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Cervical Cancer
Cervical Cancer Deaths Frustrate
Doctors-(AP-25/07/2005)
Virtually all deaths from cervical cancer
are preventable, yet the disease will kill almost 4,000 women in this
country this year. Frustrated scientists know who most of them will be:
black women in the South, Hispanics along the Texas-Mexico border, white
women in Appalachia and the rural Northeast, Vietnamese immigrants. Efforts are under way to reach those women,
including a $25 million federal program poised to let communities recruit
volunteers — average women who speak their patients' language and can
engender trust — to push Pap testing and shepherd the newly diagnosed
through an often-baffling medical system.
It's work made more urgent by the discovery
that excess cervical cancer is a red flag for other health disparities:
The same localities also have too-high rates of breast and colorectal
cancer, strokes and infant mortality. Pap smears are credited with slashing
cervical cancer deaths by 75 percent in recent decades. This simple $50
test can detect precancerous cells in time to prevent cervical cancer from
forming — or, if it's already there, in time to cure this usually
slow-growing malignancy. But most invasive cervical cancer is found
in women who haven't had a Pap in five years, or never.
Poverty is one culprit. Also, women with no
regular doctor slip through the cracks. Older women are less likely to get
a Pap, as are recent immigrants, perhaps because of language or cultural
issues. With funding from the Centers for Disease
Control and Prevention, McPhee started a program in Santa Clara County,
Calif., to fight cervical cancer among Vietnamese immigrants, who have the
nation's highest incidence of the disease — a rate five times higher than
that of white women. Poverty aside, McPhee found that women who
saw Vietnamese physicians were half as likely to have ever had a Pap.
Perhaps it's modesty with the mostly male doctors, he speculates. But when
surveyed, most of those doctors didn't know their patients were at such
high risk.
Called Suc Khoe La Vang — "health is gold"
— the program advertised Paps in Vietnamese, gave Vietnamese doctors
classes on cervical cancer and brought to the county a program that provides free Paps for the poor. And it trained
volunteer "lay health workers" to educate their friends and neighbors
about Paps. Overall, the program increased Pap testing significantly.
Among women who'd never had a Pap, 46 percent got one thanks to the
volunteers, compared with 27 percent who only saw ads. Freeman pioneered another way to use
volunteers, as "patient navigators" to help women with an abnormal Pap
result get treated, whether the barrier is money, language or winding
through the complex health care system. Among other successes, they get 95 percent
of his center's uninsured patients into some program that will pay for
their care. There is federal money for communities to
emulate such programs. A law passed this summer promises $25 million in
grants over five years for patient-navigator pilot projects. The CDC's
REACH 2010 project is providing another $35 million in grants this year to
reduce health disparities in cervical cancer and five other health
problems. And in May, the government allocated $95 million for 25
community projects aimed at reducing disparities in cervical, breast and
colorectal cancers.
[Top]
Wider Use Of Simpler Cervical Cancer Screening Could Benefit Women In
Developing Countries-(Yahoo News-02/02/2005)
An easy, inexpensive method using ordinary vinegar in
screening women for cervical cancer could be applied in more situations in
developing countries around the world, thus increasing the number of women
whose disease is caught early and treated. This is among the key findings reported in an English-language article
in the January 2005 issue of the "Revista Panamericana de Salud
Pública/Pan American Journal of Public Health," a peer-reviewed public
health journal published by the Pan American Health Organization (PAHO).
This finding is considered important because cancer of the cervix -- at
the base of the uterus -- is second only to breast cancer as the most
common form of cancer among women. Cervical cancer is caused by a sexually
transmitted virus, which causes lesions to grow on the cervix. If left
untreated, those lesions ultimately develop into cancer. Cervical cancer kills more women annually than childbirth, and it is
estimated that it could affect as many as 750,000 women by 2020 and as
many as 1 million new cases by 2050. Currently, about 230,000 women die
annually of cervical cancer and nearly 80 percent of these cases occur in
underdeveloped and poverty-stricken countries. The article's principal
author, physician Jose Jeronimo is from Peru and works at the Division of
Cancer Epidemiology and Genetics of the National Institutes of Health's
National Cancer Institute. He said that the screening method using vinegar
– known as VIA (the acronym for visual inspection with acetic acid) –
should be seen as an alternative to the Papanicolaou smear, commonly known
as the Pap smear.
With VIA, more women are likely to be followed up and receive any
additional confirmatory testing needed, and treatment. Given those
advantages, the VIA is being introduced in developing nations around the
world. However, that screening is recommended primarily for low-resource
settings, with medical personnel with limited training and with only
modest medical equipment. Many of those same advantages, however, could be found in settings in
developing countries with better-trained staff and more extensive,
up-to-date medical equipment, according to the "Revista/Journal" article.
This study was the first research ever done to try to address that
question in a developing country.
In wealthier developed countries, women routinely undergo examinations
and Pap smears in which a smear of cervical cells is taken and evaluated
at a laboratory to detect any abnormality. But the inexpensive vinegar
test – explained in the article -- involves washing the cervix with
vinegar for one minute. Then, the health worker performs a naked-eye
observation of the cervix to see whether the epithelium, a protective
tissue layer, turns white. This would indicate precancerous lesions.
Dr. Jeronimo said that "it has always been said that this VIA method
was only applicable" in low-income developing nations with few resources.
However, he noted that one of the key results of the Lima test is that "it
showed that the vinegar screening is also valuable and has an important
role to play in places in developing countries with good resources and a
good infrastructure." The other key finding, Dr. Jeronimo said, is that when the Pap smear is
used to detect cervical cancer "many women never return to be diagnosed
and be informed of their treatment, or they don't adhere to their
treatment."
According to the article, VIA-positive women knew their abnormal result
immediately during the first visit, and they immediately received special
counseling about that finding and the importance of returning in a week
for confirmatory studies with colposcopy and biopsy. In contrast, to learn
about their Pap smear result -- either positive or negative -- women had
to return one week later for a second visit, which many of them did not do
and so never received special counseling about the significance of any
positive result.
The article is based on a study of 1,921 women carried out at the
Peruvian Cancer Institute (Instituto de Enfermedades Neoplásicas) in 1999
and 2000. Both VIA and Pap smear screenings were used. According to Dr.
Jeronimo, the study showed that while "26 percent of women who were
Pap-positive did not return for follow-up procedures, only 3 percent of
the VIA-positive women did not return."
The article notes that the results of the Lima tests "outline the
potential benefits of using VIA at all levels of health care systems in
developing countries. VIA increases (early) detection of premalignant
lesions of the cervix and diminishes the probability of losing women
before they are appropriately followed up and treated. We believe," the article adds, "that VIA can be used as a screening
tool in poor countries not only in rural areas and small health centers
but also in hospitals, cancer institutes, and other health facilities with
better resources."
Last month, PAHO -- as a member of the
Alliance for Cervical Cancer Prevention (ACCP) -- issued a new publication
and reported that cervical cancer, while largely preventable, kills almost
a quarter-million women worldwide each year. The publication, a 255-page
"Manual for Planning and Implementing Cervical Cancer Prevention
Programs," is a result of the collective experiences of the Alliance,
which includes PAHO and four other international health organizations:
International Agency for Research on Cancer (IARC), PATH, EngenderHealth,
and JHPIEGO. The health alliance said in the report, which was issued in Geneva in
December, that about 80 percent of the 500,000 new cases of cervical
cancer each year worldwide occur in developing nations, mainly in Latin
America, sub-Saharan Africa, and the Indian subcontinent.
A month earlier, a PAHO report -- titled "A Situational Analysis of
Cervical Cancer in Latin America and the Caribbean" -- noted that
incidence and mortality rates from cervical cancer have declined steeply
in North America, to below 10 per 100,000 females in both Canada and the
United States. Yet rates in most Latin American and Caribbean countries
are higher than 20 cases per 100,000 (in many cases, much higher) and are
surpassed only by rates found in East Africa and Melanesia. In addition,
cervical cancer accounts for a higher percentage of cancer deaths in the
Americas--as high as 49.2 percent in Haiti, compared with 2.5 percent in
North America.
[Top]
Advanced-stage cervical cancer patient gives birth after surgery-(Yahoo
News-20/01/2005)
A patient who had her womb preserved in a
surgery to treat advanced-stage cervical cancer gave birth to a child last
fall in the first such case in Japan, hospital officials said. Cervical cancer patients are commonly treated with surgery to remove
the entire part of the uterine if the disease was not diagnosed until an
advanced stage. Women who undergo such surgeries typically lose their
ability to bear children.
The woman in her 30s, who lives in the Kanto area, was diagnosed with
advanced-stage cervical cancer in spring 2003. Later that year, Keio University Hospital in Tokyo operated on the
woman but preserved part of the womb, the officials said. About one year later, the woman became pregnant though artificial
insemination and gave birth to a baby boy in fall 2004. Both the woman and
the child are healthy even though the baby was born premature, the
officials said. "This is the first case in Japan of an advanced-stage cervical cancer
patient becoming pregnant and giving birth to a child," said Shiro Nozawa,
professor at the department of obstetrics and gynecology at Keio
University's School of Medicine. About 300 surgeries aimed at saving fertility have been performed for
advanced-stage cervical cancer patients overseas since 1987. Children were
born after at least 90 of these surgeries.
[Top]
Second cervical
cancer vaccine shows promising results in trial-(Yahoo News-14/11/2004)
Researchers say a second experimental
cervical cancer vaccine appears to broadly protect against infection and
risky precancerous conditions for more than two years. The findings affirm
scientists' belief that the disease could be progressively eradicated in a
global campaign much like smallpox and polio. The study, which was
conducted in the United States and Brazil, showed patients given the
vaccine sustained a high level of immune response against the virus that
spreads cervical cancer, and that it would prevent infection for many
years. Whether revaccination ultimately would be needed must be determined
by an additional, longer trial, researchers said. Details appear in
Friday's issue of the British medical journal the Lancet. The study was
supported by GlaxoSmithKline PLC, the vaccine's manufacturer.
Worldwide, 511,000 women are stricken with
cervical cancer each year, and about half die. It is the leading cancer
killer among women in the developing world. Cervical cancer is caused by
infection with human papilloma virus, or HPV, which is spread through sex.
There are dozens of HPV strains, but two of them -HPV-16 and HPV-18
-account for more than 70 per cent of cervical cancers. The
GlaxoSmithKline vaccine is designed to prevent infection from both major
strains. In the study, researchers recruited 1,113 women at 32 clinics
beginning in 2000. The participants, ages 15-25, had no signs of
infection. Their cases were followed for 27 months. About half of the
women received the vaccine, while the rest received a placebo. None of the
vaccinated women developed infections or cervical precancerous lesions,
said Dartmouth obstetrician Diane M. Harper, the study's lead author. The
vaccine also protected 93 per cent against abnormal Pap tests, she said.
In the placebo group, 10 women developed HPV-16 infections and four
developed HPV-18 infections by the study's seventh month.
Last May, GlaxoSmithKline started enrolling
15,000 women for a final four-year vaccine trial, although U.S. government
approval could come sooner. The government also has given vaccine
development rights to Merck & Co., and officials said the research is
being conducted co-operatively. On Nov. 1, Merck announced that its HPV-16
vaccine works for at least four years. It is conducting its own
large-scale trial of a vaccine that covers both HPV-16 and 18. Results are
expected next year.
[Top]
Study:
2 groups of Asian-Americans less likely to be screened for cervical cancer-(Yahoo
News-07/09/2004)
Korean-American and
Vietnamese-American women, who have high rates of cervical cancer, are
less likely to be screened for the disease, according to two studies in
Santa Clara County, Calif., funded by the federal Centers for Disease
Control and Prevention. The recently released studies shed light on
several aspects of Asian-American health, focusing on specific groups in
Santa Clara County and other locations nationwide. Researchers say lumping
all Asians together gives an inaccurate picture. "When you average
all the groups together, you lose the ability to identify the higher-risk
groups," said Marjorie Kagawa-Singer, a researcher involved in the
study looking at the overall health of Vietnamese-Americans in Los
Angeles, Orange and Santa Clara counties, as well as Cambodians in
Massachusetts.
That study found that only
about 65 percent of Vietnamese-American women surveyed reported having a
Pap smear in the past three years, compared with about 74 percent of
Asians nationwide and almost 86 percent of the U.S. population. The other
CDC study, focusing on Korean-American women in Santa Clara County, found
that in 2002, less than 75 percent of Korean women - compared with about
92 percent of all California women - reported ever having a Pap test,
which screens for precancerous cells in the cervix. Rates of cervical
cancer for Korean-American women are about 15 cases per 100,000.
Cervical cancer is preventable;
regular Pap tests can detect abnormalities before they become cancerous.
Women are advised to have the test at least once every three years.
"It shouldn't have to happen," said 28-year-old Phung Pham of
San Jose, Calif., whose mother had cervical cancer and died five years
ago. "You just have to go get a Pap smear, it's so simple."
According to 1992 data from the
National Cancer Institute, Vietnamese- American women have the highest
incidence of cervical cancer, with 43 cases for every 100,000 women, a
rate more than five times as high as white women. Prevention programs have
sought to address the problem. University of California-San Francisco
researchers and community-based organizations in Santa Clara County have
produced media campaigns - including one featuring Pham - a low-cost Pap
screening clinic and a program that has enrolled about 1,000
Vietnamese-American women.
The Korean-American study, a
joint effort by the University of California-Berkeley's Center for Family
and Community Health and Asian Health Services in Oakland, surveyed more
than 870 Korean-American women in Santa Clara County in 1994 and 2002.
Researchers surveyed women by phone and compared results with those for
all California women in another survey being conducted at the same time.
Screening practices improved significantly among participants from 1994 to
2002. The percentage of Korean-American women who reported having had a
Pap smear increased from 65 percent in 1994 to almost 75 percent in 2002.
Interviewers conducted the
survey in Korean or English, with more than 90 percent of participants
opting for Korean, said research coordinator Joel Moskowitz. He said
language barriers often prevent Korean-Americans from getting screened for
breast and cervical cancers. "If you are going to a provider with a
child that is an interpreter, you don't want them in the room when you are
getting a Pap test," said Moskowitz, director of the University of
California-Berkeley center.
Language also is a barrier to
screening for Vietnamese-American and other Asian women, said
Kagawa-Singer, associate professor at the University of California-Los
Angeles School of Public Health. "About 67 percent of Asian-Americans
nationwide are first-generation - and that's slightly higher here in
California - and they have limited English ability," she said.
Cultural influences play a
large role in the lack of preventive screenings among many Asian groups,
said Moon Chen, professor in the department of public health sciences at
the University of California-Davis Cancer Center. "The attitude
toward screening is one that is foreign to many Asian-Americans," he
said. "You go to the doctor if you have a problem. If you don't have
a problem, you don't seek one out."
Pham agreed. Her mother was
very modest, she said, a cultural value that probably prevented her from
being screened. "In Vietnam, having Pap smears is not something
sought after," she said. "It's something that is very private so
you keep it private. It's about exposing a very intimate part of yourself
and that takes a certain amount of trust." Raising awareness in the
Vietnamese community is the first step, Pham said. Making screening
affordable for women, especially poor, uninsured women, is the next step.
"My hope is that all women, the older moms especially, take care of
themselves so they can be with their children later in life," she
said.
[Top]
Digene
Supports Program to Reach Millions of Union Women with Cervical Cancer
and HPV Information-(Yahoo News-31/08/2004)
Digene Corp. today announced
its support for the Academy for Educational Development (AED) and the
Coalition of Labor Union Women (CLUW), which are working together to
launch a campaign to reduce cervical cancer rates among the more than 16
million women in union families across the United States. At the CLUW's
national executive board meeting in New Mexico that concluded on Sunday,
leaders announced that the partnership soon will begin distributing to
millions of union women information on cervical cancer and the human
papillomavirus (HPV) -- the primary cause of the cancer -- and information
on the need for regular screening to ensure early diagnosis and treatment.
The initiative marks the second
phase of "Working Women Reaching Out against Cervical Cancer (Working
Women ROCC!)," a five-year collaborative program between AED and CLUW,
which is funded by a grant from the Centers for Disease Control and
Prevention (CDC). Studies show that cervical cancer, a preventable
disease, disproportionately affects minority women, which make up a large
proportion of female union members. Working Women ROCC! will target the
nation's 7.5 million union women, as well as female relatives of union
members. "We commend AED and CLUW for undertaking this effort to
educate union women about HPV and cervical cancer, and opportunities to
prevent cervical cancer through regular and accurate screening," said
Evan Jones, Digene's Chairman and Chief Executive Officer.
"Furthermore, we believe that working women should have access to the
best preventive health technologies. As HPV testing along with the Pap
evolves into a standard of practice for cervical cancer screening in women
age 30 and older, it is important that all eligible women have access to
the technology and are properly educated about how to prevent cervical
cancer."
Newly elected CLUW President
Susan Phillips said, "CLUW and the thousands of union women we
represent consider health care the No. 1 priority for working families,
and are advocating for a universal health care system with cervical cancer
screening including HPV testing."
Working Women ROCC! educational
materials will be developed in English, Spanish and Vietnamese in order to
reach the highest-risk groups with the campaign's messages. Research shows
African American women have the highest age-adjusted mortality rate for
cervical cancer, followed by Hispanic women. Vietnamese women in the
United States have a cervical cancer rate more than five times greater
than Caucasian women. For outgoing CLUW President, Gloria Johnson, who
shepherded the program through its first year, cervical cancer is a
personal issue. "My daughter was recently diagnosed with cervical
cancer, so I know first-hand the devastation that a cancer diagnosis can
cause a woman and her family," said Ms. Johnson. "While she is
winning her battle, not all women are so lucky. By educating our members
and prompting them to get screened, I am confident that Working Women ROCC!
can help other women avoid this preventable disease." Ms. Johnson
noted that she will continue to play an active role in Working Women ROCC!
[Top]
US
women unnecessarily screened for cervical cancer-(cancerfacts.com-01/07/2004)
Many women in the
United States who have had a hysterectomy are undergoing PAP smear screening
even though they are not at risk of cervical cancer, according to a new
study. The finding shows that a 1996 recommendation by the U.S. Preventive
Services Task Force has largely been ignored by women and their doctors.
The recommendation was that women who have undergone complete hysterectomies
in which the uterus and cervix have been removed for reasons other than
cancer need not undergo Pap tests. The researchers led by Dr. Brenda Sirovich,
and Gilbert Welch the VA Outcomes Group, White River Junction, Vt. and
Dartmouth Medical School in Hanover, N.H., say the proportion of women
with hysterectomies who had a Pap smear did not change over the past decade.
The authors add that
most women who have undergone hysterectomy are not at risk of cervical
cancer because they no longer have a cervix. Their report appears in the
June 30 issue of The Journal of the American Medical Association (JAMA).
"It is possible that women who have had a total hysterectomy are not aware
that they are no longer at risk for cervical cancer," the authors wrote.
"Or they may simply be so enthusiastic about cancer screening that they
continue to have Pap smears regardless of the usefulness of the test.
It is also possible that physicians are largely responsible for continuing
cervical cancer screening after hysterectomy." The research team evaluated
the information from Behavioral Risk Factor Surveillance System (1992
- 2002) an annual, population-based telephone survey of U.S. adults conducted
by the Centers for Disease Control and Prevention. They analyzed the timing
of Pap tests among 187,670 women surveyed. They found that 22 million
U.S. women 18 years and older have undergone hysterectomies, representing
21 percent of the population. In 1992, before the U.S. Preventive Services
Task Force recommendations, 68.5 percent of women who had undergone hysterectomy
reported having had a Pap smear in the past 3 years. In 2002 (6 years
after the recommendation), the researchers found that 69.1 percent had
had a Pap smear during the same period. After accounting for Pap smears
that may have preceded a recent hysterectomy and hysterectomies that spared
the cervix or were performed for cervical neoplasia (tumors), they estimated
that approximately 10 million women, or almost half of all women who have
undergone hysterectomy, are being screened unnecessarily.
The authors note
that although estimates based on patient self-report may over-estimate
actual screening rates, these results suggest that millions of women are
being screened unnecessarily, and the amount of screening has not declined
following the task force recommendation. The authors also suggest Pap
smear performance measures may also be responsible. Although such measures
may not be aimed at women who have undergone a hysterectomy. "The net
effect may be that all women are encouraged to receive Pap smears in order
to meet specified benchmarks for cervical cancer screening," they wrote.
"The U.S. Preventive Services Task Force recommendations either have not
been heard or have been ignored."
[Top]
Warning
issued on pregnancy drug-(Yahoo News-09/06/2004)
Women aged between
30 and 60 years old are being urged to ask their mothers if they were
prescribed the drug Stilboestrol during pregnancy. The synthetic oestrogen
is known to contribute to an increased risk of a rare cervical cancer
and higher infertility rates. Stilboestrol was prescribed to pregnant
women who had a history or were at risk of miscarriage between 1940 and
1971. Doctors stopped prescribing Stilboestrol in 1971 but the side effects
carry over into the next generation. Women born during the period when
the drug was prescribed are being encouraged to ask their mothers if they
took the drug during pregnancy. Therapeutic Goods Administration medical
advisor John McEwan has urged women to find out if their mothers used
the drug and to consult their doctor.
"They may miscarry,
they may have difficulty conceiving," he said. "I guess that the reason
that the Adverse Drug Reactions [Advisory] Committee published this item
in its bulletin was to remind practising doctors about this, that many
of the doctors who are practising today probably hadn't even gone to medical
school in 1971." "We don't think that there will be any further serious
consequences but because this is such an unusual thing it's actually important
that women maintain an assurance that they're healthy," Mr McEwan added.
The note reminds doctors that daughters of women who took the drug need
to have regular pap smear tests and mammograms
[Top]
Virus
particles displaying linear epitopes from papillomavirus structural proteins:
next generation vaccines to prevent papillomavirus-associated cancers-(Yahoo
News-29/03/2004)
New vaccinations to
prevent infections that lead to cervical cancer and targeted therapeutics
aimed at breast cancer were examples of research highlights presented
by scientists at the 95th Annual Meeting of the American Association for
Cancer Research. Scientists described advances that feed into the drug
development 'pipeline,' and show strong promise for controlling existing
tumors or addressing the pathogen that causes tumors.
Plant viruses show
promise as carriers for new low-cost, antiviral vaccinations against human
papillomaviruses (HPV) that cause benign and malignant tumors, according
to research presented today. A consortium of researchers from Large Scale
Biology Corporation (LSBC), Vacaville, Calif., and the Department of Microbiology
and Immunology, Penn State University College of Medicine developed the
anti-HPV treatment by combining parts of papillomavirus structural proteins
with the tobacco mosaic virus (TMV). Alison McCormick, Ph.D., Senior Scientist
at LSBC, presented preliminary findings indicating that the virus-combining
technology resulted in vaccinations that promoted antibody responses to
rabbit papillomavirus types that are used as models for human papillomavirus
disease, as well as to HPV strains associated with high risk for reproductive
organ cancers.
HPV comprise a family
of viruses that are often transmitted through sexual contact. While HPVs
can cause genital warts, certain strains of the virus are known to induce
cervical, vulvar and anal cancers, and are implicated in the development
of other cancers including those to the head and neck. HPV is present
in more than 9 of ten cases of all cervical cancers. McCormick noted previous
research demonstrated that virus-like particles from HPV proteins were
very effective in generating an antibody response to a particular strain
of the virus, but that it is unlikely that these vaccines would protect
against all of the strains of HPV that cause human genital cancers. Furthermore,
the technology to generate the virus-like particles posed expensive manufacturing
challenges.
By incorporating the
immunogenic peptides from papillomaviruses into the TMV virions, researchers
at Large Scale Biology Corporation developed a relatively inexpensive,
efficient technology to produce a viral antigen that generated strong
peptide-specific immune responses in mouse models and antibodies capable
of generating partial protective response in the cottontail rabbit model.
McCormick and her colleagues are now performing research focused on improving
these novel vaccines against papillomaviruses through research funded
by the National Institutes of Standards and Technology's Advanced Technology
Program. "The key to preventing reproductive tract cancers caused by HPV
is to block the initial infection," McCormick said. "Generating vaccines
that protect against a wide array of HPV strains is a priority, since
many different strains of HPV cause cancer. Without persistent viral infection,
cancers caused by HPV are expected to fall in incidence."
Approximately 5,000
women die from cervical cancer each year in the United States. The Center
for Disease Control and Prevention estimates that 5.5 million new cases
of genital HPV occur yearly in the United States. As many as 24 million
people in the U.S. are infected with HPV at any given time. An estimated
1 million women in the U.S. have cervical dysplasia associated with HPV,
with 55,000 bearing in situ carcinomas. Approximately 15,000 U.S. women
have cervical cancer. Globally, HPV-induced cervical cancers are the most
common cancers in women in developing countries. One half-million new
cases of cervical cancer occur yearly across the globe, leading to 300,000
deaths. 80 percent of these occur in developing countries, and 90-95 percent
are associated with HPV infection. Control of the emerging worldwide health
problem caused by HPV could best be accomplished through development of
preventative and therapeutic vaccines against a wide variety of papillomavirus
types. Ideally, these vaccines should be manufactured in abundant supply
at a cost that is compatible with industrialized as well as developing
world economies. LSBC's novel plant-virus-based system could offer one
solution to this growing medical and public health need.
[Top]
Cancer
Vaccine in the Pipeline-(Times of India-15/12/2003)
In a major breakthrough
in the fight against cancer, a vaccine has been found to be effective
against cervical cancer and it would be tested in India under a WHO programme.
"Though the vaccine has been made in US, we will also test it in the country
and once the clinical trials are over we will negotiate with WHO so that
it is manufactured in India, "Indian Council of Medical Research (ICMR)
director general Prof N.K. Ganguly said, "This is the only vaccine that
has shown 100 per cent protection in animal studies against the Human
Papilloma virus that causes cervical cancer, he said.
Data to start trials
was being collected by Institute of Cytology and Preventive Oncology Delhi,
Tata Memorial Hospital, Mumbai and Cancer Institute in Chennai, he said.
There were many issues to be resolved before the clinical trials begin
in the country. Earlier it was thought that it should be tested in girls
12 years of age, but due to cultural restrictions, it has now been decided
that the vaccine would be tested in 18-year-old females without clinical
examination.
[Top]
New
Advances in the Fight Against Cervical Cancer-(HealthDayNews-25/01/2004)
Cervical cancer was
once the leading cause of cancer deaths in women. Today, because of ever-more
effective screening methods, this cancer is being detected -- and cured
-- at earlier and earlier stages. That's a message worth repeating in
January, which is designated Cervical Cancer Screening Month. As with
most cancers, early detection and treatment of cervical cancer are the
keys to survival. An estimated 12,200 new cases of the disease are diagnosed
in the United States annually, and approximately 4,100 women die from
it, the federal Centers for Disease Control and Prevention says. Virtually
all cervical cancers are caused by the human papillomavirus (HPV). While
many Americans will at some point be infected with this sexually transmitted
virus, the vast majority of people essentially clear it from their body.
Problems arise when the virus does not resolve on its own. "Most sexually
active women have had it, and it clears up," says Dr. Joseph T. Chambers,
vice chairman of obstetrics and gynecology at St. Luke's Roosevelt Hospital
Center in New York City. "It's the persistence that we need to be concerned
about," adds Chambers, who is also director of gynecologic oncology at
Continuum Health Partners in New York City.
For 50 years, the
mainstay of cervical cancer screening has been the Pap smear. In the last
few years, however, there have been improvements and additions in screening
techniques that give women more choices. The Pap smear "is probably the
most widely used cancer screening mechanism worldwide," says Dr. Kevin
Holcomb, director of gynecologic oncology at Beth Israel Medical Center
in New York City. The doctor takes a cell sample of the cervix, smears
it on a slide and sends it to a lab for analysis. While the Pap does have
a high failure rate, cervical cancer typically grows so slowly that another
test in a year will still catch it early enough. The liquid-based Pap
test, a relatively new addition to the screening field, takes the sample
in the same way but then dips it into a liquid solution instead of putting
it on a slide. "[In a traditional Pap], the cytologist has to look through
millions of cells that are layered up on one another, so it's a bit like
looking for a needle in a haystack," Holcomb explains. "You may also have
the problem where a lot of the abnormal cells aren't transferred onto
the slide. The benefit of a liquid-based test is that you have a monolayer
of cells to look at. So while they're looking for the same things, it's
more effective."Liquid-based
tests appear to have a higher sensitivity for detecting cervical cancer,
Holcomb adds.
In other recent developments,
there are new tests that hunt for the specific types of HPV known to be
associated with the development of cervical cancer. (In all, there are
about 100 subtypes of the virus, not all of which cause cancer). "Certain
testing that we are able to do at this point is able to not only check
whether those are present but also see if there are molecular changes,"
Chambers says. "It gives us one other tool for trying to see not only
if the individual has been exposed, but also [has the virus] in some way
been integrated into the cells and caused changes."
Updated cervical
cancer screening guidelines recommend that women under 30 have annual
Pap smears. Those over 30 who have had three normal (or negative) Pap
tests in a row can extend the interval between screenings to three years.
Those 65 and older who've been screened and have been getting normal results
can stop if they want. It's also not necessary to get screened if you've
had your cervix removed. In general, women should start screening three
years after becoming sexually active or when they turn 21. "In the U.S.,
since most people are participating in screening, we're picking up cancers
at earlier and earlier stages," Holcomb says. "It's those earlier stages
that are curable with surgery." And at times the surgery is minimally
invasive. One day, screening and treatment may be unnecessary. The hot
new area of research is vaccines. Recently, researchers reported good
results with a vaccine that protected against HPV 16, which accounts for
about 50 percent of cervical cancers. There is now a study under way with
a vaccine that might be effective against more than one strain of HPV,
Holcomb reports. "That's sort of the way we're going," he says. "That
may have big implications on how we screen in the future."
[Top]
Chemotherapy
Timing Crucial in Cervical Cancer-(Reuters Health-18/12/2003)
The timing and dosage
of chemotherapy for locally advanced cervical cancer appears to have an
important bearing on success, according to a new report. Shorter courses
and more intense dosing seem to be more effective. In the European Journal
of Cancer, Dr. Jayne Tierney of the Medical Research Council's Clinical
Trials Unit, London, and colleagues note that the benefits and risks of
such chemotherapy remain unclear.
To shed light on
the matter, the team conducted a review and analysis of data from 21 studies.
Comparison of radiation therapy with and without chemotherapy showed that
chemotherapy cycles of 14 days or less and higher doses of cisplatin--a
commonly used cancer drug--tended to improve survival. Conversely, longer
cycles and lower dosages seemed to worsen survival. Comparison of chemotherapy
followed by surgery versus radiation alone in five trials involving 872
patients suggested that chemotherapy strongly reduced the risk of death.
However, because of the relatively small number of patients involved and
other factors, the researchers advise caution in interpreting these results.
The team calls for further research into the impact of cisplatin dose
and intensity in women with locally advanced cervical cancer.
[Top]
Chlamydia
Linked to Cervical Cancer Risk-(Reuters Health-18/12/2003)
Women with persistent
chlamydial infection are at increased risk for developing cervical cancer,
new research suggests. Chlamydia is a common sexually transmitted infection
that can cause fertility problems for women, but oftentimes it doesn't
cause symptoms. The latest findings, coupled with other emerging evidence,
suggest that "cervical cancer should be listed as one of the potential
long-term (consequences) of genital chlamydial infection," lead investigator
Dr. Jorma Paavonen from the University of Helsinki in Finland told Reuters
Health.
Paavonen and colleagues
identified 178 women with invasive cervical cancer and matched each one
to three cancer-free controls. The investigators measured antibodies to
a component of the chlamydia organism in blood samples from both groups,
and in the case of the patients with cervical cancer, they studied the
earliest blood samples taken before the diagnosis of cancer. The presence
of antibodies to chlamydial increased the odds of cervical cancer, the
team reports in the American Journal of Obstetrics and Gynecology. The
risk was doubled when there was a long lag time (longer than 3.5 years)
between blood sampling and cervical cancer diagnosis. It's not likely
that chlamydia directly triggers cervical cancer. Persistent infection
with one or more high-risk type of human papillomavirus (HPV) is known
to cause the vast majority of cases, but emerging evidence suggests that
chlamydia is an important co-factor.
"Chlamydia trachomatis
is an immunomodulator, which causes chronic inflammation and may alter
the host immune response, and ultimately inhibit spontaneous clearance
of HPV," Paavonen said. The current study findings "further emphasize
the importance of sexual health education in primary prevention, and chlamydia
screening programs in the secondary prevention of chlamydial infections,"
Paavonen added, "particularly since the vast majority of genital chlamydial
infections are asymptomatic.
[Top]
Virus
Test May Improve Detection of Cervical Cancer-(Reuters Health-05/12/2003)
Switching from Pap
smears to human papillomavirus (HPV) testing as the primary screening
method for cervical cancer could improve detection rates, a research team
suggests. They also say that, with appropriate repeat screening, this
strategy would not increase rates of referral for more invasive tests,
which can sometimes be unnecessary. In the current of The Lancet, Dr.
J. Cuzick, at the Cancer Research UK in London, and associates outline
a screening approach in which women would first be screened for HPV, a
virus associated with the majority of cervical cancers, and those testing
positive would then have a Pap test. But "for HPV testing to be cost effective
in primary screening, it would be necessary to develop an efficient policy
for the management of women who test positive for high-risk HPV types,"
but have negative or borderline results on Pap screening, the team points
out.
To explore the possible
approaches for cervical cancer screening, the investigators studied 10,358
women, ages 30 to 60, who underwent cervical tissue testing (Pap smears)
and who also had an HPV test. Overall, HPV testing was more sensitive
than Pap tests (97.1 percent vs. 76.6 percent) in detecting precancerous
cervical tissues. The rate of false-positive tests was slightly higher
with HPV testing than with Pap tests. Among the study subjects, 825 women
had borderline Pap results or positive high-risk HPV test results and
negative Pap results. Of this subgroup, 414 women were randomly assigned
to undergo more extensive cervical tissue removal (colposcopy) and 411
women were assigned to have repeat HPV and Pap testing after 12 months
(411 women) and then undergo colposcopy if needed. Low-risk and high-risk
cervical tissue was identified in 7 percent and 3 percent of those who
had immediate colposcopy, versus 4 percent and 2 percent in the surveillance
group. Thus, the researchers deduce, "surveillance at 12 months was as
effective as immediate colposcopy." Their findings suggest that women
who had borderline Pap test results and negative HPV tests could have
been safely returned to routine screening every three to five years without
the need for additional follow-up.
In a related editorial
in The Lancet, Dr. Eduardo L. Franco calls for further studies to define
the duration of protection conferred by a negative HPV result and the
effectiveness of using Pap smears as a second screening test. Dr. Franco,
from McGill University in Montreal, points out that a cervical cancer
screening program that focuses on HPV, a sexually transmitted infection,
will place "the emphasis of prevention not only on women but on their
partners as well."
[Top]
A
Single Vaccine Could Benefit Most Women-(ET-25/09/2003)
The risk of developing
cervical cancer by women infected with the Human Papillomavirus (HPV)
is essentially the same no matter which type of virus is involved, provided
it belongs to the group of 15 or so that are currently identified as high
risk, a scientist said today. Speaking at ECCO 12 -- The European Cancer
Conference in Copenhagen, Dr. Xavier Bosch, of the Institut Català d'Oncologia,
Barcelona, Spain, said that testing with a cocktail of the majority of
high risk type virus would provide a sufficient answer for clinical guidance,
and be important to the success of any future screening or vaccination
programs.
HPV is an extremely
common sexually transmitted infection. In many cases the infections are
harmless and go away without the need for treatment. But persistent infection
with certain types of HPV increases the risk of cervical cancer. These
types can be detected in 90-100% of cases of cervical cancer, as opposed
to 5-20% of controls. These types are believed to be a necessary cause
of cervical cancer and this provides a strong rationale for their use
in screening and for the development of anti-HPV vaccines. "Women who
are not infected persistently with one of the cancer-causing types of
HPV do not develop cervical cancer", said Dr. Bosch, "and this knowledge
is helping us develop effective prevention programs."
Dr. Bosch and colleagues
derived their specific risk estimates from studying a pool of evidence
collected by IARC, the International Agency for Research on Cancer, based
in Lyon, France. In Europe it is estimated that 65,000 new cases of cervical
cancer are diagnosed each year, of which 21,000 eventually lead to death.
HPV carriers are typically young and sexually active, and evidence suggests
that males and females are equally likely to be carriers. "In Europe and
North America a vaccine including HPV 16 and 18 -- the most common high
risk types of the virus -- would prevent 72% of cases among the vaccinated",
said Dr. Bosch. "A vaccine containing types 16,18,33,31 and 45 would cover
84% of the cases."
HPV vaccinations
are still in the experimental stage, and the vaccine would be expensive
at introduction, said Dr. Bosch. "But the gains in the longer term would
be huge, both in terms of healthcare costs and in women's quality of life.
In the meantime, participation in effective screening programs, particularly
if they includes HPV testing, can detect and prevent many potential cases
of cervical cancer at a very early stage."
[Top]
Experimental
vaccine against cervical cancer said promising-(AFP-17/09/2003)
An experimental vaccine
that could protect women against two of the most common causes of cervical
cancer has yielded extremely encouraging results in clinical trials, a
US researcher said. In preliminary trials, the vaccine proved 100 percent
successful in protecting women against repeated infection by the two human
papillomaviruses (HPV) most commonly associated with this type of cancer.
"The vaccine breaks new ground in the battle to prevent the spread of
sexually transmitted diseases," said John Schiller, a researcher with
the National Cancer Institute in Bethesda, Maryland. The findings come
from a trial of 1,100 women conducted by the pharmaceutical giant GlaxoSmithKline.
The results of a similar, but separate, trial by Merck and Co., published
last year in the New England Journal of Medicine, were equally promising.
Schiller said the
vaccine, given in three separate doses, could potentially prevent up to
three quarters of the 500,000 cases of cervical cancer reported annually;
the two HPV strains used in the vaccine account for about 75 percent of
those cases. He also said that the vaccine could be a particular boon
for women in developing nations like Mexico and India where cervical cancer
rates are high, and women are not regularly screened for cervical cancer
-- through pap smears -- as they are in industrialised nations. The vaccine
could be on the market within three to five years, subject to the necessary
approvals, Schiller said, but it would likely still face a number of obstacles.
Chief among them would be the task of persuading the parents of adolescent
and pre-adolescent girls that they should be innoculated against a sexually
transmitted disease. "There are sociological issues here," said Schiller,
adding that ideally the vaccine would be positioned as an anti-cancer
agent.
Researchers believe
the vaccine would only be effective in young women who have not been sexually
active, not in women who have suffered repeated infections. But further
research will need to be done to show how long the protective effect of
the vaccine will last, Schiller said.
[Top]
Study
Links Obesity to Cervical Cancer-(ET-11/09/2003)
A new study by researchers
at the National Cancer Institute (NCI) suggests being overweight could
double a woman's risk of developing one type of cervical cancer, known
as cervical adenocarcinoma. Although infection with certain strains of
the human papillomavirus (HPV) is the primary risk factor for cervical
cancer, the latest research could help shed light on why some women with
HPV develop cervical cancer while others don't. The findings also give
women another reason to try to avoid being overweight or obese. "This
might add a small bit of evidence that trying to maintain a healthy body
weight would be desirable," said lead researcher James Lacey, PhD. An
American Cancer Society expert agreed. "We're starting to refine our knowledge
about obesity and various cancers," said Eugenia Calle, PhD, director
of analytic epidemiology at ACS.
Calle published research
earlier this year that attributed 90,000 cancer deaths in the US each
year to excess weight. Lacey's study was published in the journal Cancer
(Vol. 98, No. 4: 814-821). Obesity is already a well-known risk factor
for the most common gynecological cancer, endometrial cancer (cancer of
the uterus). It was this relationship, in part, that led the NCI researchers
to investigate how obesity might affect cervical adenocarcinoma, which
accounts for 10% to 20% of cervical cancers (squamous cell cancers account
for most of the rest). Studies in the 1980s suggested that these two types
of cancer had similar risk factors, "and that made sense because of where
these tumors occur in the cervix," said researcher Lacey, of the NCI's
Division of Cancer Epidemiology and Genetics.
Cervical adenocarcinomas
typically develop high in the cervical canal, close to the endometrial
tissue of the uterus. The research was also prompted by a better understanding
of the role HPV plays in cervical cancer development. Although most HPV
infections clear up on their own, certain strains of the virus can cause
changes in the cervix that can lead to cancer if the body is not able
to eliminate the virus. Now that HPV's role in cervical cancer is clearer,
Lacey said, researchers can look for other factors -- like obesity, sexual
history, smoking, or hormone use, for example -- that might influence
whether the virus leads to cancer.
Lacey and colleagues
compared 124 women with cervical adenocarcinoma to 139 similar women with
squamous cell cervical cancer, and 307 similar women without cervical
cancer. The researchers calculated their body mass index, or BMI, a ratio
of height to weight. A BMI between 18.5 and 24.9 is considered normal
weight; a BMI of 25 to 29.9 is considered overweight, and a BMI of 30
or above is considered obese. Women with a BMI of 25 or higher had about
twice the risk of getting cervical adenocarcinoma as women of normal weight.
Weight did not seem to influence whether women developed squamous cell
carcinoma. The researchers weren't certain why only adenocarcinoma seemed
to be influenced by obesity. It could be that hormonal factors play a
greater role in this type of cervical cancer, as they are thought to do
in endometrial cancer. However, more research would be needed to make
that determination.
Another theory is
that screening differences play a role, Lacey said. Regular Pap tests
can detect changes in cervical tissue that could lead to cancer, allowing
them to be treated before that happens. But because adenocarcinomas develop
higher in the cervix, it may be more difficult to get a good tissue sample
for the test, so precancerous changes can be overlooked. This problem
may be compounded in overweight and obese women, because excess abdominal
fat may make it even more difficult to get a good tissue sample.
Until more is known
about just how excess weight relates to cervical cancer, experts say it
is wise for women to watch their weight by getting lots of regular exercise
and eating a healthful diet. The American Cancer Society's guidelines
for healthy eating and physical activity can help. ACS recommends eating
at least five servings of fruits and vegetables every day, as well as
plenty of whole grains. Red meat should be eaten in moderation; poultry,
fish and beans are better choices. Adults should also get at least 30
minutes of moderate exercise five days a week or more. Longer, more vigorous
exercise is even better. In addition, ACS recommends regular Pap tests
to detect any changes in the cervix before they become cancerous.
[Top]
Vaccine
Won't Replace Pap Smears-(HealthDayNews-12/08/2003)
Even the most successful
cervical cancer vaccine won't make screening with Pap smears unnecessary.
That's the conclusion of a study appearing in the Aug. 13 issue of the
Journal of the American Medical Association. Researchers from Duke University
looked at preliminary data on cervical cancer vaccines that are currently
in clinical trials and used a mathematical model to predict how the vaccine
and Pap smears could be used most effectively. They found that if the
vaccine was given before a young woman became sexually active, it would
likely save money to delay the onset of screening for cervical cancer
until the age of 24.
"We examined the
cost-effectiveness of three different strategies: vaccination only, vaccination
and screening, and screening only," says study author Shalini Kulasingam,
a research associate in obstetrics and gynecology at Duke University Medical
Center. "We found the most cost-effective strategy, if an effective vaccine
was available and used in combination with screening, was to vaccinate
young girls prior to the onset of sexual activity and then to delay the
onset of screening."
The Pap smear is
the current screening method used to detect cervical cancer. The American
Cancer Society recommends that women start getting Pap smears within three
years of becoming sexually active, but no later than 21 years of age.
After that, women should have annual screenings until the age of 30. After
that, if a woman has had normal results on previous Pap smears, she can
go two to three years between tests. Screening for cervical cancer is
important because this type of cancer rarely has symptoms before it has
spread to other parts of the body.
The National Cancer
Institute estimates that 15,000 women are diagnosed with cervical cancer
every year. The sexually transmitted human papillomavirus (HPV) is a known
cause of cervical cancer. There are at least 13 high-risk types of HPV
believed to cause cervical cancer, according to Kulasingam. The vaccines
currently in clinical trials cover two of the more common types of HPV,
but not all of them.
The researchers compared
costs and life expectancy of vaccination only, vaccination and screening,
and screening alone. When looking at screening, the researchers looked
at conventional screening. They also modeled screening at one-, two-,
and five-year intervals, and varied the age at which screening started.
The mathematical model used assumed that women were vaccinated at the
age of 12. The study points out that, in reality, parents may not want
to have their child vaccinated against a sexually transmitted disease
at such a young age. Assuming the vaccine is effective, the researchers
found initial screening could be delayed until a woman was 24 and then
done every other year. Vaccination alone, however, was not a cost-effective
strategy, according to the study. The current versions of the vaccine
will cover only one or two of the high-risk types of HPV. Also, Kulasingam
points out that long-term efficacy data isn't available on the vaccine."Regardless
of the vaccine that becomes available, women will still need to be screened,"
she says.
Dr. Mark Werner,
an obstetrician and gynecologist at William Beaumont Hospital in Royal
Oak, Mich., agrees. "We probably won't know for many years what the best
screening interval is. Initially, I'm sure we'll still do once-a-year
Pap smears." This study, he says, is a first look at the many questions
a vaccine will bring up, such as the best age to give the vaccine or how
often it needs to be given. But, he adds, "The vaccine is exciting. It
will save lives for sure and maybe reduce some health-care costs."
[Top]
Reclaiming
Intimacy After Cancer-(HealthDayNews-12/06/2003)
These days, Amy Vartorella
has a different definition of a romantic evening with her husband, David
Johnson. And it isn't just 13 years of marriage and three kids that have
colored her thinking. In the past, a romantic evening would have included
intimacy. Now, she's happy going to dinner and a movie and spending time
with him. After a long struggle to recover from cervical cancer, the Ohio
couple is still in the process of reclaiming their intimate life. Resuming
sexual relations after cancer, especially gynecologic cancer, isn't easy,
as Amy, a nurse, knows firsthand. It can take some time due to pain and
psychological roadblocks.
Amy's diagnosis of
cervical cancer in late 2000 was followed by complications that required
bowel surgery and removal of an ovary. Those procedures were in addition
to the cervical cancer treatment, which included a radical hysterectomy,
chemotherapy and radiation. About six weeks after treatment ended, she
decided it was time to resume their sex life. "I wanted to prove I was
done," she says, still remembering how painful it was to attempt intercourse.
These days, it's getting more comfortable, but she says they are still
getting back to normal. So if an evening out means dinner, a movie and
time spent together, that's OK. "It means we are on our way," says the
upbeat Vartorella.
As a nurse, Vartorella
is better informed about the aftermath of cancer than most, but still
found the struggle to regain sexuality frustrating. As an ongoing study
at Ohio State University suggests, Vartorella -- who was part of the research
-- is far from alone. Sexual adjustment after cancer treatment is a problem
for many couples, says Barbara Andersen, a psychologist on staff at the
university's Comprehensive Cancer Center. For nearly 20 years, Andersen
and her co-researchers have followed cancer patients, asking them about
how they regain intimacy and the roadblocks along the way. In one of their
recent studies, they followed 150 women referred to a gynecologic oncologist
at one of two institutions affiliated with Ohio State; half had gynecologic
cancers, while the others were diagnosed with benign gynecologic problems.
Andersen asked all the women, aged 23 to 80, to answer questions about
their personality and their sexuality and then followed those with a cancer
diagnosis for 12 months.
"Twenty to 40 percent
had sexual problems," Andersen found. Loss of desire, arousal difficulties
and orgasmic difficulties were common. And the problems don't disappear
quickly, she found. Often they persisted at the 12-month follow-up. Perhaps
not surprisingly, those with sexual difficulties before the diagnosis
had the most problems making an adjustment after cancer treatment. Those
who had more symptoms of depression at the time of diagnosis had more
problems adjusting, as did those who had supplemental therapy such as
radiation. "The women who receive pelvic irradiation are at higher risk
of sexual problems because of the changes to the pelvis," Andersen says.
"The blood vessels in the tissues shrink," making it harder to become
aroused.
While health-care
providers may not even address the issue, Andersen says they are becoming
more aware of the need to discuss sexuality with their cancer patients.
Textbooks now include information on the topic, whereas they did not 20
years ago, she says. She suggests that women not wait for their doctor
to broach the subject. Instead, they should ask, and if they have treatment
options, ask further about each treatment's effect on later sexuality.
"If they ask a physician and he doesn't know [about sexuality issues],
press the physician for a referral to someone who does know," Andersen
suggests. Sometimes, solutions can be simple: using a lubricant, a measure
that might not occur to younger cancer patients, or adjusting lovemaking
times to account for the fatigue many cancer patients experience in late
afternoon or evening.
Another expert agrees
that health-care providers are becoming more aware of the need to discuss
sexuality issues, but they're not yet perfect. So Paula J. Anastasia,
a nurse specialist for gynecologic oncology patients at Cedars-Sinai Medical
Center in Los Angeles, suggests that anyone with cancer should ask the
following questions of her physician: How will the cancer diagnosis affect
my sexual functioning? When can we resume our intimate relationship? Are
there any risks or problems of which I should be aware? Communicating
with your partner, plus knowing the problems are common, can help, too,
experts say, as can just knowing it takes everyone a while to get back
to normal. It helped Amy Vartorella to know that others have the same
problems.. "Everyone I talk to [who has undergone treatment for cancer],
we're in the same boat," she says. Open communication with her husband,
she says, has also been key for her. "We both know it's going to get better,"
she says.
[Top]
Birth
Control Pill Linked to Cervical Cancer-(HealthScoutNews-03/04/2003)
Women who use birth
control pills have an increased risk of cervical cancer the longer they
are on the contraceptive, a British study confirms. The study was done
to give more definite information about the risk, which previous research
has established. The U.S. Food and Drug Administration recently revised
contraceptive labels to include that risk. What the new study provides,
says Debbie Faslow, director of breast and gynecological cancer for the
American Cancer Society, is more detail on the relationship. The risk
is directly related to length of time women use hormonal contraceptives,
as they are formally known, says a report in The Lancet. And while the
risk is higher for women infected with the human papillomavirus (HPV),
which is thought to be the major cause of cervical cancer, using the pill
elevates the risk for women free of HPV, the researchers say. That relationship
holds when many other possible risk factors are taken into account, including
number of sexual partners, use of cigarettes, and whether or not a woman
has screening for cervical cancer, says Dr. Amy Berrington, a research
fellow at the Cancer Research United Kingdom Epidemiology Unit, a lead
author of the report.
"We have done everything
we could with these data to be sure that there are not confounding factors,"
says Berrington. Working with the French International Agency for Research
on Cancer, the British epidemiologists reviewed data from 28 studies that
included more than 12,500 women with cervical cancer. They found that
the risk was increased 10 percent in a woman who used the pill for less
than five years (compared to women who never used it), 60 percent for
someone who used it for five to nine years, and was doubled for 10 years
use or more. The study doesn't establish a cause-and-effect relationship,
Berrington says. "I don't think we can ever say that with certainty,"
she says.
And Faslow says something
else must be involved, because cervical cancer has nothing to do with
hormones of the kind used in the pill. She suspects it might have something
to do with decreased use of condoms, which help prevent HPV infection,
although the British study found that the use of such barrier contraceptives
did not affect the result. A problem with an epidemiological study is
that it can rely on a person's memory of past behavior, says Dr. Carol
L. Brown, assistant attending surgeon at Memorial Sloan-Kettering Cancer
Center in New York. "No matter how well the study is planned, there are
potential biases," she says. The results might be affected by such personal
factors as the kind of woman who takes oral contraceptives or the frequency
of intercourse, Brown says. So while this meta-analysis of many studies
suggests that there may be an association, there is no absolute proof.
Worldwide, cervical
cancer is the second leading cancer in women, but most of those cases
occur in underdeveloped countries. In the United States, there are 12,000
cases and 4,000 deaths a year, Faslow says. A big question now is how
long the increased risk lingers after a woman stops using the pill. An
international study has been set up to try to determine that, Berrington
says.
[Top]
U.S.-Thai
research team pioneers low-tech approach to screening for cervical cancer-(ET-06/03/2003)
A team of U.S. and
Thai researchers announced they have developed a test and treatment procedure
for cervical cancer that can benefit women with limited access to medical
facilities. The procedure holds great promise for women in poor and rural
settings because it is low-tech and does not require follow-up visits,
which can be inconvenient or unaffordable, said JHPIEGO Corp., an affiliate
of Johns Hopkins University in Baltimore, Maryland.
JHPIEGO, which specializes
in women's and family health in poor areas, collaborated in a nine-month
pilot project with Thailand's Public Health Ministry involving almost
6,000 women in Roi Et province, 440 kilometers (275 miles) northeast of
Bangkok. Its testing method used low-cost chemicals and visual examination
instead of a Pap smear, the more complicated process typically used in
industrialized countries to detect precancerous cervical cells, said a
news release from JHPIEGO.
The treatment involved
is called cryotherapy, which is a freezing process that destroys the affected
tissue. The researchers' report on their tests, published Friday in the
Lancet, a British medical journal, said cryotherapy proved highly effective.
Of the women given cryotherapy treatment, 94 percent tested negative when
screened again after a year. Each year, more than 470,000 new cervical
cancer cases occur worldwide and about 288,000 women die from the disease,
according to JHPIEGO, which added that mortality rates are highest in
developing nations where the Pap smear is largely unavailable.
[Top]
CDC
to Inform Americans About Risky Pregnancy Drug-(Reuters-04/03/2003)
The U.S. Centers
for Disease Control and Prevention said it was spearheading an effort
to better inform millions of Americans who may have been exposed to a
defunct pregnancy drug now linked to cancer. The CDC, which is responsible
for tracking disease and stamping out epidemics, said it was refocusing
attention on Diethylstilbestrol (DES), a synthetic form of estrogen, because
many of its past users were still unaware of its health risks. The CDC
announcement follows more than 30 years of research in the medical community
on the health effects of DES.
An estimated 5 million
to 10 million pregnant women and their children were exposed to the drug
between 1938 and 1971, when it was prescribed to prevent miscarriages
and premature deliveries in expectant mothers with low estrogen levels.
The U.S. Food and Drug Administration advised doctors to stop prescribing
it to pregnant women following a study published in the New England Journal
of Medicine, which linked the drug to a rare vaginal cancer in girls and
young women. Subsequent research has cited a range of other DES health-related
problems in women, including increased risks for breast cancer and infertility.
Men exposed to the
drug have a greater chance of developing noncancerous testicular growths.
"It happened several decades ago, so it's gone off the radar screen for
a lot of people who were exposed as well as (health care) providers,"
said Marsha Vanderford, a spokeswoman for the CDC's national center for
environmental health. The centerpiece of the CDC's education campaign
is a new Web site, www.cdc.gov/DES, which lists the names of the more
than 75 types of DES-like drugs that once circulated in the United States.
The site also offers advice to those who may have been exposed to the
drug, including recommendations that women have regular mammograms and
breast exams and share their medical history with children who were exposed
to the drug.
[Top]
Study
Identifies Major Viruses Tied to Cervical Cancer-(HealthScoutNews-05/02/03)
A new study may help tweak the development of tailor-made vaccines against
cervical cancer by identifying 18 strains of a sexually transmitted virus
that causes most cases of the disease. Researchers have identified 18
types of human papillomavirus (HPV) that have been linked to cervical
cancer. While most of the types were already known, three more have been
added to the list of "probable" carcinogens. The results appear in The
New England Journal of Medicine. "This codifies what's been the clinical
practice in Western countries for at least five years with worldwide justification,"
says Dr. Giuseppe Del Priore, assistant director of gynecologic oncology
at New York University Medical Center and director of the Cancer and Fertility
Society. "It estimates the risk perhaps more precisely."
The
authors revisit 11 existing studies, the results of which have already
been incorporated into clinical practice, Del Priore says. Virtually all
cases of cervical cancer are caused by HPV, which is sexually transmitted.
While more than 80 types of HPV have been identified, only 30 or so have
been linked with malignancies. According to an accompanying article by
Dr. Thomas Wright of Columbia University College of Physicians and Surgeons,
the vast majority of cervical carcinomas contain one of 18 types of HPV
DNA, as shown in this report. Cervical cancer is the second most common
cancer in women worldwide and the main cancer afflicting women in most
developing countries.
In
1995, the International Agency for Research on Cancer (IARC) ruled that
there was enough evidence to classify HPV types 16 and 18 as carcinogenic.
Last November, researchers announced that a vaccine appears to be highly
effective against HPV 16, which accounts for about 50 percent of all cervical
cancer cases. When the IARC made its conclusions, data on other types
of HPV were limited, the study authors say. Seven additional studies have
been completed since then, giving researchers enough information to draw
additional conclusions. Here, the study authors pooled data from those
seven studies, in addition to the four earlier ones that had formed the
basis of the IARC's 1995 announcement. These 11 studies came from nine
countries and involved 1,918 women with confirmed cervical cancer as well
as 1,928 women without cervical cancer.
HPV
DNA was detected in almost 91 percent of the women with cancer and in
slightly more than 13 percent of the control women. The most common types
of HPV in the women with cancer, in descending order of frequency, were
16, 18, 45, 31, 33, 52, 58 and 35. Among the control women, the most frequent
types were 16, 18, 45, 31, 6, 58, 35 and 33. Based on this information,
15 types of HPV were classified as high-risk. They were 16, 18, 31, 33,
35, 39, 45, 51, 52, 56, 58, 59, 68, 73 and 82. Three types -- 26, 53,
and 66 -- were classified as probable high-risk types. Twelve were categorized
as low-risk. Eight types -- 16, 18, 45, 31, 33, 52, 58 and 35 -- accounted
for 95 percent of the cervical cancers seen in the 11 studies. "[These
findings] imply that an effective vaccine against the five most common
HPV types could prevent about 90 percent of the cases of cervical cancer
worldwide," the authors write.
Vaccines catering to specific geographical regions would have to take
into account differences in the distribution of HPV. Commercial tests
already look for most of these strains, Del Priore says. The ones that
aren't included represent such a small number of total cases that adding
them into the mix probably wouldn't be worth it. The study points out
that the Hybrid Capture II test hunts for all the high-risk HPV types
except 26, 53, 66, 73 and 82. Still, according to the study, in this sample
of women, the test would have missed only 1.1 percent of infections in
the group of patients with cancer and 0.4 percent in the control group.
"It's really nothing we're going to change practice on. It's a miniscule
change," Del Priore says. The key to cervical health is prevention. Women
should make sure they get screened regularly.
[Top]
Herpes,
HPV May Spell Cervical Cancer-(Health Scout News-06/11/2002)
New
research suggests that herpes and another common sexually transmitted
virus can be a deadly combination, raising the risk that infected women
will develop cervical cancer. The findings seem to explain why some women
are more prone to cervical cancer. "We know that HPV (human papillomavirus)
causes cancer, but a lot of people have HPV and never get cancer," explains
Stephen E. Hawes, an assistant professor of epidemiology at the University
of Washington at Seattle and author of a commentary on the new study.
An
estimated 13,000 American women fall victim to cervical cancer each year
and 4,100 will die, according to the American Cancer Society. However,
tests known as Pap smears let many more stop the disease in its tracks
before it becomes serious. Deaths from the cancer dropped by 74 percent
from 1955 to 1992, after the tests became popular. Scientists think at
least 90 percent of cervical cancer cases are caused by HPV, which may
be the most common sexually transmitted disease. HPV causes inflammation,
which makes the cervix more hospitable to cancerous cells by preventing
them from dying naturally, Hawes explains. "This process can take years
to develop -- 20 to 30 years after you have your initial HPV infection,"
he says.
Some
scientists have suspected that herpes could make things worse. An international
group of researchers tested that theory by examining medical records from
seven countries of 1,263 women with cervical cancer and 1,117 women free
of the disease. The findings appear in the Journal of the National Cancer
Institute. The researchers from the International Agency for Research
on Cancer found signs of infection with herpes simplex virus 2 in about
44 percent of the women with cancer, but only in 26 percent of the other
women. They also found HPV in nearly 95 percent of the women with cancer,
but only in 15 percent of the healthy women. Of all women who were infected
with HPV, herpes increased their risk of cervical cancer by two to three
times.
Dr.
Tom Wright, a pathologist at Columbia University, says the findings confirm
those of a 1991 study in Latin America. However, it's still unclear how
herpes works to make women more susceptible to cervical cancer since the
virus doesn't cause as much dangerous inflammation, he adds. There is
hope for the future, however. "The biggest issues right now are the development
of vaccines to prevent infection with high-risk types of HPV and new molecular
tests to identify those women at greatest risk for developing cervical
cancer," he says.
[Top]
New
Technique Tested Against Cervical Cancer (Reuters-04/09/2002)
British scientists
have devised a new technique that kills cervical cancer cells without
harming healthy ones, which could improve treatment for the deadly disease.
The technique, called RNA interference, wipes out the deadly cells by
silencing genes in a virus that contributes to the illness. "Our work
has identified a novel agent with major therapeutic potential for the
treatment, and possibly also the prevention, of human cervical cancer,"
Professor Jo Milner, of the University of York, said. Unlike chemotherapy,
which has serious side effects because it destroys healthy as well as
cancerous cells, RNA interference restores the immune system and only
targets the cancerous cells. Cancer develops when something goes wrong
during normal cell division and instead of destroying itself, the mutated
cell develops uncontrollably and forms a tumor.
Cervical cancer,
the second most common cancer in women worldwide, is linked to the human
papilloma virus which attacks two important proteins in the body called
p53 and RB. RB controls cell division and p53 kills damaged cells that
could become cancerous. Without them mutated cells can multiply uncontrollably.
But in laboratory studies using cancer cells from human tumors, Milner
and Dr. Ming Jiang found that when they silenced two genes in the virus
all the cancer cells died while healthy cells were not harmed. Their research
is reported in the journal Oncogene. "As soon as we silenced the viral
genes, the infected cancer cells committed suicide," said Milner, adding
that the results were "absolutely remarkable."
Cervical cancer affects
about 465,000 women worldwide each year and causes 300,000 deaths. If
the illness is diagnosed and treated early there is a high survival rate.
[Top]
More
Details on Cervical Cancer - Virus Link (Reuters Health-25/07/2002)
Human papillomavirus
(HPV) is known to increase cervical cancer risk. Now Dutch researchers
have found this risk may be increased 100 times among women harboring
a certain strain of the virus. There are more than 100 different types
of HPV, including some that cause genital warts. Some of these viruses
are sexually transmitted, and some are linked to cancer. It is believed
that certain "high-risk" HPV subtypes are the primary cause of cervical
cancer. However, HPV infection usually goes away on its own, and most
women who get the virus do not develop cervical cancer.
In the study, Dr.
Yolanda van der Graaf of the University Medical Center Utrecht in the
Netherlands and colleagues examined the medical records of 77 women who
developed cervical cancer and had submitted Pap smears before being diagnosed
with the disease. The researchers went back and tested the Pap smears
for signs of HPV and compared the test results from cancer patients to
270 women who did not develop the disease. The average follow-up time
between disease-free Pap smear and cancerdiagnosis was 5-1/2 years.
Reporting in a recent
issue of the American Journal of Epidemiology, the investigators found
that 71% of women who later developed cervical cancer received earlier
Pap smears that showed no sign of cervical cancer, but did contain HPV.
In contrast, only 11% of women who never developed cervical cancer had
earlier Pap smears that tested positive for HPV. These numbers translate
into a 19-fold increased risk of developing cervical cancer for women
infected with HPV.
The link between
HPV and future risk of cervical cancer was especially strong in women
infected with high-risk subtypes of the virus, the report indicates. Women
infected with the subtypes 18, 31 or 33 were more than 50 times as likely
to develop cervical cancer as uninfected women. Furthermore, those who
were infected with the 16 subtype showed a more than 100-fold increased
risk of cancer compared with those who were virus-free, the team found.
While many women with HPV eventually clear themselves of the infection,
for a minority of women HPV persists. Previous research has shown that
women with persistent infections are more likely than others to develop
tissue abnormalities that can become cancerous. Indeed, in this study,
van der Graaf and colleagues found that 78% of women who later developed
cervical cancer had persistent HPV infections. The link between HPV type
and cancer has led researchers to consider whether screening women for
HPV might act as an early test for cervical cancer. If laboratories are
able to pinpoint certain HPV subtypes, as well as the amount of virus
present in samples, the authors write, testing for HPV may indeed become
useful as a primary screening tool for cervical cancer.
[Top]
Study
finds pill increases cervical cancer risk in some women-(Associated Press-26/03/2002)
Women
infected with the common sexually transmitted human papilloma virus could
be more likely to develop cervical cancer if they have taken birth control
pills for a long time, new research has found. Some gynecologists believe
that contraceptive pills might increase the risk of cervical cancer, but
others are doubtful because previous studies have not ruled out the possibility
that pill users might simply be more likely to be infected with the human
papilloma virus, the main cause of cervical cancer. Experts say the new
study, conducted by the International Agency for Research on Cancer, an
arm of the World Health Organization, lends support to the view that there
is a real connection between birth control pills and cervical cancer.
However,
Dr. Jack Cuzick, head of mathematics, statistics and epidemiology at Cancer
Research UK in London, who was not connected with the study, said the
findings should be interpreted cautiously because the women were only
tested for the human papilloma virus, or HPV, once. "Ideally, they should
be positive on two occasions, at least six months apart, before you call
them positive," he said.
Virtually
all cervical cancer is caused by the human papilloma virus, or HPV. Nearly
all sexually active women will be infected by HPV sometime during their
lives, but in most cases the immune system quickly eliminates it. The
key issue is why, in some cases, the virus is not eliminated. If the infection
persists, the chances of cancer increase enormously. "This study suggests
that if you've got an HPV infection, oral contraceptives may actually
be promoting the rate at which that progresses to cancer," Cuzick said.
The
research was to be published on the Web site of The Lancet medical journal.
The
WHO researchers pooled evidence collected in eight earlier studies of
3,769 women from four continents, who were tested for HPV and told the
investigators about their use of birth control pills. A total of 1,853
had cervical cancer, while 1,916 did not. As expected, nearly all the
women with cancer tested positive for HPV, while hardly any who were cancer-free
had the virus.
The
WHO researchers found that women infected with HPV who had used birth
control pills for an accumulated total of five years or more were nearly
three times more likely to develop cervical cancer than HPV infected women
who had never taken the pill. The increased risk persisted for up to 14
years after stopping the contraceptives. Women who had taken the pill
for 10 years or more were four times more likely to get the disease than
those who had never taken it. Using the pill for less than five years
did not result in a higher chance of cervical cancer. The study also found
that women who had taken the pill were no more likely than the others
to be carriers of HPV.
That
indicates that rather than enhancing the chances of getting an HPV infection
or of prolonging one - as some have suspected - the pill promotes progression
of the infection to cancer, said David Skegg, head of the preventive and
social medicine department at the University of Otago in New Zealand who
was not involved in the research.
Women
have about a 1 percent chance of developing cervical cancer. That means
that, based on the study's findings, taking the pill for five years or
more could push that chance up to about 3 percent and taking it for a
total of 10 years could raise it to about 4 percent.
Worldwide,
almost 360,000 women were diagnosed with cervical cancer in 1990, the
latest date for which figures are available. Of those, 190,000 died of
the disease. It is the second most common cancer in women. Cervical cancer
strikes 12,900 American women each year and kills 4,400 of them.
[Top]
FDA
Panel Backs Cervical Cancer Screening Test-(Reuters Health-08/03/2002)
A
panel of expert advisors to the US Food and Drug Administration (FDA)
conditionally backed the expanded use of a human papillomavirus (HPV)
DNA probe for cervical cancer screening. The FDA's Microbiology Device
Panel voted 6 to 2 in favor of approving Digene Corporation's HPV DNA
test Hybrid Capture 2 as a general screening test for the absence of high-grade
cervical disease or cancer, when used in conjunction with a Pap smear
in women aged 30 and older.
The
Hybrid Capture 2 can detect 13 HPV DNA types in cervical specimens. HPV
is a common infection, affecting an estimated 75% of sexually active American
adults. Often the infection goes away on its own. But infection with certain
HPV strains is linked to an increased risk of cervical cancer. If the
FDA should follow its committee recommendation, the test would now be
indicated for helping identify women at risk for cervical cancer based
upon the presence of HPV. The FDA previously cleared the first-generation
hybrid DNA probe in 1995 for determining the grade of HPV-related disease
in confirmed cases and to support unclear Pap smear results. The Hybrid
Capture 2 is an updated version of that first-generation test.
In
seeking the new indication, Digene's Chief Scientific Officer Dr. Attila
Lorincz said that the company was in effect seeking to develop a new stratification
system for high-risk women. At present, Lorincz noted that women are classified
as either high-risk or low-risk based upon their and their partner's sexual
history. Lorincz said the HPV test would provide a more objective method
for identifying high-risk individuals with a negative Pap smear result.
Lorincz said those women could then be followed more closely, allowing
for earlier intervention. "Imagine, there are about 5,000 deaths a year
due to cervical cancer. This is a highly treatable disease when caught
early. There should be no deaths," Lorincz said.
Under
the current American College of Obstetrics and Gynecology (ACOG) guidelines,
women 30 and older are encouraged to have a Pap smear every one to three
years. Women with positive results are either given a more invasive test
for cervical disease or re-tested more frequently, depending upon the
grade of the results.
Testifying
on behalf of the company, experts said the DNA probe would also provide
additional assurance to millions of women that they are at low risk for
the disease. The Pap smear currently misses about 50% of patie |
