Posts Tagged ‘cervical cancer’

Preventing Cervical Cancer Through HPV & Pap Smear Screening

HPV Vaccine Cervical CancerIn the mid 20th century, Dr. George Papanicolaou published his initial research about abnormal cells in cervical scrapings and cervical cancer. The test that now bears his name, the “Pap” smear, is perhaps the most successful cancer screening test in modern medical history. Cervical cancer was the leading cause of cancer deaths in American women in the early 20th century; but since widespread screening began, cervical cancer rates have fallen by 70%. The Pap smear works by finding abnormal cells before symptoms of cervical cancer appear. Cervical cancer is prevented by treating pre-cancerous lesions of the cervix, known as cervical dysplasia. Gynecologists have a number of minor office surgeries to treat cervical dysplasia, such as freezing or removing the abnormal cells.

Despite this success, recommendations for cervical cancer screening and pap smears have changed dramatically in recent years. Many of these changes reflect a better understanding of the cause of cervical cancer. Almost all cervical cancers and cervical dysplasia are caused by a viral infection with human papillomavirus, or HPV. A majority of women have a HPV infection at some point in their adult lives. Most men and women infected with HPV will resolve the infections without any signs or symptoms. A small minority of women with an HPV infection will develop abnormal pap smears, cervical dysplasia and cervical cancer. HPV does the most damage when it is persistent. It will take years and maybe decades from initial HPV infection to develop cervical dysplasia and cervical cancer.

The American Cancer Society updated its cervical cancer screening guidelines in 2012. For women over 30 years of age, cervical cancer screening can include both an HPV test and a traditional Pap smear. More than 90 percent of women will have a negative HPV test and negative Pap smear. This is very reassuring news for these women. The combination of these two tests will detect nearly all cases of cervical dysplasia and cervical cancer. Furthermore, women who are negative for both tests are highly unlikely to develop cervical cancer in the next five years. The American Cancer Society and other professional organizations have recommended that women between the ages of 30 and 65 have a Pap smear and HPV test every five years to screen for cervical cancer.

HPV testing in women under 30 years old is not recommended. HPV infections are common in this age group, and cervical cancer is relatively rare in women under 30.

The “annual exam” is a time-honored tradition for gynecologists in the United States, based on Dr. Papanicolaou’s historic breakthrough in the 20th century. In this century, multiple new tests and screening strategies have been developed, as well as an HPV vaccine recommended for girls age 9 through 26, to protect against the two types of HPV that cause most cervical cancers (click here for more on the HPV vaccine).

These new guidelines reflect a better understanding of the cause of cervical cancer, and promise to further reduce the burden of cervical cancer in women worldwide.

Author: Kevin Ault, MD
Winship Cancer Institute member and Professor, Gynecology and Obstetrics, Emory University School of Medicine

Dr. Kevin AultAbout Dr. Kevin Ault
Dr. Ault is currently Professor of Gynecology and Obstetrics at the Emory University School of Medicine and a Winship Cancer Institute member. Dr. Ault’s research interests are based in infectious diseases and women’s health. He is an investigator in vaccine trials for both herpes simplex virus and human papilloma virus. His multidisciplinary research in the pathogenesis of infections due to chlamydia and gonorrhea has been supported by the National Institutes of Health. Board certified by the American Board of Obstetrics and Gynecology since 1995, Dr. Ault came to Emory in 2005 from the University of Iowa Hospitals and Clinics in Iowa City.

 

 

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As HPV-Associated Cancer Incidence Rates Rise: What’s the Value of the HPV Vaccine?

HPV Vaccine Cervical CancerA recent report from the National Health Institute shows that overall cancer rates among men and women are on the decline but the incidence rates of certain HPV-associated cancers are increasing. This news concerns healthcare professionals because they know there is a vaccine on the market that can prevent cervical cancer in girls and decrease the incidence of other HPV-related cancers. Gardasil, FDA approved and released in 2006, is a vaccine that helps protect girls ages 9 – 26 against two types of HPV that cause about 75% of cervical cancer cases, as well as two other types of HPV that cause genital warts, vaginal, vulvar, anal and oropharyngeal (head and neck, back-of-throat, tongue and tonsils) cancers.

The report also showed that the US vaccination rates among young girls, compared to other industrialized nations, are low. In 2010, less than 50% of girls ages 13 through 17 had received one HPV vaccine dose and unfortunately only a third received all three recommended doses. Completion rates were lower in certain areas of the country and with different population groups:

  • Girls living in the South
  • Girls living below poverty level
  • Hispanic girls

The US Government’s Healthy People 2020 target is 80 percent for the three dose coverage. It is important to educate healthcare providers and parents of the importance of completing the 3- dose vaccine schedule. The vaccine is safe and effective. It also is a great example of the medical advances that cancer researchers and clinicians can point to in the struggle against cancer. We could save the lives of many women and men by encouraging parents to get their children vaccinated today!

To get more information on the vaccine we recommend you speak to your pediatrician or child’s primary care physician. You can also review other blogs from Winship Cancer Institute of Emory University physicians (listed below), or visit the Centers for Disease Control and Prevention website.

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Get the Real 4-1-1 on HPV

Cervical Cancer Awareness HPVWho could have imagined that a three-letter virus – HPV — could generate so much confusion and controversy?

Oh, wait, there is precedence for all the political posturing, fear and mis-information about HPV, the human papillomavirus, one of the most common sexually transmitted infections. We saw the same take place around HIV, a far more deadly virus and one that continues to wreak havoc and claims thousands of lives a year. And it took decades of advocacy, much of which is still ongoing, to bring attention to the need to stop HIV in its tracks, before it leads to AIDS. That same advocacy and public health campaigning is now underway to help consumers better understand HPV and what people can do about it, and how important it is for young people to receive vaccines that can protect them from infection with the virus.

Researchers have identified more than 40 types of HPV, a very common virus that the human body normally sheds on its own. Two types – HPV 16 and HPV 18 — are of special concern in the cancer community, though, because, undetected and untreated, they lead to most cases of cervical cancer. Now one of them, HPV16, is proving to be the cause of most new cases of throat cancers that develop at the base of the tongue and tonsils.

Routine pap tests and annual gynecological exams have lowered cervical cancer incidence in the United States, but cervical cancer is still one of the leading cancer killers of women worldwide. Thus, great research emphasis was placed on finding a vaccine to prevent infection with HPV 16 and 18 in the first place. Now there are two such HPV vaccines licensed by the FDA to prevent the spread of HPV and thus to prevent cervical cancer.

While screening with the Pap test has long proven an effective way to help prevent cervical cancer in developed countries, screening for HPV 16 infection for throat or other kinds of cancer would be fruitless. While 20 million Americans are estimated to be living with HPV 16 in their systems, 90% of those people will clear the virus on their own. A big concern with HPV 16 and throat cancer is that doctors do not yet understand why the virus becomes cancer in some.

Because the virus is so widespread yet causes cancer in a relatively small percentage of cases of infection, screening for it does not make sense, explains Dr. Shin, a leading head and neck cancer specialist at Winship Cancer Institute of Emory University. The most important unanswered question about HPV16 and throat cancer is why does it develop into cancer in some people but not in the majority of people.

“How does this virus get into a host cell and then go into carcinogenesis? This is what we would like to address,” explains Dr. Dong Moon Shin. Winship researchers such as Shin are aggressively looking for answers.

Much of the confusion and political hoopla about HPV have stemmed from misinformation about the vaccine, which is unfortunate. The vaccine is safe. It is effective. Because of the rising incidence of oropharyngeal cancer, it is now advised that both girls and boys also receive the vaccine, which is given in a series of three shots. To be effective, the shots must be given before a girl or boy becomes sexually active and is not administered to females after they hit age 26. Some of the concern about the vaccine is that parents don’t like the idea of giving children another round of vaccines, but the HPV vaccines have been approved by the FDA after rigorous clinical trials. They work.

HPV facts & stats:

  • More than 40 types of HPV have been identified by researchers.
  • More than 20 million adult Americans are believed to be living with the HPV 16 virus.
  • In 90 percent of cases, the body’s immune system clears HPV within two years.

Prognosis for cases of HPV16-caused throat cancer is good, so long as the patient is a non-smoker. Winship researchers and others are looking for ways to identify whether patients with HPV16-caused throat cancer need as much treatment as patients whose cancer is not caused by the virus.

Dr. Peter Rossi and Dr. Namita Khanna just hosted an online chat on the topic of HPV and cervical cancer. For their thoughts, check out the HPV / Cervical Cancer chat transcript.

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Cervical Cancer & HPV 101 – Part I

Cervical Cancer & HPV MD ChatJanuary is Cervical Health Awareness Month. To help raise awareness around cervical health and cervical cancer, this is the first of a two-part blog post series on the topic. Before we dig deeper into cervical cancer types and risk factors, here a few cervical health-related statistics you should be aware of:

  • Cervical cancer was previously the leading cancer-related cause of death for women in the U.S. In the last 40 years, however, the number of deaths from cervical cancer has dropped. According to the National Institute of Health (NIH) & CDC, the decline is largely “the result of many women getting regular Pap tests, which can find cervical precancer before it turns into cancer.”
  • Approximately 10,800 new cases of HPV-related cervical cancer are diagnosed in the U.S. each year.
  • Greater than 70% of all cervical cancers (carcinomas) were squamous cell type, and nearly 20% were adenocarcinomas, between 1998-2003.

Cervical Cancer Types

Squamous cell carcinoma and adenocarcinoma are the two types of cervical cancer. Each type is distinguished based on its appearance under a microscope. Both squamous cell and adenocarcinoma begin in the cells that line hollow organs, but squamous cells have a thin, flat appearance while adenocarcinomas involve cells with secretory functions. As is noted in the statistic above, the squamous cell carcinoma type of cervical cancer is far more common and currently makes up approximately 90% of cervical carcinoma cases. Both types have similar risk factors, prognoses, and treatments.

Cervical Cancer Risk Factors

HPV

According to the CDC, “almost all cervical cancers are caused by the human papillomavirus (HPV),” which is why it is so important that parents and young women understand their options for getting vaccinated to protect themselves from typically symptomless HPV. Emory Healthcare will be hosting an online chat on the topic of cervical cancer and HPV. The chat will cover everything from cervical cancer prevention and diagnosis to treatment options, along with information on the relationship between HPV and cervical cancer.

Smoking

As is the case the with all cancers, smoking increases your risk. Take steps to quit smoking today.

Birth Control

Having given birth to three or more children or having been on birth control pills for over 5 years can increase your risk for cervical cancer.

In our next post on cervical cancer, we’ll cover its connection to the HPV virus, including more information on the HPV vaccine and its effectiveness and the relationship between various HPV strains and cervical cancer. In the meantime, if you have questions on the topic of cervical cancer, or something you want to see covered in our next post, let us know in the comments section below!

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HPV16 Vaccine Safe and Effective

Winship Cancer Institute of Emory University

Winship Cancer Institute of Emory University

Some cancers remain stubborn to treat. Pancreatic cancer, small cell lung cancer, late stage breast cancer and ovarian cancer are just a few of them. So when researchers find treatments – and even better, ways to prevent cancer – we celebrate.

Scientists at Winship Cancer Institute and many other research centers were therefore concerned about a recent statement that a vaccine to prevent cervical cancer causes mental illness. The statement is not accurate. The vaccine is safe. It is also effective. It is a great example of the medical advances that cancer researchers and clinicians can point to in the struggle against cancer.

The vaccine, which prevents the spread of Human Papilloma Virus-16 or HPV-16, has been approved by the FDA for use in girls who are not yet sexually active.  The vaccine is also under consideration for approval in boys to help prevent the spread of HPV16-related head and neck cancers caused by the same virus. Many researchers and clinicians consider HPV16-related head and neck cancers to be at epidemic levels.

“We don’t need to wait until all these molecular events are understood,” said Dong Moon Shin, M.D., director of Winship Cancer Institute’s head and neck cancer prevention program.  “This vaccine is successful in preventing cervical cancer, and we are hoping the vaccine provide similar preventive properties in head and neck cancer. We are very hopeful.”

Why a Pap Smear Might Not Catch All Cervical Cancers

Most women are familiar with the Pap smear, also known as the pap test. Most of us are also aware that the main goal of the Pap smear is to identify cancerous or abnormal cells that may turn into cancer after collecting them from the lining of the cervix. However, based on findings recently published in the International Journal of Cancer, Pap smears may not be the most reliable way to pinpoint cancer types that can often be harder to detect.

According to Kevin Ault, MD, an associate professor of obstetrics and gynecology at Emory’s School of Medicine and Winship Cancer Institute, the Pap smear is not always effective in the diagnosis of adenocarcinoma. Ault came to this conclusion after conducting a post-hoc analysis of Gardasil vaccine trials. Adenocarcinoma is a type of cervical cancer that begins significantly far up the cervical canal, an area that often is not sampled when a Pap smear is conducted.

Andenocarcinoma is the second most common type of cervical cancer, accounting for about 20 percent of all cervical cancer cases. While the overall incidence rate of cervical cancer is on the decline, Ault reports the proportion of andenocarcinoma cervical cancer is rising.

As the 8th most common type of cancer in American women, more than 12,000 new cases of invasive cervical cancer are diagnosed each year. Scientists believe that pre-invasive cervical cancer may develop over a period of months or years after the cervix is infected with the sexually transmitted HPV.

A leading expert and pioneer in the field of human papilloma virus (HPV), Ault suggests women might seek an HPV and Pap test at the same time. Why? A positive HPV test may be an indicator for early stages of adenocarcinoma cervical cancer that can’t be determined via a standard Pap test.