Baltimore County offering free Pap tests

Baltimore, MD

In honor of January being Cervical Cancer Awareness Month, the Baltimore County Health Department is offering free Pap tests, mammograms and breast exams for eligible women between 18 and 65.

The department also screens for eligibility, schedules appointments and manages the cases of women with abnormal test results.

About 11,000 women in the United States are diagnosed with cervical cancer each year, and more than 3,500 women will die from the disease. A Pap test, which is recommended annually, is one of the most effective ways to detect cervical cancer, health officials said.

For more information on these free tests, call 410-887-3432 or visit baltimorecountymd.gov/go/cancerprogram.

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January is National Cervical Cancer Awareness Month

As the month of January brings cervical cancer into focus, it’s a great time to increase public understanding of the disease, including its prevalence, approaches to screening and prevention, treatment options, and resources that offer updated cervical cancer information throughout the year.

Cervical cancer affects the cervix, the part of the body that connects the uterus (or womb) to the vagina (or birth canal). Each year in the United States, more than 11,000 women are diagnosed with cervical cancer and close to 4,000 die of the disease.[1] Certain types of the Human papillomavirus (HPV), most commonly HPV 16 and HPV 18, are linked to cervical cancer, and several other high-risk types of HPV also contribute to cancer. Vaccines such as Gardasil® and Cervarix™ that are designed to prevent infection with high-risk types of HPV have the potential to greatly reduce the occurrence of cervical cancer.

Staying informed with the latest news on prevention and screening is an important step in reducing your risk of developing cervical cancer, while access to current, in-depth treatment information can help you choose optimal care and achieve the best possible outcome from treatment.
Learning More About Cervical Cancer

* Find informative tips on managing cervical cancer at Cervical Cancer Tips.
* To find expanded information on the prevention, screening, and treatment of cervical cancer, stay updated with the lasted news on the disease, and join a cervical cancer community, visit the Cervical Cancer Information Center.
* Women&Cancer magazine covers a broad range of women’s health topics including cervical cancer. This quarterly women's health and lifestyle magazine is dedicated to topics related to the prevention and management of cancer while emphasizing wellness, fostering community, and inspiring hope. Free one-year subscriptions are available at http://womenandcancermag.com/Subscribe2.aspx.
* Sign up to receive Cancer Consultants’ free online cervical cancer newsletter, which provides disease-specific features, current news, tips, and nutrition and wellness information. Subscribe at http://patient.cancerconsultants.com/MemberCenter.aspx/.
* Visit the Cancer Store on Cancerconsultants.com for book titles with topics ranging from personal cancer memoirs to expert nutritional guides about fueling your body to prevent and fight cancer.

Reference:

[1] American Cancer Society. Cancer Facts and Figures 2008. Available at http://www.cancer.org/docroot/STT/stt_0.asp. (Accessed December 2008).

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Doctor tries to boost the odds for cervical cancer patients

Baltimore, MD

Dr. Robert Bristow is an associate professor in Johns Hopkins School of Medicine's Department of Gynecology and Obstetrics and the director of the Kelly Gynecologic Oncology Service at the Johns Hopkins Ovarian Cancer Center. For Cervical Cancer Awareness Month in January, Bristow discussed the move toward robot-assisted minimally invasive surgery and how to reduce cervical cancer rates. More than 11,000 new cases of cervical cancer will be diagnosed in the United States this year, and 3,870 people are expected to die from the disease.

What kinds of gynecologic cancers are there, and are you more focused on cervical cancer?

The three main gynecologic cancers are ovarian, endometrial and cervical cancer. Endometrial is uterine cancer, and that's the most common. Ovarian is the second-most common, but has the highest mortality rate. Ovarian cancer by itself has a higher mortality rate than cervical and uterine combined. It tends to present at a more advanced stage. It's harder to detect early and harder to treat in an advanced stage.

Cervical and uterine tend to present at an earlier stage, and therefore have a higher cure rate.

One of my principal areas of interest is surgery and surgical techniques and research, and one of the things I have been very excited about in the last 12 to 18 months is [the] push to start doing surgeries for cervical cancer and uterine cancer using a minimally invasive approach using the robot.

How does it work?

With standard laproscopic surgery, which is known as keyhole surgery, you are doing an operation in the abdomen through three or four very small incisions using instruments that are a foot or a foot-and-a-half long.

There is a fairly flat learning curve for that. It takes a long time to get proficient in operating that way, because you are operating at the end of a stick, and all your motions with your hands are in reverse.

The robotic surgery is a system set up with computer-enhanced instruments that are similar to the laproscopy instruments but the surgeon sits at a console 10 or 15 feet away from the patient.

The advantage is the instruments are wristed so they can move like the human wrist, so you have about 270 degrees of motion. There are two optical tubes so when you sit down at the console, you are seeing it in three dimensions.

It really expands our capabilities in terms of what we are able to do from a technical standpoint. It's faster and it's also better for the patients.

Patients have virtually no pain after this procedure. You go and see them the day after the surgery and they are up packing their bags getting ready to get out of the hospital after a radical hysterectomy for cervical cancer, where they would normally be in the hospital for three or four days.

So what is the catch?

Part of the catch is for a hospital, there is a big capital investment and the expense to invest in the robot. And there is a learning curve to it.

It's much easier to learn than straight laproscopy, but you can't take someone without any prior experience and sit them down at the console and expect them to be able to do the operation in a reasonable amount of time.

You are using this with cervical and uterine cancer and some early ovarian cancers. Why not more ovarian cancers?

About 70 percent of ovarian cancers present with advanced disease where the tumor has spread out of the ovaries and the uterus and is in the colon or the liver. The goal for those surgeries is to do a debulking, which is basically to get all the cancer out you can see. That is not a procedure that lends itself readily to the keyhole surgery.

How did you get interested in this field of gynecologic oncology?

I ultimately decided to go into obstetrics/gynecology for a selfish reason. It was the rotation I had as a medical student I had the most fun on. I originally wanted to go into just obstetrics, because that was the most enjoyable to me.

Then I came to Hopkins for my residency and the first rotation I did was oncology. I started on July 1, and by the Fourth of July, I knew this was what I wanted to do.

The patients were so sick and so challenging, and they were really the patients that needed someone to take care of them. I really gravitated to that.

Isn't it hard to cope with patients that don't always have good outcomes?

It has a lot to do with your perspective and the old adage of whether the glass is half-empty or -full.

We are always going to hope to cure the cancer, but realistically we aren't going to be able to do that for everybody. We may not even do that for most people.

The question becomes how are you going to help the folks that aren't going to survive their cancer really survive in the time they have left and have a good quality of life.

Have screening techniques improved for cervical cancer?

I think we are getting better. The Pap test is the conventional test for cervical cancer. It has its limitations. It's not a perfect test, and the reason women get annual tests is because it can miss some signs of early cancers. But if you string together enough tests in a row, you will be likely to pick them up.

One of the things that came out about five years ago or so is the idea of testing for the human papillomavirus, or HPV, which is a causative agent for about 90 percent of cervical cancers. Now that can be coupled with the Pap test to identify a higher-risk population of women who may benefit from a more aggressive screening program.

So I think those two testing tools are probably as good as we really need to identify precancer and be able to treat it.

But the big problem we have with cervical cancer is access to screening techniques.

If you could guarantee that every woman in Maryland could get a Pap test plus or minus an HPV test for her whole life, we could probably eradicate cervical cancer.

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Bill in Alabama could help prevent cervical cancer and save lives of women

Selma, AL

Cervical cancer claimed an estimated 3,870 women nationwide this year with another 11,070 reported cases, according to the National Cancer Institute.

Cervical cancer is a disease in which malignant cells form in the tissues of the cervix, located at the lower end of the uterus, leading to the vagina, or birth canal. Infection of the cervix with human papillomavirus (HPV) is the most common cause of cervical cancer, but it’s important to know that not all women with HPV infection will develop cervical cancer.

State Rep. James Gordon, D-Mobile, has pre-filed a measure in the Alabama House that would require the State Board of Health to provide each parent or guardian of a female student entering the sixth grade information about infection and the immunization against HPV. Further, the measure would require each school that enrolls a sixth grade female to have the parents or guardians furnish to the school by the 20th day of the new school year a written statement to reflect the parent or guardians had received the information; the student has received or is receiving the immunization or the parent/guardian has decided not to have the student’s information handed over to the school.

Knowledge can save lives. Gordon’s attempt at educating Alabama parents and guardians is on target.

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Circumcision May Cut Cervical Cancer Rates

Saginaw, MI

HPV Less Common In Circumcised Men

Male circumcision may slow the spread of human papillomavirus, including the types that cause cervical and other cancers, two new studies said.

Researchers in one study looked at people in South Africa. They divided a group of 18- to 24-year-old men and had half circumcised. Over 21 months, they found that there was a lower chance of high-risk HPV infection in the circumcised men.

In another study, 400 men in two U.S. cities who showed no outward signs of HPV -- such as genital warts -- were tested. About 16 percent were uncircumcised. Circumcised men were half as likely to have HPV on their skin or in their semen.

Carrie Nielson of Oregon Health and Science University, who ran the U.S. study, said the results could mean baby boys should be circumcised to lower the risk of future diseases.

Circumcision rates have been dropping rapidly in the U.S.

Other studies, especially in developing nations, have shown that circumcised men are less likely to contract HIV.

Both studies are published in the January 1 issue of the Journal of Infectious Diseases.

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Allergic reactions to Gardasil uncommon: study

London

A study of Merck & Co Inc's cervical cancer vaccine Gardasil found that allergic reactions were uncommon and most young women can tolerate subsequent doses, Australian researchers said on Wednesday.

The research involved 25 Australian girls with suspected hypersensitivity to the vaccine which was administered as part of a national immunization program to all females aged 12 to 26 in the country beginning in 2007.

More than 380,000 doses of the vaccine have been given under the program, Sharon Choo of the Royal Children's Hospital in Melbourne and colleagues wrote in the British Medical Journal.

"Our clinical recommendation is that females with suspected hypersensitivity to the quadrivalent vaccine should be evaluated before receiving more doses, and any challenges with the same vaccine should be carried out in a supervised setting," they said.

Choo and colleagues noted some components of Merck's treatment -- such as aluminum salts and yeast -- have been associated with allergic reactions.

But skin tests of the 25 girls with suspected hypersensitivity showed that only three of them experienced probable reactions to the jabs.

The researchers also noted that suspected reactions such as hives are often "idiosyncratic" and do not increase the risk of adverse reactions in subsequent shots.

Gardasil and GlaxoSmithKline Plc's Cervarix are designed to be given to girls and young women to protect against cancer-causing strains of the sexually transmitted human papillomavirus (HPV), which can cause cervical cancer.

Gardasil targets four strains of HPV -- two responsible for cervical cancer and two causing the less serious condition of genital warts. Glaxo's product targets the two cancer strains.

In October, the U.S. Centers for Disease Control and Prevention reported that girls and young women given Gardasil were no more likely than usual to faint, have an allergic reaction, blood clot or other adverse reaction.

The report was based on 375,000 doses of the vaccine given from August 2006 to July 2008 after the agency had received 10,326 reports of adverse events following HPV vaccination in the United States.

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Merck targets univ. females in HPV vaccine campaign

College Park, MD

Junior physiology and neurobiology major Jamie Lee is on the fence.

She is trying to decide whether to receive the Gardasil vaccine, a drug released in 2006 that helps prevent certain types of cervical cancer and genital warts.

"I'm hesitant to take anything that hasn't been on the market very long," Lee said. "There hasn't been enough research on it."

But Merck, the company that makes Gardasil, wants to change her mind. This fall, the company launched an informational campaign about HPV, the virus that can cause cervical cancer, to encourage college-age women to talk with their doctors about the virus, Merck spokeswoman Darby Stern said in an e-mail. The HPV facts campaign is targeting 50 universities across the country.

Alli Matson, sexual health education programs coordinator for the University Health Center, said the campaign began in October with the launch of www.HPV.com, an informational website created by Merck. The program is set to continue through the end of the fall semester, Stern said in an e-mail. At the university, Merck is spreading information through coffee sleeves, brochures and fliers about how women can protect themselves against HPV.

"The HPV Facts campaign is part of our ongoing efforts to provide important disease information to young women so that they can talk to their doctors about how to help protect themselves against HPV," Stern wrote.

Gardasil became available at the university just months after its June 2006 release, Matson said. The three-shot series costs $150 per shot at the health center.

The shot was increasingly popular in its first year of availability, said Tina Thorburn, nursing supervisor at the health center. Thorburn didn't have access to exact numbers because the health center is updating its computer system, but she estimated there were as many as 200 students who have been vaccinated.

"When Merck was doing all the advertising on television, we got a huge amount of girls coming in for [Gardasil]," she said. continued

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