply to most women:

• Age 21-29 years: Pap testing every 3 years.
• Age 30-65 years: Screening using one of these tests:
  • HPV testing every 5 years
  • HPV/Pap cotesting every 5 years
  • Pap testing every 3 years 
• Older than 65 years: If you have been screened at regular intervals and your test results for the last decade have been normal, you may be advised that you no longer need to be screened for cervical cancer. Screening should continue past age 65 for women with recent abnormal Pap or HPV tests.

Depending on the test results and her age, a woman may have another test after 12 months, or she may have an exam called a colposcopy to allow her provider to examine the cervix and, if needed, remove a sample of tissue for analysis (a procedure called a biopsy).

What Does It Mean If a Woman Has a Positive HPV Test after Many Years of Negative Tests?

Sometimes, after a several negative HPV tests, a woman may have a positive HPV test result. This is not necessarily a sign of a new HPV infection, and it doesn’t mean that she or her partner has a new sexual partner. Sometimes an HPV infection can become active again after many years. Other viruses behave this way as well, for example the chickenpox virus can reactivate later in life to cause shingles.

There is no way to tell whether a newly positive HPV test result is a sign of a new infection or a reactivation of an old infection. Researchers don’t know whether a reactivated HPV infection has the same risk of causing precancer or cancer as a new HPV infection.

Screening for Other HPV-Related Cancers

There are no FDA-approved tests to detect HPV infections or HPV-caused cell changes in anal, rectal, vulvar, vaginal, penile, or oropharyngeal tissues. However, there is some evidence that, among populations that are at higher risk for HPV infection, such as men who have sex with men or men who are HIV-positive, anal Pap tests may help to detect early cell changes or precancerous cells. In anal Pap tests, a sample of anal cells is checked for abnormal cells.

Treatment for Cell Changes Caused by HPV Infection

Although HPV infection itself cannot be treated, there are treatments for the precancerous cell changes caused by infection with high-risk HPV.

• Precancerous cervical cell changes: Most women who have precancerous cervical cell changes are treated with the loop electrosurgical excision procedure (LEEP), which is a method to remove the abnormal tissue.
• Precancerous vaginal, vulvar, penile, and anal lesions; genital warts; and benign respiratory tract tumors: Treatment methods include topical medicines, surgical excision, cryosurgery, and LEEP.
• HPV-related cancers: Individuals who develop an HPV-related cancer generally receive the same treatment as patients with tumors at the same site that are not related to HPV infection. However, patients with HPV-positive oropharyngeal cancer may receive different treatments than patients whose oropharyngeal cancers are not caused by HPV. 

How Does HPV Cause Cancer?

Once high-risk HPV infects cells, it interferes with the ways in which these cells communicate with one another, causing infected cells to multiply in an uncontrolled manner. These infected cells are usually recognized and controlled by the immune system. However, sometimes the infected cells remain and continue to grow, eventually forming an area of precancerous cells that, if not treated, can become cancer. Research has found that it can take 10 to 20 years, or even longer, for HPV-infected cervical cells to develop into a cancerous tumor.

Among women whose cervical cells are infected with high-risk HPV, several factors increase the chance that the infection will be long lasting and lead to precancerous cervical cells:

• giving birth to many children
• using oral contraceptives for a long time
• smoking cigarettes

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What is a Loop Electrosurgical Excision Procedure?

LEEP stands for Loop Electrosurgical Excision Procedure. It’s a treatment to prevent cancer after precancerous cells are identified during cervical cancer screening. Precancerous cells are caused by HPV, the human papillomavirus.

80% of Americans will contract HPV, making it the most common sexually transmitted infection. HPV causes genital warts, and persistent strains lead to cervical, vaginal, anal, throat, and neck cancer. Despite screening programs, 4,000 US women die from HPV related cervical cancer annually. A LEEP procedure saves lives. 

80% of Americans will contract HPV, making it the most common sexually transmitted infection. Persistent HPV strains lead to cervical, vaginal, anal, throat, and neck cancer. Despite screening programs, 4,000 US women die from HPV related cervical cancer annually. A LEEP procedure saves lives.

A small wire loop is used to remove abnormal cells from your cervix. The thin wire loop is attached to an electrical current to cut away the top layer of cervical cells and remove the effects of HPV. 

HPV effects are detected during a routine paps smears, the first step in cervical cancer prevention. When someone has an abnormal pap smear, the next step is a diagnostic procedure called a colposcopy.

A colposcopy is an office procedure that allows your doctor to visualize the cervix more closely using a microscope. The colposcope identifies abnormal cervical tissue that cannot be seen with the naked eye. Areas of the cervix concerning for pre-cancer or cancer can then be biopsied (sampled) during the exam.

If the biopsy shows a precancerous lesion then, your healthcare provider may recommend a LEEP (loop electrosurgical excision procedure.)

Where is a LEEP Procedure performed?

A Loop electro excision procedure can be performed in a variety of settings. Most commonly, Obgyns perform this procedure in the office setting. 

The office, surgery center, or hospital are all reasonable and appropriate surgical settings.

Can my family visit me?

Most LEEP procedures are performed in a medical office setting. A trusted family member should drive you to and from the appointment. If the procedure is done in an hospital or Ambulatory Surgery Center, your family is welcome to stay with you before and after the procedure.

Does my procedure require an anesthetic?

Anesthesia is required for a LEEP procedure. The type of anesthesia will vary depending on the surgical setting, the surgeon’s experience, and the availability of office equipment. 

Oral sedation, paracervical block, IV sedation, and general anesthesia are all potential anesthetic options. 

In the office setting, anesthesia is provided via a paracervical anesthetic. A paracervical block is an anesthetic technique done by a gynecologist to numb the uterus. Medication is injected into the cervical tissue to reduce pain during surgery. For a LEEP procedure, a medication called epinephrine is mixed with the anesthetic to reduce the risk of intraoperative bleeding.

Some gynecologists also recommend oral medication to reduce anxiety.

What’s the procedure when I check in?

Most surgeries will involve a preoperative visit with your surgeon. The risks and benefits of the procedure will be discussed in detail and questions regarding your procedure are discussed. The surgical consent form is reviewed, signed, or updated with any changes.

In most settings, patients will receive a preoperative phone call by a nurse or medical assistant one to two days before surgery. If any blood work or preoperative testing is required, it will be scheduled and confirmed.

When a LEEP procedure is performed in an office setting, the experience will feel like a normal office visit. After checking in, you will be taken to a procedure room. The medical assistant will prepare the room and provide a gown or leg coverings. When all is prepared, your surgeon will come and review any last-minute questions.

If a LEEP is scheduled in a hospital or Ambulatory Surgery Center, the staff will guide you to the preoperative holding area to change into a surgical gown and store your valuables. If an IV is required, it will be placed at this time. You will meet the nursing team who will provide care during your stay. The anesthesia team will come to interview you and answer questions. Typically your surgeon will also come and review any last-minute questions.

What happens in the operating room??

For an office-based procedure, your surgeon will help position your legs into the stirrups. A speculum is placed into the vagina to allow visualization of the cervix, the opening of your uterus located at the back of the vagina. The cervix is cleaned to make the area sterile. 

A paracervical block anesthetic is then gently injected into the cervical tissue. The medication absorbs into the surrounding area to numb the nerves and make the procedure more comfortable. 

The surgeon selects the appropriate sized LEEP wire to match the size and appearance of your cervix. Because a low dose electrical current is used to do the cutting, a grounding pad is placed on the outside of your leg. The doctor will take extra precautions to ensure an adequate and safe view of the cervix. A grounding pad is placed on the outside of your leg.

Once all preoperative safety checks are confirmed, the surgeon will activate the electrical current to pass the wire across the top layer of the cervix. This action removes a small, pancake layer of cervical cells. This specimen is sent to a pathologist for analysis. 

The electrical current is then used to stop any bleeding through a process called cauterization. Often, a drying chemical called Monsel’s solution is painted onto the cervix to prevent bleeding later on. This chemical is messy and will cause a brown, coffee-ground vaginal discharge over the next few days. 

In the hospital setting, things function a little differently. 

After the preoperative evaluation, the team will guide you to the operating or procedure room. You will move from the mobile bed to the operating table. Once you are positioned comfortably and safely, the anesthesiologist will give you medication through your IV if the procedure is being done outside of the office setting. 

The OR nursing team will cover your body with sterile drapes and prep the vagina for surgical sterility. The team then performs a “surgical time-out.” A surgical safety checklist is read out loud requiring all surgical team members to be present and attentive.

The surgeon then performs the surgical procedure as described above.

Once the procedure is complete. A post-procedure review is done together as a surgical team. All instruments and equipment are counted and verified. Once complete, the anesthesiologist will begin to assist the patient in waking up for transfer to the recovery room.

How long will I be in the operating room?

Once the patient enters the operating room a series of safety steps must occur. This process takes about 20 minutes. 

A LEEP procedure takes approximately 10–15 minutes of surgical time. This includes the surgical time as well as accounting for positioning, the speculum insertion, a paracervical block anesthetic, and removal of the instruments.

When can I go home?

After an office-based LEEP procedure, patients may go home after getting dressed as long as you are feeling normal. 

Hospital-based procedures under general anesthesia will follow a different process. 

Postoperative recovery time will vary from person to person. Each patient must meet certain discharge criteria. The patient’s vital signs must be stable. The patient must be alert, oriented, and able to walk with assistance. Postoperative nausea, vomiting, and pain must be controlled as well as confirmation of no postoperative bleeding.

The nursing team will go over discharge instructions, and the plan for postoperative pain management options will be confirmed.

LEEP procedures require a minimal amount of postoperative recovery. Patients are often discharged as early as 30–60 minutes after the procedure.

What is the usual recovery time

You should be able to resume all work and household activities the day after your procedure. You should expect to feel a little vaginal soreness for 2–3 days. Mild uterine cramping is also common. 

Some patients will require mild pain medication like NSAIDs or even low dose narcotics for a brief period of time. 

It is wise to wear a sanitary pad for a few days as you may experience vaginal spotting or dark vaginal discharge. 

You will be instructed to abide by pelvic rest for approximately one week. This includes no douching, no sex, and no tampons. 

You should call your doctor if you experience heavy vaginal bleeding, fevers, or worsening abdominal pain.

What aftercare is required?

Most women should be able to return to normal daily activities the next day. You should speak with your physician regarding the resumption of sexual activity. Typically, the recommendation is no intercourse for 1–2 weeks. 

You should not use tampons for up to seven days after the procedure to reduce the potential risk of infection.

Light bleeding, spotting, and brown or black discharge is common and expected. Sanitary napkins are advised. 

Your doctor will schedule a postoperative examination to evaluate your cervix 1–2 weeks after the procedure. The cervical specimen pathology report will be reviewed during this visit. 

A follow-up pap smear will be scheduled to confirm all of the abnormal cells have been successfully removed and do not come back. 

Danger Signals to look out for after the procedure

After a LEEP procedure, we expect light spotting and vaginal discharge.

If you experience heavy bleeding, abdominal or pelvic pain, a fever, or pain that increases over time beyond 24 hours, call your physician. After any surgery contact your physician if you meet any of the following criteria:

What should I pack at home to take with?

Nothing special is required after a LEEP procedure. A supply of sanitary napkins will help keep your clothing clean.

What information should I provide to my doctors and nurses?

It is very important to provide your doctor with an updated list of all medications, vitamins, and dietary supplements prior to surgery. All medication and food allergies should be reviewed. Share any lab work, radiologic procedures, or other medical tests done by other healthcare providers with your surgeon prior to your procedure.

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