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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. 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. 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. 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. 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. 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! 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." 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 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. 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. 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." 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. 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. 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." 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." 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. 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. 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." 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. 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. 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. 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. 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. 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. 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. 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. 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. 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 patients with significant precursors for cervical cancer, observed Dr. Maureen Killackey, director of the Basset Regional Cancer Program in Cooperstown, New York. "It's clear to the public that the Pap smear is less than a perfect test," she said. Voicing similar support for use of the test was the Association of Reproductive Health Professionals, other healthcare professionals and patient advocates. In making the recommendation, the committee had to struggle with a different interpretation of the data and its clinical implications. A total of eight studies were submitted for the panel's consideration, including six conducted outside the US and three that were conducted using an older-generation test. The FDA said that only three of the eight tests showed a statistically significant difference in sensitivity, and due to the study differences, the data did not appear to be "poolable" across the studies to support approval of the test as a primary screening method. Digene countered that although the absolute increase in identifying low-risk individuals varied according to the Pap results, the relative increase in sensitivity was always significant when compared to the Pap smear alone. Panel members voting in favor of approval said they believed there was sufficient evidence to show that tests could aid detection, if coupled with the appropriate patient and physician education. "It's a good test, but we don't have the data for clinical practice," noted panel member Dr. L. Barth Reller, a professor of pathology and clinical microbiology at the Duke University Medical Center. The panel members said the recommendations should be developed prior to approval, but that they would leave it up to the FDA to determine if additional clinical trials might be needed. Digene CEO Evan Jones said that Digene believes new trials would not be necessary. Jones said it was the company's belief that it could work with the FDA to develop the appropriate recommendations. The FDA often follows its committee's advice, but the agency is not bound by their votes. If the FDA approves the new indication, Lorincz said Digene expects the DNA probe to have a moderate effect on screening for cervical cancer at first with a growing influence over time. Cost of the Hybrid Capture 2 currently ranges from $40 to $70. But Lorincz said Digene anticipates that the cost would decrease due to accompanying increase in volume. ACOG Director of Clinical Practice Mary F. Mitchell said the organization currently is also considering incorporating the HPV test into its guidelines, but does not at this time believe that there is sufficient data to make its addition clinically relevant. Approval for new Digene cancer test urged-(Reuters-11/03/2002) Digene's test for the virus that causes most cases of cervical cancer should be approved for use as a general screening test with Pap smears in women age 30 and older, a US advisory panel ruled. The gene-based test already is on the market for helping doctors and patients decide what to do when Pap smears, the standard screening tests for cervical cancer, provide inconclusive results. Wider use of Digene's test will catch women at higher risk for cervical cancer who are missed by annual Pap smears, the company argued. Called the Hybrid Capture 2 HPV DNA Test, Digene's test looks for the human papilloma virus (HPV), a sexually transmitted virus found in about 99 percent of cervical cancers. Pap smears detect abnormal cells that may be cancerous or precancerous. Members of a Food and Drug Administration (FDA) advisory committee voted 6-2 to urge agency approval for combining Digene's test with all Pap smears, not just questionable ones, in women 30 and older. Having HPV after age 30 suggests the virus may have persisted for years and is more likely to be dangerous. More than 35 million US women in that age group have Pap smears annually. "This (test) will improve cancer detection," said Dr. George Birdsong, a pathologist at Grady Memorial Hospital and a panel member. The test also may reassure women with normal Pap smears that they are at low risk for cervical cancer, which kills about 4,400 US women annually, Digene said. The disease is treatable if caught early but lethal in late stages. Having HPV, however, does not always mean cancer. The infection usually clears up without causing illness, and panel members expressed concerns about how women and doctors would react to positive results. Follow-up from a positive HPV test, with a normal Pap smear, could range from conducting different tests to advising a repeat of the same tests in a year or sooner. The panel urged the FDA to require Digene, as a condition of approval, to develop recommendations for how doctors should respond to test results and to provide educational materials for patients about what a positive HPV test means. Digene Chairman and Chief Executive Evan Jones said the company expected it would be able to meet the panel's conditions. FDA approval for using the test with Pap smears "should help establish a new standard" for cervical cancer screening, Jones said in an interview. Industry analysts say FDA approval for the wider use would expand significantly Digene's potential market for the product from its current indication, which covers the approximately 2 million abnormal U.S. Pap smears each year. HIV1 women more susceptible to cancer: Study-(Times of India Online-14/01/2001) According to the results of a study published in Lancet magazine, HIV-1 positive women are at increased risk of developing invasive vulvar cancer. In the USA, about 110,000-155,000 women are affected with HIV-1, and they are at an increased risk of developing preinvasive cervical lesions which are also known as the precursor to cancer and invasive cervical cancer. Conley and colleagues did a study in 925 women to investigate the incidence of these lesions in HIV-1 positive and HIV-1 negative women and to examine risk factors. The incidence of vulvovaginal or anal warts was 16 times higher in HIV-1 positive women than in HIV-1 negative women. Substantial information suggests an association between immunosuppression and development of warts. Viral warts and cancer were present in 30 of 481 HIV-1 positive and four of 437 HIV-1 negative women at enrolment. 33 of 385 HIV-1 positive and two of 341 HIV-1 negative women developed vulvovaginal or perianal lesions. At enrolment, and every 6 months thereafter, participants were interviewed and underwent gynaecological examination. This examination included visual inspection of the vulva, vagina, and perianal region, a Pap smear test, cervicovaginal lavage, cervical colposcopy, and, in some cases, biopsy. Study participants included 319 women from HIV-AIDS clinics, 142 from methadone maintenance clinics, 282 from sexually transmitted disease clinics, and 182 from a clinic for study of heterosexual HIV transmission. Age, race and ethnic origin, income, age at first sexual intercourse, and history of cigarette smoking did not differ by much between women infected and not infected with HIV-1. However, HIV-1 positive women were significantly more likely to have had human papilloma-virus DNA detected in a lavage sample at enrolment and to have had a history of prostitution, intravenous drug use, and a sexually transmitted disease. The incidence of vulvovaginal or perianal lesions was 16 times higher in HIV-1 positive than in HIV-1 negative women. Overall, nine of 478 HIV-1 positive women without viral warts at enrolment were subsequently diagnosed with high-grade viral warts. The number of cases of invasive carcinoma, identified in HIV-1 positive women during the study, lend support to the findings of Frisch, that malignancies associated with human papilloma virus increase in people with HIV-1. As a result, during gynaecological examination, HIV-1 positive women should have a thorough inspection of the vulva and perianal region. Women with any degree of abnormality, except for typical, visible benign lesions, should be referred for colposcopy and biopsy, so that pre-invasive or invasive disease can be ruled out. Smallpox vaccine to cure cervical cancer –(Times of India Online-21/11/2001) Scientists at the British Biotechnology firm, Xeneva Group Plc have made a major breakthrough with the discovery of a modified version of the smallpox vaccine which is being seen as an effective cure for Human Papilloma Virus (HPV). Doctors at Britain's Cancer Research Campaign are hoping that with this vaccine they will be able to curb the deadly Human Papilloma Virus from spreading in the human body and causing cervical cancer. They feel that it will boost the body's immune system against the virus enough to prevent infected cells from developing into cancerous cells. However the vaccine is still to be tested. Says Dr. Stephen Man, University of Wales,"We hope to recruit at least 20 women infected with the virus to see if the vaccine actually works. Each patient will be given the vaccine. Thereafter, their blood tests, and tissue samples will be examined and their immune response will be monitored to see if the vaccine is effective in any way." Dr.Man and his colleagues, Dr.Alison Fiander and Dr.Amanda Tristam are hoping that the vaccine proves to be an alternative to laser treatment and surgery, generally used to battle cancer. HPV is a fairly common virus and nearly eighty percent of the world population of women is affected with it at some time during their lives. In most cases the immune response is sufficient enough to deal with it but in some cases, the early cells turn into cancerous cells. Although there are more than a hundred types of the Human Papilloma Virus, not every one of them causes cervical cancer. It is only types sixteen and eighteen that carry the highest risk for cervical cancer. Cervical cancer affects almost 465,000 women worldwide each year and is responsible for nearly 300,000 deaths. If diagnosed and treated in its earliest stages, this type of cancer can be cured. Scientists are very optimistic with the discovery of this new vaccine and even before the tests are showing positive results, researchers have begun work on developing vaccines for women in advanced stages of cervical cancer. In addition to this work is on to discover preventive drugs to protect young girls from becoming infected with HPV. Common virus may reduce cervical cancer risk-(Times of India Online-08/04/2001) A common virus may interfere with the human papillomavirus (HPV), a sexually transmitted infection linked to cervical cancer. In a new study, women with HPV who also were infected with the adeno-associated virus (AAV) were less likely to have cervical abnormalities, or lesions, that could become cancerous. AAV may interfere with HPV to help protect women from developing precancerous lesions that sometimes develop into cervical cancer. There is however a need for long-term studies to find out the precise role of AAV in women with HPV. HPV can cause genital warts, although the infection does not always cause symptoms. Some strains of the virus increase a woman's risk of cervical cancer. The study followed more than 300 South Carolina women, who received routine Pap smears at county health departments. Fifty-five had high-grade cervical lesions, meaning the abnormalities had a high risk of becoming cancerous; 162 women had low-grade lesions and 96 were lesion-free. Nearly 71 per cent of women without cervical lesions and 67 per cent of women with low-grade lesions tested positive for AAV. The AAV infection was present in only about 54 per cent of women with high-grade lesions. The researchers also found that women with higher levels of AAV had a lower risk of high-grade lesions, and that high-grade lesions were most common in women who had HPV but did not have AAV. Screening for HPV and AAV at the time of a routine Pap smear may help identify women at increased risk of developing high-grade lesions, according to the investigators. However, the relationship between AAV and HPV needs to be confirmed first. The researchers are not sure how AAV may reduce the risk of cervical lesions. More and more evidence suggests that AAV and HPV infect the same tissue in women, so the two viruses may interact in some way. AAV may interfere with high-risk HPV's ability to integrate into human cells. But the exact role of AAV remains uncertain. If confirmed, the findings may lead to a better understanding of cervical cancer, and perhaps improved screening for and prevention of the disease. There is still no consensus on screening for HPV, which is definitely linked to cervical cancer. New vaccine approach may help treat and prevent pre-cancerous lesions and cervical cancer-(Cancer Info-28/03/2001) A new vaccine approach may help treat and prevent pre-cancerous lesions and cervical cancer. Researchers have identified new vaccine targets for cancer-causing strains of the human papilloma virus (HPV). The scientists reported the discovery of four epitopes (protein fragments) from the virus that can induce a cellular immune response in human cells in vitro and may lead to an effective vaccine for treatment and prevention of cervical intraepithelial neoplasia (CIN), pre-cancerous lesions that develop into cervical cancer. An estimated 20 million Americans are infected with HPV, a virus that is well known for causing genital warts but also accounts for over 95 percent of cervical cancer cases. CIN lesions, which precede most if not all cases of cervical cancer, occur in over 50,000 women in the United States each year. Currently, CIN is detected by PAP smear and treated by surgical removal of the pre-cancerous lesions, a costly procedure that may result in reproductive complications and requires continual post-surgery monitoring for recurrence. A vaccine is being developed that is designed to bolster the immune system against HPV, potentially providing a new way to treat and prevent both CIN and cervical cancer. Previous research has indicated that a cellular immune response led by cytotoxic T cells is capable of controlling tumor growth and destroying virus-infected cells in HPV-infected patients. The latest research shows that it may be possible to emulate this successful immune response with a vaccine that consists of epitopes from several cancer-causing strains of HPV. There are over 70 identified types of HPV, but only a relatively few high-risk strains, including HPV-16 and HPV-18, are known to cause CIN and cervical cancer. Scientists have identified epitopes predicted to activate cytotoxic T cells (CTLs) from several proteins of most cancer causing HPV strains. The current study showed that four epitopes from HPV-18, three derived from E6 and one derived from E7, were highly immunogenic using human cells in vitro, meaning they induce a CTL response. Research by others has indicated that E6 and E7 proteins are "oncoproteins" that are responsible for the transformation of HPV-infected cells into CIN and cancer cells. It is believed that a vaccine based on epitopes derived from these proteins may provide strong therapeutic benefit by teaching the immune system to recognize and attack HPV-infected cells at all stages of pre-cancerous and cancerous development. Clinical trials of an HPV epitope-based vaccine have shown the potential benefit of this approach to treat CIN. The conformation of additional HPV epitopes, such as those identified in the current study, is important in creating an effective vaccine. The present cancer program is focused on developing vaccines for breast, colon and lung cancer as well as prostate and CIN/cervical cancer using gene maps of cancer-associated proteins and infectious agents to design vaccines that induce cellular immunity. An extensive technology platform is based on pioneering work in deciphering the genetic code which regulates T-cell activation and identifying antigen fragments known as epitopes which can activate highly targeted T-cell responses to tumors, viruses, bacteria and parasites. This new field of pharmacology opens two significant areas of pharmaceutical development: protective vaccines that activate T-cell protection against infections, such as HIV and hepatitis C, and therapeutic vaccines designed to stimulate antigen-specific T-cell responses to infections, such as HIV, hepatitis C and hepatitis B, and tumors such as breast, colon, lung and prostate. Scientists identify new vaccine targets for cancer-causing strains of human papilloma virus-(Cancer Info-28/03/2001) A new vaccine which targets cancer-causing strains of the human papilloma virus (HPV) may help treat and prevent pre-cancerous lesions and cervical cancer. Four epitopes (protein fragments) from the virus that can induce a cellular immune response in human cells in vitro and may lead to an effective vaccine for treatment and prevention of cervical intraepithelial neoplasia (CIN), pre-cancerous lesions that develop into cervical cancer have been identified. An estimated 20 million Americans are infected with HPV, a virus that is well known for causing genital warts but also accounts for over 95 percent of cervical cancer cases. CIN lesions, which precede most if not all cases of cervical cancer, occur in over 50,000 women in the United States each year. Currently, CIN is detected by PAP smear and treated by surgical removal of the pre-cancerous lesions, a costly procedure that may result in reproductive complications and requires continual post-surgery monitoring for recurrence. The new vaccine is designed to bolster the immune system against HPV, potentially providing a new way to treat and prevent both CIN and cervical cancer. Previous research had indicated that a cellular immune response led by cytotoxic T cells is capable of controlling tumor growth and destroying virus-infected cells in HPV-infected patients. Research shows that it may be possible to emulate this successful immune response with a vaccine that consists of epitopes from several cancer-causing strains of HPV. There are over 70 identified types of HPV, but only a relatively few high-risk strains, including HPV-16 and HPV-18, are known to cause CIN and cervical cancer. Epitopes predicted to activate cytotoxic T cells (CTLs) from several proteins of most cancer causing HPV strains have been identified. The study showed that four epitopes from HPV-18, three derived from E6 and one derived from E7, were highly immunogenic using human cells in vitro, meaning they induce a CTL response. It is believed that a vaccine based on epitopes derived from these proteins may provide strong therapeutic benefit by teaching the immune system to recognize and attack HPV-infected cells at all stages of pre-cancerous and cancerous development. Chlamydia Infection Linked to Cervical Cancer-(Cancer Info-17/01/2001) If the message to
practice safe sex weren't strong enough, consider this: a new study shows
the sexually transmitted disease chlamydia increases a woman's risk of
developing cervical cancer. Chlamydia trachomatis,
which strikes more than 4 million people each year, has been found to
increase a woman's risk of squamous cell carcinoma of the cervix 6.6 times.
The study is based on blood samples of 128 women with advanced cervical
cancer in Finland, Sweden and Norway. The human papillomavirus
(HPV) is a common sexually transmitted disease closely associated with
cervical cancer. Until now, there has been no clear link between chlamydia
and cervical cancer, although it has been linked to pelvic inflammatory
disease and infertility. An estimated 12,800 women are diagnosed with
cervical cancer every year in the United States and about 4,800 will die
from it. This is the first study providing evidence of an association
between exposure to specific serotypes of C trachomatis and cervical cancer.
Many people may not
know they have a chlamydial infection because symptoms may be mild or
not present. Symptoms of chlamydia may include: Abnormal discharge
(mucus or pus) from the vagina or penis In the study, women
were tested for 10 types of chlamydia and three were linked to cervical
cancer. Serotype G was found to increase a woman's risk by 6.6 times.
Serotype D increased the risk by 2.7 times and serotype I by 3.8 times,
according to the study. Those exposed to more than one serotype also showed
an increased risk. The researchers controlled for HPV and smoking, which
is also a risk factor for cervical cancer. The authors say that
although the link between bacterial infections and cancer is not clear,
genetic damage and the body's response to cell changes "could initiate
or promote cervical carcinogenesis." These data provide additional justification
for expanding chlamydial infection screening, not only to protect against
pelvic inflammatory disease and infertility, but potentially to prevent
cervical cancer. The good news from the report is that cervical cancer is one of the few diseases in which the causes are becoming clearer, although more research is needed. Cervical Cancer Study in the Shanxi Province of China-(Times of India-06/08/2000) The Pap test for detecting cervical cancer is among the top success stories of modern medicine. Since the test was developed in the 1940s, the mortality rate from cervical cancer in some populations has dropped by 84%. In other parts, however these effects have yet to filter to. In developing countries where medical infrastructure cannot support expensive or complicated testing, only about 5% of the women have ever had a Pap test. As a result cervical cancer remains one of the leading causes of death. A new screening test, which is less expensive and can be performed in areas without sophisticated resources must be developed. Researchers have focused on the Shanxi province in China where cervical cancer rates are 20-30 times higher than in the United States and conventional Pap tests are difficult or impossible to obtain. 2100 Chinese women between the ages of 35 and 45 were screened for whom the risk of cervical dysplasia is the highest. 6 different screening tools were investigated: -The ThinPrep Pap Test. -Two tests for detecting evidence of infection with human papilloma virus or HPV which is related to virtually all cases of cervical cancer. A self test taken by the women themselves and that taken by doctors. -Nonmagnified visual inspection of the cervix. -Fluorescence spectroscopy which uses a laser beam to differentiate normal from abnormal tissue. -Colposcopic examinations (magnified visualization) Biopsies were also performed to compare the accuracy against these benchmarks. Once data has been analysed, researchers hope to determine which tests or combinations of tests will be most effective in different parts of the world, depending on human and financial resources. The return of the virus-(Bombay Times-05/05/00) The human papilloma virus, which causes most of the world’s cervical cancer, also appears to cause some oral cancer, mostly tumours found in the tonsils. These tumours are, however, much less deadly than other cancers of the Head and Neck that are caued by the usual culprits, smoking or alcohol. Cervical Cancer Education Website Launched (Reuters Health- 07/01/00) The first Internet-based cervical cancer public education campaign was launched on 6th. The goal of the campaign is to reach 5 million women this month, designated Cervical Cancer Month, via the website, www.cervicalcancercampaign.org. The site's launch was announced during a live webcast organized by the American Medical Women's Association, America Online, and the National Cervical Cancer Public Education Campaign. Spokespersons with the campaign noted that each year 500,000 women are diagnosed with the cancer worldwide. The purpose of the website is to educate women as to the importance of regular Pap smear screening in the early detection of cervical cancer. The site also includes information about the link between the sexually transmitted disease human papillomavirus (HPV) and cervical cancer and the tests that are now available to test for HPV. Most cases of cervical cancer are linked to HPV infection. "Cervical cancer is preventable,'' Dr. Angel Houghton of Houston, Texas, and the American Women's Medical Association told reporters. "Unclear results on Pap smear can be confirmed with HPV testing,'' she added. "No women need die from this disease. It is curable if caught early,'' Houghton asserted. Study backs alternative to pap tests - (TOI-06/01/00)
One stop screening for cervical cancer successful (Reuters Health-16/12/99) Source-Cancer 1999:86:2659-2667 In California, cervical cancer is more than twice as common among Hispanic women than non-Hispanic whites. Part of the reason for this is poor cancer education, screening, and treatment among certain high-risk groups, but a new study suggests that these factors can be significantly improved by a new approach: one-stop education and screening at a neighborhood church. In the December 15th issue of the journal Cancer, Dr. Christina Holschneider of the University of California Los Angeles and colleagues from there and elsewhere report on a pilot program run at an inner-city church in South Los Angeles. All non-pregnant women over 18 in the congregation who had not had a Pap smear in the last year were invited to participate in the free program, offered before and after Sunday religious services for six weeks and on three Saturdays. The program, offered in English and Spanish, began with the women completing a survey about their health history, behavior, and knowledge. A Pap smear was then taken and processed immediately onsite by a board-certified cytopathologist. While awaiting the test results, the women were given a short education program about cervical cancer awareness and prevention. The Pap smear results were given to each woman privately, and if needed, additional testing was done. ``Once it is more broadly implemented, this novel, single-visit approach could prove to be a major breakthrough'' in attempts to decrease the rate of cervical cancer in hard-to-reach communities, the study authors conclude. |
