Presentation to FDA intended to raise awarenes of Gardasil cervical cancer vaccine risks

Critics of Gardasil vaccine speak up to FDA about Gardasil risks

FORT WAYNE, Ind.

A Fort Wayne couple is keeping their fingers crossed that a presentation Friday before Food and Drug Administration officials will open eyes about the risks associated with the Gardasil vaccine.
Multimedia.

Several FDA offices were scheduled to hear testimony on behalf of parents who say their daughters have died or suffered debilitating side effects from the drug designed to prevent cervical cancer.

Dan and Kim Chitwood's daughter Taylor has battled seizures since taking Gardasil shots two and a half years ago.

Kim Chitwood says, “Just very hopeful that this will be presented in a way that, um, nationally and worldwide, people will find out about Gardasil and things that it can cause."

Caleigh Miller of Fort Wayne is also suffering from seizures; a problem her parents are convinced is a result of Gardasil shots.

The Centers for Disease Control stand behind the vaccine, as a safe way to prevent cases of cervical cancer that health officials insist will otherwise kill thousands of women.

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Detect cervical cancer at early stage

Pensacola, FL

According to the American Cancer Society, more than 1,400,000 people in the United States were diagnosed with cancer last year.

February is "National Cancer Prevention Month". By keeping yourself healthy, you can help prevent some types of cancer.

One of the types is cervical cancer. Cervical cancer can be detected by your gynocologist. It's important to have regular pap smears to prevent cervical cancer, which is caused by the STD human papillomavirus.

"In the united states, HPV counts for about 20 million new infections per year. In fact, about 80 percent of all women will acquire HPV by time they're 50-years-old," said Dr. Rodney Rocconi, U.S.A. Mitchell Cancer Institute.

Dr. Rocconi said sometimes HPV is asymptomatic, and if it's left untreated, some types can cause cancer. But with regular pap smears, at least once a year, cancer can be prevented.

"It usually develops over a period of years into a pre-invasive disease so there's some subtle changes that happens to the cervix that smolder for years without symptoms. So what's very important for women is to make sure they get their pap smears on time so that you can catch it in those pre-invasive states. When done so and done properly, those are always curable cases so it's very important," he said.

If a woman does develop abnormal cells on her cervix, and the cells are detected early on, they can be destroyed.

"Treatment for pre-invasive disease is quite easy. It involves either laser, freezing the cells, sometimes even removing parts of the cells like a biopsy. And those types of surgeries can preserve fertility which is important in the young patient population. Early cervical cancers also have a fairly good cure rate as well," said Dr. Rocconi.

He said prevention is key. That's why it's so important for early screening. He also says women should spread the word to female friends and family to get screened, because it could save their lives.

Dr. Rocconi also suggests that woman get vaccinated against the cancer causing strains of HPV. The Gardasil vaccination has been approved by the FDA for girls as young as nine-years-old.

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Pap smear test first line of defense against cervical cancer

Maryville, TN

Don't be telling Dr. Kim Collins you don't have time for your Pap test, or that it's uncomfortable, or that you don't like going to the doctor. She's not buying those excuses.

“Just woman up and do it,” Collins said.

Collins, an obstetrician/gynecologist with Women's Care Group in Maryville, said the importance of having a Pap test cannot be overemphasized. This simple test can detect potential problems in their earliest stages, allowing treatment to begin before the condition becomes cervical cancer. Cervical cancer is a slow growing cancer caused by certain strains of the human papillomavirus (HPV), an extremely common sexually transmitted disease among women and men.

Cervical cancer has no warning signs in early stages. This is why Pap tests are so important. In the Papanicolaou (Pap) test, cells are gathered from the cervix and then examined closely under a microscope for abnormalities. Collins said cervical cancer rates in the United States have fallen more than 50 percent in the past 30 years thanks to the widespread use of the Pap test.

New guidelines for Pap screenings were released in December 2009. Rather than an annual Pap test, women ages 21 to 29 may be screened every two years, and women 30 and above every three years as long as they have had three negative Paps in row. Collins emphasized that an annual physical exam is still indicated because it involves much more than the one test.

According to the Tennessee Department of Health, risk factors for cervical cancer include high-risk sexual behavior; a personal and/or family history of cervical cancer; cigarette smoking; and previous HPV infection. African-American women are more prone to develop cervical cancer than Caucasian and Hispanic women are.

As for having Pap tests, Collins won't accept any excuses for avoiding them.

“I tell my patients this about mammograms and Pap tests,” Collins said. “Is this your favorite thing to do? No. But, when they say this is painful or uncomfortable, my response is, ‘Not as uncomfortable as surgery and radiation and chemotherapy.' There are worse things. If you eventually get diagnosed, you're headed for far more discomfort and pain.”

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Free cervical cancer screenings offered in Valdosta, Florida

Tallahassee,FL

South Georgia Medical Center invites all women who have not had a pap smear in at least three years to get one for free tonight at the Pearlman Cancer Center.

The American Cancer Society says more than 11,270 new cases of invasive cervical cancer were detected last year.

Doctors encourage women to keep up with regular screenings.

"Pap smears actually detect pre-cancerous legions, which is a great advantage in the sense of heading off cancer," said Dr. Boland Woodward, an obstetrician-gynecologist with Southern OB/GYN in Valdosta.

Screenings and breast exams are being offered today at the Pearlman Cancer Center until 7 p.m. But the latest is that they're full with pre-scheduled appointments. And walk-ins will no longer be offered tonight.

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Importance of Pap Smear Test cervical cancer screening emphasized by Missouri doctor

Osage Beach, MO

During Cervical Cancer Screening Month and Cervical Health Awareness Month in January, physicians with Lake Regional Health System in Osage Beach, Mo., are encouraging women and parents of young girls to learn more about early detection and prevention.

“It’s important that women know about this disease,” said Gynecologist Becky Simpson, M.D., with Lake Area Women’s Center in Osage Beach. “It can be treated if detected early, and most cases now can be prevented.”

According to the American Cancer Society, nearly 12,000 U.S. women are diagnosed with cervical cancer each year, and about 4,000 die from it. However, more lives are being saved thanks to increased use of the Pap test — the screening procedure used to find changes in the cervix before cancer develops — and a recently approved vaccination.

Almost all cases of cervical cancer are caused by the Human Papillomavirus — the most common sexually transmitted disease. If an HPV infection isn’t treated or doesn’t clear on its own, it eventually can result in cervical cancer.

“The fastest, easiest way to detect HPV is through an annual Pap test,” Dr. Simpson said. “During this test, we take a sample of cells from the cervix, which is the bottom part of the womb. The cells then are examined for abnormalities or infections, which can be early signs of cancer.”

If an HPV infection is detected and the abnormal cells are treated early, most cases of cervical cancer can be prevented. For this reason, doctors recommend annual Pap tests and pelvic exams for women ages 18 and older, or those who have become sexually active.

Doctors also encourage women ages nine to 26 to get vaccinated against HPV. The vaccine, Gardasil, is a series of three vaccines. They help protect against four types of HPV, two of which cause 70 percent of cervical cancer cases.

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U.S. experts mixed on whether HPV Test should replace Pap Smear Test to diagnose cervical cancer

Norwalk, CN

DNA testing for the human papillomavirus should replace the Pap smear as the main way to screen women for cervical cancer, according to Italian researchers.

Their recommendation is based on a study that found that the human papillomavirus (HPV) test prevented more cases of cervical cancer than the conventional Pap smear. Results of the study were published online Jan. 19 in The Lancet Oncology.

The HPV test should become the screening tool of choice for women 35 and older, the researchers said. It could be done less frequently than the Pap test, which could be used only in women who have tested positive for HPV, they said.

The Pap smear, first introduced in the 1950s, looks for changes in the cervix that could lead to cervical cancer. The HPV test works a step further back in the process, looking to see if women are infected with HPV.

HPV causes cervical cancer, which remains a significant health problem, particularly in less resource-rich areas of the world.

DNA testing for HPV, though, does have drawbacks -- namely that it is less specific, meaning it is likely to pick up more false-positives, than a Pap smear. This results in many more callbacks for women to undergo further testing.

Using HPV as a primary screening tool results in a callback rate of about 25 to 30 percent, said Dr. Mark Einstein, a gynecologic oncologist and director of clinical research at Montefiore Medical Center in New York City. By contrast, Pap smears have a callback rate of about 5 to 7 percent, he said.

For their study, the Italian researchers compared HPV testing alone with HPV testing plus a Pap smear in 94,370 women aged 25 to 60 years old.

During the first phase of the study, women 35 to 60 who tested positive for HPV were given a cervical examination, called a colposcopy. Younger women got a colposcopy if their Pap smear was abnormal or if HPV results were positive several times, indicating that their body had not been able to clear the infection.

Screening for HPV DNA appeared more effective in older women, but the testing in younger women led to over-diagnosis of a particular type of cervical lesion, the study found.

Not all experts agree, though, that current practice would change based on the study's findings alone.

"I don't think this is going to change any strategies we do now, but I do think it's more evidence that HPV testing can predict who's going to develop cervical cancer," said Dr. Jay Brooks, chairman of hematology/oncology at Ochsner Health System in Baton Rouge, La. "HPV testing, in certain populations, can really predict who would benefit from treatment."

Einstein had a somewhat different take on the findings. "This shows that the strategy does work," he said. "It does make sense, it's cost-effective and effective. This is happening in single-payer health systems which have national screening. We're behind in the U.S."

The strategy makes particular sense in less-developed countries, where women could do an HPV test themselves with a "self swab" and then send the swab in for analysis, Einstein said.

In the United States, cervical cancer screening guidelines were changed in November. Women now are being told that they should get their first screening for cervical cancer -- including a Pap test -- at age 21. The previous recommendation was to start Pap tests three years after becoming sexually active or at age 21, whichever came first.

And, rather than have an annual Pap test, most women need to be screened every other year or less, depending on their age, according to the new guidelines.

Cervical cancer rates have dropped more than 50 percent in the last 30 years in the United States, according to the guidelines. That decline has been largely attributed to widespread use of the Pap test.

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Cervical cancer deaths may be cut by 100k per year in poor nations with new screening test

London, UK

A simple "see and treat" approach using a test costing $2 could help doctors prevent 100,000 cervical cancer deaths a year in women in poorer countries, British scientists said on Friday.

Cervical cancer is the leading cause of cancer death among women in developing nations where the main barriers to tackling the disease are poor health service infrastructure and high costs of screening and vaccines.

But British researchers said visual inspection with acetic acid (VIA) -- which costs significantly less than $9 human papillomavirus (HPV) or cervical cell lab tests more commonly used in developed nations -- could be the answer.

Around 300,000 women worldwide die from cervical cancer each year and up to 85 percent of those deaths occur in developing countries.

"VIA is an effective and affordable tool to screen women for pre-cancerous lesions of the cervix in under-resourced countries," said David McGregor of University College London, who led the research.

"Coupled with simple treatment measures, VIA could potentially reduce these cancer deaths by a third, which means nearly 100,000 women saved each year."

VIA is a simple test where a very small dose of acetate acid solution is applied to the cervix to detect pre-cancerous lesions. A positive result can be treated immediately.

This is referred to as the "see and treat" approach and experts say it can work well in small clinics without advanced equipment and laboratories.

Drug firms Merck & Co and GlaxoSmithKline make Gardasil and Cervarix vaccines which protect against a number of strains of HPV -- the most common sexually transmitted disease in the world and the main cause of cervical cancer.

But unlike in developed nations, where cervical screening programs are well established and vaccination programs against HPV are growing, access to tests and vaccines in many countries in Africa, Asia and southern America is limited.

The study in the Obstetrician & Gynecologist journal said research in rural and isolated communities had shown that VIA is accurate, acceptable to women, and cuts cancer death rates.

But it said raising awareness about screening programs to ensure higher uptake in the population was also a challenge.

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Don't skip cervical cancer screenings

Decatur, IL

Sexual health is a notoriously difficult subject to bring up, but time after time, research has shown that awareness saves lives.

In recognition of Cervical Cancer Awareness Month, Illinois Public Health Director Dr. Damon T. Arnold's office issued a press release urging Illinois women to proceed as recommended with their regular screenings.

Dr. Derin Rominger, a Decatur Memorial Hospital obstetrician-gynecologist, said the guidelines for cervical cancer screenings have changed in recent years.

The former guidelines stated that women should begin receiving Pap smears, tests for changes in the cells of the cervix, at age 18 or upon becoming sexually active, Rominger said.

"We just don't see that much cervical cancer in the teenage group," he said. "They seem to be able to clear the virus that causes these problems."

New guidelines state that women should start getting the tests at age 21 or three years after becoming sexually active, Rominger said.

Once women start receiving the screenings, those who fall into the lower-risk categories of being in a monogamous relationship and having a series of negative Pap smears will need them less often, Rominger said. But those who have had abnormal smears in the past, have had new sexual partners or are immunosuppressed will need to be screened annually, he said.

Research has shown a strong connection between certain strains of human papillomavirus, or HPV, and cervical cancer, Rominger said. Two main strains are responsible for 90 percent of cervical cancers, he added.

"Basically, we've known for a long time there was some sort of a factor," Rominger said of the relationship between HPV and cervical cancer.

In the past few years, vaccines such as Merck's Gardasil and GlaxoSmithKline's Cervarix, which protect against some of the strains known to cause cervical cancer, have become available.

Vaccination is one thing young women can do to reduce their risk of HPV infection and, ultimately, cervical cancer, Rominger said. Women between the ages of 11 and 26 currently are eligible for vaccination.

Although doctors prefer to give the vaccine to women before their "sexual debut," Rominger said, "just because she's been sexually active or had an abnormal Pap smear doesn't mean she's not eligible for the vaccine."

Another measure of protection is to practice safer sex, he said. Use a condom to protect against transmission of the virus and other sexually transmitted diseases.

Refrain from smoking, which has been shown to double the risk of cervical cancer, Rominger said. And be sure to get in for routine Pap smears as they are recommended by a physician, he added.

"The whole key is that early detection," Rominger said.

In 16 years of practice, he has seen only seven cases of cervical cancer. All of those women had gone at least 10 years or more without a Pap smear, he said.

The screenings save lives by locating precancerous cells, and doctors sometimes must take measures to remove those growths, Rominger said.

"Those are the ones that have a greater chance of progressing to cervical cancer," he said.

According to the recent release from Arnold's office, it is estimated that in 2010, 610 women in Illinois will be diagnosed with cervical cancer, and about 180 will die from it.

But those deaths are avoidable through routine screenings and preventive measures, Arnold said.

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January is Cervical Health Awareness Month

Courtesy National Cervical Cancer Coalition

Somewhere around 11,000 new cases of cervical cancer will be diagnosed among American women in 2010. An estimated 4,000 women will die from this disease, the only cancer known to be exclusively caused by a common virus, the Human Papillomavirus (HPV). High-risk HPVs may cause cases of mouth, head and neck cancer as well, according to research recently completed.

Other than those practicing lifelong abstinence, most adults acquire an HPV infection during their lifetimes. But mostly the infections turn out harmless and dissappear on their own.

Other infections persist and if they remain untreated for years, or even decades, may lead to cancer. Precancer detection is essential for treatment to prevent the development of cancer. Get a Pap test regularly from a gynocologist in order to detect when HPV causes cells to change long before they progress to cervical cancer.

Regular screening is still recommended despite any new information coming out. Cervical cytology screening is recommended for women every two years beginning at age 21.

The National Cervical Cancer Coalition (NCCC) founded in 1996, is a grassroots nonprofit organization dedicated to serving women with, or at risk for, cervical cancer and HPV disease. For more information visit the Web site at www.nccc-online.org.

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New cervical cancer screening test firm get first order from distributor in China

Rockville, MD

Rockville-based MarkPap has won its first order for low-cost kits to detect cervical cancer in women in poor and underdeveloped regions. The order is the first source of outside revenue for the firm, according to The Washington Post.

The 5-year deal with a Chinese distributor for 1 million test kits is worth $13.5 million to MarkPap, which was founded by Nenad and Olivera Markovic and makes its homes at the Shady Grove Innovation Center. The test is innovative because results can easily be sent for analysis via computer, or even cellphone, overcoming the problem of a lack of trained pathologists in an area, the Post reported.

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New cervical cancer screenin guidelines "surrounded by confusion"

Wilmington, NC

Video

Doctor Sandra Hall has been busy fielding calls from patients concerned about new pap smear and mammogram recommendations. Last week, a government task force said women should not start getting mammograms at age forty - instead, they should wait until they turn fifty.

“They said from age 40 to 49 that benefit was small, they would have to screen 1,900 women to save one woman's life compared to age 50 to 59 where you'd have to screen about 1,300 women. They're not saying there isn't a benefit; they're saying it's small,” explained Dr. Sandra Hall.

While that was sinking in, women under thirty were then told annual pap smears were no longer needed. They were told that an exam every two years would be enough to catch slow-growing cervical cancer.

Dr. Hall said, “It can take ten, sometimes 20 years to grow. We know a lot more about cervical cancer these days, about the HPV virus that causes cervical cancer, and it isn't women being screened dying from cervical cancer, it's women who aren't being screened.”

Still, Doctor Hall said it is important to remember this task force is made up of people who aren't oncologists, treating cancer on a regular basis. These recommendations do not apply to everyone, especially if you have ever had an abnormal pap smear or a history of cancer in your family.

“I think the most important thing is to talk to your doctor. Your individual risk is so important and these are general recommendations, they're not mandates,” added Dr. Hall.

So even though it is now recommended that women under thirty, who have never had an abnormal pap smear, wait two years between tests, Doctor Hall said you still need a pelvic exam every year.

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Will cutting back on teen Pap tests result in more STDs?

Atlanta, GA

Teen girls can skip Pap tests, according to new guidelines that say women should start cervical cancer screening at age 21. But some experts are concerned that rates of sexually transmitted diseases or unplanned pregnancies could increase without the Pap test to prompt a doctor's visit.

As it stands, as many as one in four U.S. teenage girls has had an STD at some point in her life, often soon after she becomes sexually active, according to research published this week in Pediatrics.

"I am concerned that without the recommendation for young women to get Pap smears early on, they will lose important opportunities to seek advice and to learn about their health -- particularly their sexual health -- at a time in their lives when they need it most," says Kimberly Spector, an adolescent-health educator in Los Angeles, California. "Regardless of the tests performed during a gynecologist visit, the conversation regarding sexual health risks and preventative measures can be very informative and empowering for young patients."

In the past, women were told to start Pap tests, which can detect abnormal cells in the cervix, three years after becoming sexually active or at age 21 -- whichever came first. However, these abnormal cells often go away on their own, particularly in young women. If they don't, such cells grow so slowly that catching them at age 21 is still early enough to remove them before they become cancerous. And catching them sooner could lead to unnecessary tests and treatments that sometimes damage the cervix, increasing the risk for a premature birth later in life.

The new guidelines still recommend that girls who are under 21 see a gynecologist; they just don't need Pap tests, according to the American College of Obstetricians and Gynecologists. The fear, however, is that some teens may misinterpret the new rules and miss out on important discussions about contraception and protection against STDs such as gonorrhea, bacterial vaginosis, chlamydia, and human papillomavirus.

"If women hear that they no longer need Pap tests annually or until they are 21, perhaps they wouldn't seek any preventive health care, and whether this results in decreased screening and identification of chlamydia and other STDs remains to be determined, but it is concerning," says Harold Wiesenfeld, M.D., the director of the division of reproductive infectious diseases at the University of Pittsburgh School of Medicine, in Pennsylvania.

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Many STDs, including chlamydia and gonorrhea, have no symptoms. "Unless screened, young women will remain undiagnosed, untreated, and at risk for complications, including pelvic inflammatory disease, which results in infertility," says Wiesenfeld, who is also an associate investigator at Magee-Womens Research Institute, in Pittsburgh. "[Still] the Pap test is not the 100 percent trigger to do chlamydia screening," he says. "We need to do a better job about STD screening overall."

Teens who are sexually active should use contraception and take steps (such as using condoms) to prevent STDs, even if they don't need Pap tests, says Alina Salganicoff, Ph.D., the vice president and director of women's health policy for the Henry J. Kaiser Family Foundation, an advocacy group based in Menlo Park, California.

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"We are going to have to pay special attention to how we educate our adolescent patients about contraception and STD prevention," she says.

However, most experts agree that Pap tests are indeed unnecessary for younger women and that the new guidelines will not put them at risk. Most also agree that the new guidelines are not an effort to limit care.

"I do not fear the consequences because these guidelines are well thought out and give us a great opportunity to focus on who is at risk for cervical cancer," says Bobbie Gostout, M.D., the chair of the department of obstetrics and gynecology at the Mayo Clinic, in Rochester, Minnesota.

"Cervical cancer screening is very important, but we are getting smarter at screening," she says. "We are backing off from screening those that have less to gain from it." The cervical guidelines, which recommend that sexually active teens still be counseled and tested for STDs (although a pelvic exam might not be necessary), "hit it right," she says.

Teens who have received human papillomavirus vaccines, such as Gardasil, are protected against several HPV strains that are linked to many, but not all, cervical cancers and to genital warts. These types of vaccines may eventually reduce cervical cancer rates even further (rates have been dropping since the 1970s), although experts say the impact won't be seen for 10 to 15 years. Therefore, girls and women given the HPV shot need to have Pap tests starting at age 21 and every two years after that, just like those who haven't had the shot.

The Centers for Disease Control and Prevention has added Gardasil to its routine childhood vaccine schedule. It recommends that Gardasil, which is administered in three doses, be given to all girls ages 11 and 12, and even for girls as young as 9, with catch-up doses for girls and women ages 13 to 26 who haven't been vaccinated.

"We know that the HPV types targeted by the new vaccine are linked to cervical cancers that tend to occur five years earlier than cervical cancers caused by other HPV types," Gostout says. "So once adolescents are well vaccinated against HPV, we should have even more confidence in eliminating Pap tests in younger women."

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"We are now rolling out the vaccine, and clearly the first group that will experience broader protection is young women," agrees the Kaiser Family Foundation's Salganicoff. "The HPV vaccine is a really important step that young women can take in terms of protecting themselves against HPV and subsequent cervical cancer."

Ideally, teens should have an HPV shot and see a gynecologist for counseling about STDs before they become sexually active, experts say. HPV vaccines don't protect women who have already been infected with the virus.

"Ideally, women need to establish a relationship with a reproductive health provider before they become sexually active," Wiesenfeld says.

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Cervical cancer testing guidelines revised

Washington, D.C.

A national physician’s organization has revised its cervical cancer screening guidelines, saying that women in their 20s can have a Pap smear every two years, instead of every year.

The statements follow closely after the start of an ongoing discussion on regular mammograms, stemming from debate on when women should start having the procedure — in their 40s or 50s.

The proximity of the two items has prompted some to worry about a perceived drift toward future health care rationing, fueled by debate over health care reform.

But the American College of Obstetricians and Gynecologists, which released the new cervical cancer guidelines last week, said women younger than 21 are at very low risk of cancer — and screening them may lead to “unnecessary and harmful evaluation and treatment.”

The organization said women should have their first cervical cancer screening at age 21 and can be rescreened less frequently than previously recommended. The new guidelines say most women younger than 30 should undergo cervical screening once every two years instead of annually.

Those age 30 and older can be rescreened once every three years, according to an ACOG news release.

Abilene physician Peter Norton said that in some ways, issues behind the new guidelines stretch back to the 1940s. In 1945, the test gained the support of the American Cancer Society.

Cervical cancer is a slow-growing cancer caused by certain strains of the human papillomavirus (HPV), a common sexually transmitted disease among women and men that also causes genital and anal warts, as well as oral and anal cancer.

“It’s the first time you really know the cause of a cancer — that it’s a virus,” Norton said.

The ability to discover abnormalities earlier, and to find premalignant cells early on, sounds “very logical and very good,” he said.

But in the last 10 years, it’s become known that not all of the infections progress to a cancerous state. So a certain percentage of women may not need to be treated at all, since their own immune systems are able to handle the infection.

“When you couple that with the fact that the cervix is important to maintaining a pregnancy to term, anything that we do to treat premalignant cells might damage the cervix to a certain extent,” he said. “So that becomes an issue.”

All such things considered, Norton worried that because of the suggested guidelines, some patients would be left untreated, leaving them open “to expose other people to HPV.”

“That’s not isolating the disease the way infectious diseases have been traditionally isolated,” he said.

Sexual activity — skin to skin contact, not necessarily intercourse — is what spreads HPV, Norton said.

“We know that there are certain groups of women who probably do not need Pap smears,” he said. “I feel age 21 was used because they feel most girls, probably 60 to 80 percent, are going to be sexually active by the time they’re 18 or 19 years old.”

But that number isn’t accurate for everyone, he said.

Women should start receiving Pap smears three years after the initiation of intercourse, he said.

And for some women, waiting as much as three years between screenings might be “too long,” he said.

Cervical cancer rates have fallen more than 50 percent in the past 30 years in the United States because of the widespread use of the Pap test, according to ACOG, which said in its statement that the majority of deaths from cervical cancer in the U.S. are among women who are screened infrequently or not at all.

Vaccination against HPV is expected to cut cervical cancer rates in the future, but for now, ACOG’s guidelines say vaccinated women should follow the same Pap guidelines as those who are unvaccinated.

Norton dubbed it “interesting” that the guidelines were coming out around the time of the national health debate, though ACOG has said that its similarly timed release is simply coincidental.

Helen Teague, coordinator for women’s health/community initiatives with Hendrick Health System’s Vera West Women’s Center, said she worried that both the breast cancer debate and the revised screening guidelines might herald “the beginnings of the rationing of health care.”

Teague said cervical cancer is preventable with screening and she touted the procedure as safe.

“My question in this whole thing, not only with the mammogram suggestion and now this, is why is it advisable to keep women, in this case, young women, in the dark about their health?” she said. “If we have the technology, why aren’t we using it? Why would we delay in using it?”

An initial cervical cancer screening sets an important baseline for future screenings, she said.

“Most of the folks who make these decisions do not see the faces of those these decisions impact,” she said.

Nationally, some sought to connect the mammogram recommendations to the health-care overhaul, contending that such findings are the way that medical rationing starts.

Under the pending legislation, “nothing would prohibit the federal government from deciding if tests, treatments and procedures are too expensive, and therefore, unnecessary,” Sens. Jon Kyl of Arizona, the Republican Whip, and Tom Coburn of Oklahoma, a physician, said in a joint statement.

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Cancer screening guidelines for women questioned

Washington, D.C.

Recent changes in women's cancer screening advice stunned some local health care providers.

Last week, a recommendation issued by the U.S. Preventive Services Task Force said women should generally begin getting routine mammographies at age 50, instead of 40.

The American College of Obstetricians and Gynecologists also recommended limiting cervical cancer screenings to women ages 21 and older, regardless of their sexual history.

Local medical officials question the logic that these new recommendations will prevent unnecessary anxiety and false alarms among younger women.

Wayne Young, director of Battle Creek Health System's The Cancer Care Center, said women in their 40s who are given mammographies are more likely to detect breast cancer at an early stage when it is more treatable.

A mammography is not 100 percent accurate, but it is the best early detection tool physicians have, he said. Abnormal results can be followed with needle biopsies and further tests for cancer.

"It's a little discomfort for some women; for others it will save their lives," he said.

Young said his mother and sister died of breast cancer before age 50. His three daughters will be screened early because of their genetic link, but he wanted all young women to get the best preventive treatment available to them as soon as possible.

His biggest concern is that health insurers will follow these agencies' recommendations and retract coverage for screening younger women, he said.

"That will become an issue because, especially in this economy, that will be an extra out-of-pocket cost and some people will put it off until age 50," he said.

Dr. Kari Formsma, a Battle Creek gynecologist and obstetrician with Pathway Women's Health, said she is concerned about the recommendation to limit cervical cancer screenings regardless of women's sexual history.

She said the guideline fails to acknowledge child sexual abuse and teenage promiscuity.

Cervical cancer is caused by certain strains of the human papillomavirus. It is a sexually transmitted infection that a condom cannot protect against. A woman's risk of developing cervical cancer increases with the number of sexual partners she has.

o it doesn't make sense to say a 21-year-old virgin is at more risk of getting cervical cancer than a 12-year-old victim of sexual abuse who has had multiple partners before age 21, she said.

The American College of Obstetricians and Gynecologists issued the recommendation because cervical cancer takes an average of five years to develop. But that assumes women don't begin having sex until they are 16, Formsma said.

She agreed with the task force's recommendation against teaching breast self-examinations on the grounds that it is often more harmful than not. Women who perform self-exams are more likely to find and be treated for benign lumps, according to the research.

"Breast self-exams, I tell patients to do them if they feel like it," she said. "I'd rather them do things that are a clearly proven benefit, like exercising every day."

She also applauded the move away from annual cervical cancer exams to every two years for women with normal Pap tests.

The money spent on unnecessary exams would do more good testing sexually active teens for infections, she said.

Overall, Formsma recommended patients disclose their full sexual history with their doctor to know how high a risk they have of developing cervical cancer, and then schedule screenings on an individual basis.

Young said the same is true for women in their 40s who are concerned about breast cancer. Women who have a family history of breast cancer or a genetic predisposition should consult their doctor about getting earlier screenings.

"A woman just needs to check with her primary care physician because those people ... can recommend whether she should get a mammogram or not," he said.

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New cervical cancer screening guidelines: No more 'annual' Pap Smear Tests

Washington, D.C.

Doctors Say Young Women Can Wait for First Pap, and Get Them Less Often

Pap smears may no longer be called "annuals" if doctors follow new cervical cancer screening recommendations from the American College of Obstetricians and Gynecologists.

The group announced today that women should start getting cervical cancer screenings at age 21 instead of 18, and that women could wait longer between the screenings -- regardless of when a woman starts having sex.

Women in their 20s with normal Pap smear results now should get screenings every two years instead of every year, and women in their 30s can wait three years between screenings, according to the new ACOG guidelines.

After a week of uproar over the controversial recommendations for less mammogram screenings for women, doctors say they will have to wait and see how the public reacts to the new pap smear guidelines.

"This is not a radical change in screening practices. This is something that's been coming gradually since the 1980s," said Dr. Alan G. Waxman, who helped write the new guidelines.

Some doctors hailed the decision as a way to reduce a host of problems caused by excessive screening; yet, a few others worried it might trigger more women to neglect annual checkups with gynecologists.

Waxman said the move toward fewer screenings will reduce unnecessary treatment in young women and protect them from future pregnancy complications.

On one hand, college-aged women have very high HPV infection rates. Dr. John Curtin, of The Cancer Institute at NYU Langone Medical Center in New York City said 70 percent of all college-aged sexually active people have contracted HPV. These high infection rates translate into a high number of abnormal pap smears.

However, the ACOG guidelines point out that only 0.1 percent of cervical cancer occurs in women under 21 years of age in part, doctors believe, because young women's immune systems are strong enough to fight off HPV before it causes cancer. When dysplasias progress to cancers it's usually a result of older women missing screenings for years at a time; 50 percent of women diagnosed with cervical cancer each year never had a pap smear before, according to the ACOG statement.

And some research has suggested the diagnostic surgery that often follow an abnormal result can pose problems for future pregnancies in some women.

"The driving force behind the change was the numerous studies that show women who are treated for cervical dysplasias are more likely to have a preterm birth," said Waxman, who is a professor at the University of New Mexico in Albuquerque.

Unnecessary HPV Treatment Can Lead to Pregnancy Problems

Waxman explained that the LEEP procedure to remove precancerous tissue often caused by an infection with the human papillomavirus, or HPV, also weakens the cervix. In fact, it's estimated, one in 18 women who've had a LEEP procedure will go on to give birth prematurely.

But, he added, new studies have shown "with most of the cervical abnormalities in adolescents, most of them get better by themselves. ... The thought is that these are the people who have most of their child-bearing years in front of them."

The ACOG recommendations cite studies showing that up to 90 percent of these infections are cleared on their own in adolescents within a few years.

The measure also was intended to reduce anxiety in young women who may struggle with the news that they are infected with a sexually transmitted virus known to cause cancer.

"I was convinced I was dying, that I had cancer. There was not enough education back then," said Nicole C., a resident of La Porte, Texas, who was diagnosed at age 22 with cervical dysplasia -- an abnormal Pap smear -- caused by HPV. "My doctor at the time made me feel horrible about myself, accusing me of not being truthful about how many partners I'd had."

Reducing Anxiety Now and Later On

Nicole, who asked that her last name not be used for privacy reasons, had her first abnormal Pap smear in 1998. As the years passed, more of her friends were diagnosed with cervical dysplasia in their 20s.

As Nicole started serving as an impromptu counselor to explain how HPV is spread, she aimed to soothe fears and reduce the stigma.

"If I had known more back then, I would not have freaked out about it," she said. "I wished they had done that [changed the guidelines] years ago."

Many doctors say they recognize the same anxiety on their young patients' faces.

"Yes, the diagnosis of an abnormal Pap can cause emotional distress to an adolescent girl, and I have certainly seen that," said Dr. Elizabeth Alderman of Montefiore Medical Center in the Bronx, N.Y. "[Cervical biopsies] and repeat Pap smears with visits cost a lot of money."

In fact, some doctors felt the new recommendations did not go far enough.

Dr. Diane Harper of the University of Missouri-Kansas, who specializes in HPV infections, felt that ACOG is behind the other recommending bodies in the United States that argue screening should start at age 25, not age 21.

"There is ample evidence that screening earlier than 25 years is only costly with many false positives," said Harper. "The rest of the world is going to an every-five-or-six-year screening interval ... and ACOG is now just endorsing the three-year interval for HPV negative and Pap negative [women]."

Doctors speaking to ABCNews.com also said they felt the best way to prevent more cancer deaths wasn't to re-screen women who are already seeing doctors regularly, but to try to get women who aren't getting screenings at all into the doctors.

"Whether we screen everybody every two or three years isn't probably not going to make a big difference I don't think, just as long as they are getting screened," said Curtin. "The fact remains there are unscreened patients and they are at risk for cancer."

Doctors speaking to ABCNews.com also said they felt the best way to prevent more cancer deaths wasn't to re-screen women who are already seeing doctors regularly, but to try to get women who aren't getting screenings at all into the doctors.

"Whether we screen everybody every two or three years is probably not going to make a big difference, just as long as they are getting screened," said Curtin. "The fact remains there are unscreened patients and they are at risk for cancer."

Negative Effects of Fewer Pap Smears Unknown

On the other hand, many women admit that the only reason they go to a doctor is for an annual Pap smear and contraception. For those reasons, some doctors worry such women won't receive any medical checkups at all.

"Honestly, the first time it was discovered, I was going to Planned Parenthood for contraception because I had just become sexually active. It was only my second partner," said Alicia, a 32-year-old woman from New Orleans who also did not want her last name used.

Alicia had her first abnormal Pap smear when she was 18.

"I cried, and I really, really freaked out," she said.

But the task of treating her abnormal Pap smears made her aware of her health.

"That was a pivotal moment in my life," she said. "I started doing things better. I started getting into gardening and doing things to calm down."

Dr. Donnica Moore, president of Sapphire Women's Health Group and an obstetrician-gynecologist by training, worried that the new guidelines might keep women who've had a normal Pap smear, or no symptoms, away from the doctor.

"Women may now assume -- incorrectly -- that if they only need a Pap smear every two or three years, then they only need to see their gynecologist every two to three years, and for many of these women, their gynecologist is their primary care physician," said Moore. "Thus, they will not be getting a routine physical, breast exam, blood pressure measurement, and sexually-transmitted infection testing."

Changing Recommendations on Pap Smears
However, Friday's changes aren't the first to affect cervical cancer screenings. Over the years, doctors have scaled back on cervical cancer screening schedules after more research proved less frequent screenings were effective.

"It is about time this occurred," said Dr. Mark Einstein of the Montefiore Medical Center in the Bronx, N.Y. "Oftentimes, young women are put into a 'high-risk' category, clinically, because they have a [positive] Pap test that is essentially just a sign of an HPV infection -- but it is not clinically relevant. This leads to anxiety and over-testing."

Dr. Joanna Cain of Brown University agreed, and argued that the HPV vaccine will further decrease the transmission of the virus that is responsible for up to 70 percent of cancers in the coming years.

Below is a timeline of changes to cervical cancer screenings over the years, according to Waxman:

1957 -- The American Cancer Society runs a nationwide campaign for women to get a Pap test every year.

1976 -- Canadian health leaders examine data and recommend a woman get a Pap smear every two years, after a woman has three consecutive normal Pap smears.

1980 -- The American Cancer Society follows Canadian guidelines recommending a woman get a Pap smear every two years after three consecutive normal Pap smears.

1988 -- The American College of Obstetricians and Gynecologists recommends starting screening at 18, or with the onset of sexual activity and getting a Pap test every year. But after three negative Pap tests, women should be screened less often.

2003 -- ACOG guidelines shift from recommending the first Pap smear at age 18 or the onset of intercourse to age 21 or three years after the onset of intercourse.

2008 -- The American College of Obstetricians and Gynecologists guidelines shift to recommend adolescents who have a minor abnormality on a Pap test wait to get biopsies and a diagnostic test called a colposcopy.

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Pap Smear Test guidelines changed: Fewer Pap Tests advised for women in 20's

Washington, D.C.

Most women in their 20s can have a Pap smear every two years instead of annually, say new guidelines that conclude that's enough to detect slow-growing cervical cancer.

The change by the American College of Obstetricians and Gynecologists comes amid a separate debate over when regular mammograms to detect breast cancer should begin. The timing of the Pap guidelines is coincidence, said ACOG, which began reviewing its recommendations in late 2007 and published the update today in the journal Obstetrics & Gynecology.

The guidelines also say:

— Routine Paps should start at age 21. Previously, ACOG had urged a first Pap either within three years of first sexual intercourse or at age 21.

— Women 30 and older should wait three years between Paps once they have had three consecutive clear tests. Other national guidelines have long recommended the three-year interval; ACOG had previously backed a two- to three-year wait.

— Women with HIV, other immune-weakening conditions or previous cervical abnormalities may need more frequent screening.

Paps can spot precancerous changes in the cervix in time to prevent invasive cancer, and widespread use has halved cervical cancer rates in the U.S. in recent decades. About 11,270 new cases will be diagnosed this year, and about 4,070 women will die from it, according to American Cancer Society estimates. Half of women diagnosed with cervical cancer have never had a Pap, and another 10 percent haven't had one in five years.

Cervical cancer is caused by certain strains of the extremely common sexually transmitted virus called HPV, for human papillomavirus. There is a new HPV vaccine that should cut cervical cancer in the future; ACOG's guidelines say for now vaccinated women should follow the same Pap guidelines as the unvaccinated.

But the updated guidelines reflect better understanding of HPV. Infection is high among sexually active teens and young adults. Women's bodies very often fight off an HPV infection on their own without lasting harm, although it can take a year or two. The younger the woman, the more likely that HPV is going to be transient.

Moreover, ACOG cited studies showing no increased risk of cancer developing in women in their 20s if they extended Pap screening from every year to every two years.

As for adolescents, ACOG said cervical cancer in teens is rare — one or two cases per million 15- to 19-year-olds — while HPV-caused cervical abnormalities usually go away on their own, and unnecessary treatment increases the girls' risk of premature labor years later.

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New cervical cancer test beats pap smear test

London, UK

A new way to test for cervical cancer is more accurate than a pap smear and identified more dangerous lesions, an Italian study showed on Tuesday.

Researchers used the traditional test for the human papilloma virus that causes cervical cancer and combined it with another that indicated specific cancer-causing activity in cells, said Guglielmo Ronco, a cancer epidemiologist at the Centre for Cancer Prevention in Turin, who led the study.

A simple test for a protein called P16INK4A provided a biomarker showing cell changes that indicated a woman likely has pre-cancerous lesions, Ronco and colleagues reported in the journal Lancet Oncology.

"The marker shows there was some sort of disruption by the HPV virus," Ronco said. "Only a small minority of women who have an HPV infection actually develop cancer. The challenge is to find out who are at higher risk of developing cancer."

Cervical cancer is the second most common type of cancer in women. Each year an estimated 500,000 women are diagnosed with the disease and about 300,000 die from it, mostly in the developing world.

Merck & Co's Gardasil and GlaxoSmithKline's Cervarix are vaccines that protect against some strains of the virus.

More countries are also adopting screening tests, but the problem is pap smears produce too many false positives -- meaning women get a test that suggests they have potentially cancerous or pre-cancerous changes when in fact they do not.

An HPV test looks for the virus while in a pap smear doctors scrape cells from the cervix and examine them under a microscope for abnormalities that could indicate precancerous lesions.

"Most HPV infections simply regress without causing disease," Ronco said in a telephone interview. "They disappear spontaneously, which is the reason there are so many false positives."

The Italian team collected cervical cell samples from women who had already tested positive for the HPV virus, most of whom had already undergone an expensive colposcopy exam -- a close examination of the cervix using a magnifying instrument.

Then they tested for P16INK4A protein in more than 1,100 of these women and found that it helped identified 88 percent of those who had the cancer-causing lesions with far fewer false positives. The protein is more active in cervical-cancer cells.

The refined test also identified 50 percent more of the dangerous lesions than pap smears and required fewer women to be referred for colposcopy, Ronco said.

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Washington University PET scanner tracks cervical cancer

St. Louis, MO

A machine invented at Washington University to reveal the inner workings of brains and hearts is emerging as a premier tool for tracking cervical cancer.

The device, called a positron emission tomography (PET) scanner, is similar to MRI scanners but uses radioactivity instead of X-rays to create images of blood flowing through organs, brain activity and other processes.

New research from the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University show that PET scans are more accurate than any other method at predicting the aggressiveness of a cervical cancer tumor. The device also effectively shows whether treatments had destroyed the cancer.

Previously, doctors had no way to determine whether radiation or other therapies were working until a patient experienced symptoms or another tumor was found.

"The look on (patients') faces, the happiness and the joy when you tell them, "It looks like you're going to do really well.' That's really powerful," said Dr. Julie K. Schwarz, a Barnes-Jewish Hospital resident in the Department of Radiation Oncology.

Schwarz was the lead author on one of the PET studies that was published last month in the Journal of the American Medical Association. Her research team studied women who had PET scans three months after completing radiation and chemotherapy between 2003 and 2006. The scans provided a more reliable measure of whether the cancer would recur, and, just as importantly, revealed whether the cancer was already beginning to return.

Each year, more than 10,000 women develop cervical cancer in the United States; about 3,900 die of the disease.

A key to turning PET scans into cancer-fighting tools was figuring out how to turn one property of cancer cells - their need for sugar to fuel growth - against them.

Now, researchers are trying to find out if the scans can do more than identify cancer cells quickly.

PET scans aren't used yet for every cancer patient, but they are proving to be effective at helping doctors decide whether to continue treatment. The scans already are used to detect spreading and recurrence of breast, ovarian, brain and other types of cancers.

"It has a big impact on preventing radical therapy that has no hope of curing the patient," said Dr. Barry Siegel, director of nuclear medicine at the Mallinckrodt Institute of Radiology at Washington University.

In some studies, researchers treated cancer patients with chemotherapy drugs, and within days, they were able to use PET scans to see whether the drug is working or a different type of treatment was needed.

The technology is complicated and expensive and requires highly specialized technicians to make the radioactive chemicals and administer the tests and well-trained doctors to interpret the results, said Dr. Elizabeth Swisher, a gynecological oncologist and associate professor at the University of Washington in Seattle. And, she added, the scans are not standardized.

"It's not the same to get a PET scan everywhere," Swisher said. "Just because it's an expensive test doesn't mean it's a good test."


Washington University is a leader in PET technology, Swisher said, adding that studies such as the one on Monroe will likely expand the use of PET in cancer treatment.

Monroe, who lives in south St. Louis County, had put off going to the doctor, even though she suspected that something was wrong. But after she was diagnosed with cervical cancer, she didn't put off treatment. She never missed a day.

The PET scan she had toward the end of her treatment showed that her tumor has shrunk significantly, Schwarz said. It's likely that the tumor will continue to shrink and disappear - a very promising prognosis. A follow-up PET scan three months after she completes chemotherapy will tell for sure.

"They told me (my PET scan) all looks good," Monroe said. "That's good enough for me. I'm happy with that."

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Delaware cervical cancer rates drop

Wilmington, DE

A report released Friday by Delaware's Division of Public Health shows cancers rates in Delaware are declining. The state compared cancer statistics from 2001 through 2005 to numbers from 1991 through 1995.

The state said overall cancer rates are down five percent from a decade ago. The state said the number of men diagnosed with lung cancer has dropped 20%.

The report also showed cancer death rates have declined 17%. The biggest improvement came in the death rates from cervical cancer. The state said that rate fell by 31% over the last decade.

"It's great news, and on top of that our racial disparities are declining or being eliminated," said Lisa Henry of the Division of Public Health.

State officials said the decline is due, in part, to an increased number of cancer screenings, which can detect cancer early before it has a chance to spread.

Henry said the state will continue to offer free cancer screenings and to try and increase public awareness to drive cancer rates down even further. The state also offers free cancer treatments to qualified families. The Division of Public Health said hundreds of people have already been helped by the program.

The state said even with the decline, cancer rates in Delaware remain higher than the national average. However, Delaware's cancer rates are falling faster than the national rates.

For more information on Delaware cancer screenings, call 1-800-464-HELP.

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Pap Test screening shown to lower incidence of adenocarcinoma of the cervix

New York, NY

Contrary to common opinion, routine cervical screening can identify early-stage adenocarcinoma and adenosquamous carcinoma of the cervix, according to a large case-control study that used routine records of cervical cytology from UK databases.

"Although there can be no doubt about its effectiveness in preventing squamous cell carcinoma, there is little evidence of any benefit on adenocarcinoma and adenosquamous carcinoma of the cervix, and many authors have concluded that it is ineffective," Dr. Peter Sasieni and co-investigators point out in the International Journal of Cancer for August 1.

They evaluated screening histories for 3305 women, ages 20 to 69 years, with invasive cervical cancer diagnosed since 1990. The cancers included adenocarcinomas (19%), adenosquamous carcinomas (4%), and squamous carcinomas (77%).

For each subject, Dr. Sasieni, at the Wolfson Institute of Preventive Medicine in London, and co-researchers chose an age-matched control from the same group practice, and another from a different practice in the same area. They used these data to estimate the magnitude and duration of the low-risk period following a negative smear, and the degree of protection associated with routine screening.

The odds ratio of developing a stage 1B tumor or worse within 2.5 years of an invasive cervical cancer was 0.23 for adenocarcinoma, 0.09 for squamous carcinoma, and 0.10 for adenosquamous carcinoma. The differences between 2.5 and 3.5 years after a negative smear were even larger, with odds ratios of 0.67 for adenocarcinoma, 0.15 for squamous carcinoma, and 0.20 for adenosquamous tumors.

"It is no surprise that screening is less protective against adenocarcinoma of the cervix," Dr. Sasieni's team points out. "These can occur in the endocervical canal and are less amenable to detection at an early stage by exfoliation cytology."

Still, the researchers maintain that screening has a significant impact on the incidence of adenocarcinoma. They estimate that such tumors can be detected, but it may be harder to do so, and requires a shorter lead time than for squamous cell carcinoma.

By contrast, the impact of screening on adenosquamous carcinoma was nearly the same as the impact on squamous carcinoma. The authors theorize that this similarity between the two types "represents phenotypic drift of lesions that evolve from CIN and only later acquire glandular involvement."

Source:Int J Cancer 2009;125:525-529.

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Budget woes puts free breast and cervical exams on chopping block in Chicago

Chicago, IL

The Illinois Breast and Cervical Cancer Program will have to cut more than half of its services if an income tax increase does not occur, reports Chi-Town Daily News. The state and federally funded program gives free breast screenings and mammograms for women over 40, cervical exams for women over 35 and cancer treatment to eligible women. With expected budget cuts, the program stands to lose $9 million. More than 36,000 uninsured women in Illinois, a third of which are from Chicago, benefit from the program; more than 21,000 would no longer receive services.

Without the program, many women will delay screening or avoid treatment, said Dr. David Ansell, chief medical officer at Rush University Medical Center, and chairman of the Metropolitan Chicago Breast Cancer Task Force. Many health programs like the Illinois Breast and Cervical Cancer Program stand to lose funding in the 2010 budget approved by the General Assembly that has yet to be signed by Gov. Pat Quinn. The budget lacks an income tax increase the governor said would save human and health services in the state. Lawmakers will continue battling over the budget and Quinn's proposed tax hike in a special session this Tuesday.

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Cervical cancer spot turns theatre into giant cervix

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Vancouver, BC

It's not as bad as it sounds. To encourage women to get regular Pap smears, and to promote its Cervical Cancer Screening Program, BC Cancer Agency partnered with Cineplex Odeon Theatres to air "Eye of the Cervix" in theatres.

Friendly enough ad. The curtain opens to reveal a pretty, congenial doctor. She asks if we're comfortable, does a quick swab and decisively says, "And we're done."

Closing lines bring it home: "It doesn't take long to prevent cervical cancer. Remember to have regular Pap tests."

We like it just fine, and it even made us feel productive, but here's where wanky boyfriends turn to their partners and go, "When was the last time you got checked?"

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Cervical cancer- shame and fear?

Seattle, WA

Thanks to the new HPV commercials the general public is now aware that cervical cancer can be caused by an STD. They urge more people to be tested and vaccinated, yet now that it has been added to the ‘dirty disease’ category like HIV and AIDS will less women be tested or comfortably admit their diagnosis? It’s sad that we live in a judgmental world. Cancer is cancer no matter where it is on your body. Breast cancer carried the same hush-hush stigma not so long ago and more women lost their lives going undiagnosed or diagnosed too late.

Not all patients with cervical cancer had HPV. In the words of a 33 year old woman who underwent a radical hysterectomy to save her life, “I have no family history of cervical cancer; I’ve never had any STDs; I haven’t had multiple sex partners; and I don’t HPV. Perhaps, when people are aware that one has cervical cancer, they won't look at it as being a "dirty woman" disease like my family did.”

No one deserves cancer. No one battling cancer deserves to be treated with anything but love and compassion. Remember, any STD can occur with just one time, just one partner. Yes, the risk increases with more partners but the reality of infidelity, or an unknowing infected partner can lead to HPV.

The Seattle Cancer Care Alliance advises, “Regular Pap tests are important to your survival: about 90 percent of women whose cervical cancer was detected by a Pap test will survive. The figure is much lower--only 40 percent--for women whose cancer was not diagnosed until they experienced vaginal bleeding.”

According to the American Society of Clinical Oncology, possible symptoms are:

• Blood spots or light bleeding between or following periods


• * Menstrual bleeding that is longer and heavier than usual


• * Bleeding after intercourse, douching, or a pelvic examination


• * Pain during sexual intercourse


• * Bleeding after menopause


• * Increased vaginal discharge

Be informed, be supportive and never live in fear or shame when your life or their's is on the line.

Find a Gynecologic Oncologist: http://www.wcn.org/findadoctor/ Gynecologic oncologists are specially trained to care for women with gynecologic cancers such as cervical cancer, endometrial, or uterine cancer, or ovarian cancer.

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Israeli company says can detect cervical cancer earlier

Jerusalem, Israel

Israel's Zetiq, a unit of Bio-Light Ltd (BOLT.TA), said on Monday it successfully completed clinical trials for its technology for the early detection of cervical cancer.

Bio-Light's shares were up 24.4 percent at 1.33 shekels in afternoon trading in Tel Aviv.

According to the results, the testing can detect pre-cancerous cells in 90 percent of patients, Zetiq said in a statement, noting it was higher than the traditionally used Pap test and similar to that for the HPV virus, which can cause cervical cancer.

"The results of this trial confirm that Zetiq has the potential to develop novel and effective products for early diagnosis of cervical cancer and probably other indications," said Ami Eyal, Bio-Light's chief executive.

"The company plans to complete the development of its product for screening to early identify cervical cancers, and to proceed towards international collaborations and product commercialisation".

Cervical cancer is the second leading cause of cancer in women worldwide. Early identification of the disease greatly increases the survival rate.

Screen tests for cervical cancer are performed routinely in the western world, and have a large market that in the United States alone surpasses $1.5 billion. In developing countries there is no effective screening test available to identify cervical cancer. (Reporting by Steven Scheer, editing by Will Waterman)

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Cervical screening protocal has saved countless lives

Trenton, NJ

By Dr. Margaret Jaskowski-Lutsic

Since the advent of a cervical screening protocol, the incidence and mortality from cervical cancer has consistency fallen. The disease typically has a long premalignant state.

Cervical cancer is the second-leading cause of death from cancer in women worldwide. It is the third most-common gynecological malignancy in the United States.

There are 13,000 new cases of invasive cervical cancer each year, with approximately 4,000 deaths.

Due to regular cervical smear tests, which allow microscopic examination of cervical cells, detection of early changes can be treated before a malignancy occurs.

Cervical dysplasia can be triggered by human papillomavirus, or HPV, in approximately 70 percent of the cases. Women with cervical intraepithelial neoplasia, or CIN, can undergo a colposcopy to further evaluate the extent of cervical dysplasia. This procedure will assist the gynecologist in determining the type of surveillance that should occur and also the type of procedure that should be performed next. The procedures include cryotherapy, a loop electrosurgical excision procedure, laser or cold conization.

Most of these procedures can be typically performed at Oakwood Southshore Surgery Center. The sensitivity, professionalism and caring of our staff will keep your mind at ease from the moment you enter the facility to the moment you leave.

Dr. Margaret Jaskowski-Lutsic is a Trenton-based obstetrician and gynecologist affiliated with the Oakwood Healthcare System.

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Cervical cancer screening should continue after 50

HemOnc Today

Data from an observational prospective study of the incidence of cervical cancer indicates that age is not a good discriminative risk factor for early cutoff of cervical cancer screening. Researchers found that the risk for cervical cancer, even after several negative cervical smear tests by the age of 50, was still similar to that of women of younger ages.

The researchers analyzed data from a Dutch national registry of histopathology and cytopathology. They compared data from 218,847 women aged 45 to 54, and 445,382 women aged 30 to 44 at the time of a third negative smear test.

After 10 years, 105 women had developed cervical cancer within 2,595,964 woman-years at risk in the 30 to 44 age group, and 42 within 1,278,532 woman-years at risk in the 45 to 54 age group.

The incidence rate of cervical cancer was similar in both age groups at 41 per 100,000 (95% CI, 33-51) for the 30 to 44 years age group vs. 36 per 100,000 (95% CI, 24-52) in the 45 to 54 age group.

The findings suggested it would not be consistent to stop screening these women while also not relaxing the screening policy for younger women with similar screening histories, according to a press release.

“Our conclusion lends support to the current cervical cancer screening guidelines in England and other developed countries, which do not discriminate women by age up to 60 to 65,” the researchers wrote.

Modern computer technology may allow for individually tailored screening invitations, according to Björn Strander, MD, director at the Cervical Screening Oncology Center at Sahlgren’s University Hospital in Göteborg, Sweden.

“We have to pay close attention to developments in invasive cancer in age groups above the cut-off point for screening and be prepared to adjust the screening ages as we learn more,” he said in an accompanying editorial.

Rebolj M. BMJ. 2009;doi:10.1136/bmj.b1354.

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New advanced DNA test could make pap smears obsolete

Lufkin, TX

Annual pap smears could soon move to medical history books. Dr. Kay Carter said the new advanced dna test could save women's lives. "It can tell whether the DNA is high risk or low risk DNA for the HPV virus," said Dr. Carter.

She said the DNA test will make gynecologists' jobs easier. That is because it is a one step screening process

"If a woman has a high risk HPV virus then we will automatically go directly to biopsies and test that gives us more accurate information than the pap smear screen does," said Dr. Carter.

Dr. Carter believes most women get an annual pap smear out of routine and don't really understand its purpose. "I don't think that women classically understand the pap smear and why we have to do it," said Dr. Carter. She said the new DNA test makes it easier to understand that there is a virus that causes cervical cancer and women need to be checked for that virus.

Women over 30 could drop the annual pap smear and instead get a DNA test every three, five or ten years. The women we talked to said the pap smear does not bother them. "It's better to be safe than sorry, waiting three years is a long time, once a year is pretty accurate," said Becca Tatum, patient.

"You're going to have to come in for a yearly exam anyways, a breast exam, a pelvic exam so you mine as well get the pap smear done while you are," said Wendy Burger, patient.

Dr. Carter said over time, the DNA test will also cut yearly medical expenses.

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Will HPV Test Replace Pap Smear in Cervical Cancer Screening?

April 07, 2009 05:57 PM ET | Deborah Kotz

In response to my blog post yesterday on Farrah Fawcett and anal cancer, I received an interesting E-mail from a reader who had been diagnosed with cervical cancer 10 years ago as a result of an infection with human papillomavirus. She had heard of the study published in last week's New England Journal of Medicine showing that a newer DNA test for HPV saves more lives from cervical cancer than traditional Pap smears. Here's an excerpt from her letter:

"I was hoping to get your take on the new HPV DNA test that is being touted as the replacement to the Pap smear. Reason I ask is that currently, HPV testing is ONLY recommend for women over 30 and the fact that they would do away with the Pap in favor of HPV DNA testing has many of us in the survivor community wondering what this all means. Will women under 30 get the HPV test? Will Paps be gone and HPV DNA testing only exist for women over 30? What does it all mean?"

The American College of Obstetricians and Gynecologists currently recommends annual Pap screens—which involve taking a small scraping of cells from the cervix—for young women about three years after they begin having sex or by age 21, whichever comes first. Starting at age 30, women have three options: If they have had three negative Pap results, they can continue annual Pap testing or switch to screening every two or three years. They can also add screening with an HPV-DNA test, which is not a blood test but also involves taking a small sample of cells from the cervix. (Those with HIV or certain other conditions should continue annual screening.)

I asked Kenneth Noller, past president of ACOG and chair of the department of obstetrics and gynecology at Tufts Medical Center, if he could tell me what this latest research means for cervical cancer screening.

Will this new study change anything? Will Pap smears indeed become a thing of the past?
"One study never does anything by itself, but there are a lot of studies showing HPV tests are better than doing cytology on a Pap smear," says Noller. "But that's if you're comparing a one-time Pap smear with a one-time HPV test, which was how the latest study was performed." The two tests perform about equally, on the other hand, when a woman receives one or the other repeatedly over several years. That being said, Noller predicts that Pap smears will become less common in women over 30 as more doctors turn to HPV testing.

What about women under 30? Shouldn't they have HPV tests too?
Not unless they have an abnormal Pap smear, Noller says. Widespread HPV testing in that younger group, he says, could lead to "unnecessary testing, treatment, and worry." While about 15 to 20 percent of women under 30 test positive for a high-risk HPV strain, about 90 percent of those infections vanish without treatment. For this reason, doctors tend to perform HPV tests in younger women only when there's an abnormal Pap result and they need to determine whether further procedures are warranted. Women over 30, on the other hand, are less likely to be infected with HPV, but those who are infected are more likely to have a persistent infection. If HPV tests completely replace Paps in women over 30, Noller says he's not sure how many labs will remain in business to keep analyzing cells from Pap tests.

So, what should women do?
Women under 30 should stick with Pap smears, and those over 30 should speak to their doctor about HPV testing. The HPV test could be particularly useful if it's been several years since a woman's last screening. For now, there's no reason to panic if you're a younger women. Paps are still widely available.

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HPV Test Screens Best for Cervical Cancer

New York, NY

With the right test, a single round of screening can decrease the risk of death from cervical cancer by more than 50%, according to research published in the current issue of the New England Journal of Medicine.

The large, longitudinal study, conducted in nearly 500 villages in the rural Osmanabad district of central India, analyzed the effectiveness of three methods of screening, including the standard pap smear and the newer test for human papillomavirus, or HPV, whose sexually transmitted high-risk strains are known to cause cervical cancer. (Read "Cancer and Insurance: Who Do You Call?")

More broadly, researchers hope their findings will help determine how best to implement health outreach programs in developing communities — a crucial step toward preventing cancer deaths, which are increasing worldwide.

"In developing countries, screening is not that common," says Dr. Rengaswamy Sankaranarayanan, lead author of the study and head of the screening group at the International Agency for Research on Cancer. There are small-scale cancer screening efforts underway primarily in urban areas throughout Latin America, sub-Saharan Africa and South Asia, but they serve only a tiny slice of the population who would benefit, according to Sankaranarayanan. For example, "in India, less than one million pap smears are taken each year," he says, a fraction of the more than 200 million women who are at risk for developing cervical cancer.

Sankaranarayanan's study involved more than 130,000 women, ages 30 to 59, who were randomly divided into three test groups and a control group. Women in the test groups were screened using one of three tests: a pap smear, an HPV test or a visual inspection of the cervix after application of acetic acid (VIA), a component of vinegar that causes precancerous lesions to turn white. Among the study participants, only eight had ever undergone cervical cancer screening before. Women in the control group were informed about the causes and dangers of cervical cancer and instructed where they could go for testing, but were not given specific appointments; only 6% of those women followed through with screenings.

"One of the major barriers for screening is that you need to go to a screening center, you have to wait, you have to go back," says Sankaranarayanan. "Many of these women are poor women who have to go and work in the field every day." And many do not understand that cervical cancer can be deadly. "There are a lot of false assumptions," he says. "People aren't aware of the severity of the disease."

Of the women in the three experimental groups, who were given pre-scheduled screening appointments, nearly 80% showed up. Those who had a positive screen result or visual evidence of cervical dysplasia (abnormal cells on the cervix) were given follow-up treatment, including further testing, cryotherapy (the freezing and removal of abnormal cells) and, in cases of more serious cancer, surgery and radiation. (Read "Despite US Drop, Cancer Rates Grow Worldwide.")

Over the course of the eight-year study — women were tracked from 1999 to 2007 — researchers found that the HPV screen routed out more cancer and prevented more deaths than either of the other screening tests, and did so with the fewest false negatives. Among some 30,000 women screened for HPV, only eight patients who received negative results went on to develop cervical cancer. In the pap smear group, 22 women, or nearly three times as many as in the HPV group, who had negative results later developed cancer. In the VIA group, there were even more false negatives, with 25 women. In addition, in the HPV and pap smear groups, 60% of cancers were detected early, in stage I of development, compared with 42% in the VIA group.

"HPV appears to be a better test for screening," Sankaranarayanan says, reaffirming previous studies that have established a strong correlation between positive tests for HPV and development of cancerous lesions.

But HPV is a tricky virus to manage. Sankaranarayanan points out that, first, it is exceedingly common; there are some 100 different strains of HPV, of which 30 or 40 affect the vast majority of sexually active people during the course of their lifetimes. The Centers for Disease Control and Prevention reports that as many as 80% of sexually active women (and 50% of all men and women) will be infected with HPV at some point. Second, the body most often clears the HPV virus on its own, without ever causing cancer or other symptoms (some strains of HPV also cause genital warts). "More than 80% of the infections will clear within two years of acquiring," he says, underscoring the accepted recommendation by the American College of Obstetricians and Gynecologists that HPV tests not be used as a cervical-cancer screening tool in younger women, but only in women ages 30 and older. Infections are more likely to be persistent in this age group, which puts them at greater risk for cervical cancer. For younger women and girls, between the ages of 11 and 26, health authorities in the U.S. and several European countries recommend the HPV vaccine to prevent infection.

From a practical standpoint, limiting HPV testing to women over 30 can also reduce unnecessary costs in treating patients in whom the infection would have resolved itself, a particularly important factor to consider when attempting to get cervical cancer prevention programs off the ground in the developing world and among lower-income women, Sankaranarayanan says. Indeed, the current standard in HPV tests, the Hybrid Capture II, which was used for this study, is already too costly for wide-scale application, running as much as $30 per test. Realistically, in order to be used on a grand scale, tests would have to cost about $1 each, Sankaranarayanan estimates.

In that respect, there may be hope on the horizon. A Chinese study, funded in part by the Bill & Melinda Gates Foundation (as was the current study) and published in 2008, reported that a new HPV test, called careHPV, is easier to use, produces results faster and is just as effective as the Hybrid Capture II. Researchers say that when careHPV becomes available — Sankaranarayanan anticipates it will be on the market within two years — it will cost a fraction of the price of the Hybrid Capture II.

In the meantime, he says we need to educate people about cervical cancer and the virus that causes it, particularly in the developing world. Combating the disease begins with simple steps, Sankaranarayanan says: "Taking away the stigma of HPV infection and specifically targeting these deprived groups with the proper education."

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FDA Approved First DNA Test for Two Types of HPV, Cervical Cancer Strains

Washington, D.C.

FDA News

FOR IMMEDIATE RELEASE
March 13, 2009

FDA Approved First DNA Test for Two Types of Human Papillomavirus
Agency also approved second DNA test for wider range of HPV types

The U.S. Food and Drug Administration yesterday approved the first DNA test that identifies the two types of human papillomavirus (HPV) that cause the majority of cervical cancers among women in the United States.

The test, called Cervista HPV 16/18, detects the DNA sequences for HPV type 16 and HPV type 18 in cervical cells. Differentiating these HPV types gives health care professionals more information on a patient’s risk of subsequently developing cervical cancer.

A positive Cervista 16/18 test result indicates whether HPV type 16, 18 or both types are present in the cervical sample.

The FDA also approved yesterday the Cervista HPV HR test, which is the second DNA test that detects essentially all of the high-risk HPV types in cervical cell samples. The Cervista HPV HR test uses a method similar to the Cervista HPV 16/18 test to detect the DNA sequences of these HPV types.

In women age 30 and older or women with borderline cytology, the Cervista HPV 16/18 test can be used together with cytology and the Cervista HPV HR test to assess risk of cervical disease.

“Results from these two tests, when considered with a physician’s assessment of the patient’s history, other risk factors, and professional guidelines, can help physicians better determine risk and could lead to better patient management,” said Daniel G. Schultz, M.D., director of the FDA’s Center for Devices and Radiological Health.

HPV is the most common sexually transmitted infection in the United States. The U.S. Centers for Disease Control and Prevention estimates that more than 6 million Americans become infected with genital HPV each year and that more than half of all sexually active women and men become infected at some time in their lives.

For most women, the body's own defense system clears the virus and infected women do not develop related health problems. However, some HPV types can cause cell abnormalities on the lining of the cervix that later can become malignant. While there are many different types of HPV, types 16 and 18 cause about 70 percent of all cervical cancers.

Cervista HPV 16/18 and Cervista HPV HR are manufactured by Madison, Wis.-based Third Wave Technologies.

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Free pelvic exam, Pap test, and mammogram offered in Chicago

Chicago, IL

Early detection is the battle cry against some deadly diseases suffered by women.

But for those without health insurance, the high cost of mammograms and other tests often keeps them from finding out critical information until it's too late.

MetroSouth Medical Center (formerly St. Francis Hospital) is offering free breast and cervical cancer screenings for uninsured English-, Chinese- and Spanish-speaking patients through the Illinois Breast and Cervical Cancer Program.

Women 35 and older who have no health insurance can obtain free mammograms, pelvic exams and Pap smears all on the same day, by appointment. Younger women without insurance also may be seen if they have a referral from a physician.

About one in eight women will develop invasive breast cancer in her lifetime, according to the American Cancer Society. Early detection and treatment have dramatically increased breast cancer survival rates. According to the ACS, when breast cancer is found early and confined to the breast, the five-year survival rate is 98 percent. The first sign of an abnormality is often detected through screening mammography, a non-invasive, low-dose X-ray.

According to the U.S. Centers for Disease Control, cervical cancer once was the leading cause of cancer death for U.S. women. However, the number of cases and deaths have decreased significantly over the last four decades largely due to the increasing number of women getting regular Pap tests, which can detect cervical precancer before it turns into cancer.

The free screenings are available to individuals and groups. MetroSouth offers free transportation. It may send buses to pick up eligible groups, or offer gas cards and CTA passes for individuals.

Group participants also get complimentary educational presentations and lunch provided by MetroSouth Medical Center. All test results are typically provided to patients within 24 to 48 hours.

"We understand what a woman goes through if she has to wait too long for this important test, so we're doing everything we can to make the process fast, simple, comfortable and available to all of our patients," said Maureen Hansen, the hospital's lead mammographer.

The tests are available by appointment at MetroSouth Medical Center, 12935 S. Gregory St., Blue Island.

More information for English speakers is at (708) 489-7940, for Spanish speakers is at (708) 489-7942, and for Chinese speakers is at (708) 489-7941.

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Women invited to free cancer screening event Saturday in Corvallis, NY

Corvallis, NY

The Women’s Cancer Coalition will offer free breast and cervical cancer screenings from 9 a.m. to 1 p.m. Saturday at Samaritan Obstetrics and Gynecology, 3640 N.W. Samaritan Drive, Suite 270.

The screenings — including Pap tests, clinical breast exams and digital mammograms — will be offered to women of all ages who do not have access to regular screenings, including the uninsured or under-insured.

Women 30 and older can also be tested for the HPV virus, the cause of cervical cancer. Participants will receive test results in the mail. Any abnormal results will be referred to the Women’s Cancer Coalition for follow up.

For more information, call (541) 768-5220; or call (541) 768-5540 the day of the screening. Childcare will be available and light refreshments will be served.

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MA health center offers cervical cancer screening, preventive care services

Mashpee, MA

Community Health Center of Cape Cod is now enrolling eligible patients into a new program that emphasizes prevention, early detection and screening services for certain types of cancer, including breast, cervical, prostate, and colorectal, as well as heart disease and stroke.

The new Care Coordination program serves women and men who typically are unable to access such services because of insurance limitations and who are most likely to be at risk for disease due to age or a previous abnormal finding.

“These services are in keeping with our “complete medical home” approach to care,” said Chief Executive Officer Karen Gardner.

As a primary care provider, the Health Center works with patients to make sure they are compliant with age-appropriate prevention and screening tools. “These services will be integrated with their ongoing health care management,” Gardner said.

Early detection has shown to be a determining factor in successfully treating these diseases, according to Lisa Taylor, MD, an internist at the Health Center.

“There are relatively simple screening tests that can alert us to a potential problem. When dealt with early on, it can make a big difference in a patient’s overall health and well-being,” she said.

Women enrolled in the program may receive a clinical breast exam and mammogram, pelvic exam and PAP test, and colonoscopy. Men may receive a rectal exam and prostate specific antigen test (PSA) and colonoscopy. All participants receive risk reduction education, lifestyle intervention and preventive services for heart disease and stroke. Case management and patient navigation services are available to help link enrollees to services, identify payment mechanisms and guide them through the healthcare system.

The Health Center’s eligible patients include Massachusetts residents between the ages of 40 and 64. Patients between the ages of 20 and 39 or over 64 who have had an abnormal finding may also be eligible. Eligibility requirements vary according to individuals’ age, insurance and income level.

The Care Coordination program is funded by the Massachusetts Department of Public Health (DPH). It is a restructuring of the former Women’s Health Network and Men’s Health Partnership, which was suspended by the DPH in June 2008.

Recognizing the ability of community health centers to deliver comprehensive care, the Department asked the Health Center to implement the Care Coordination program and incorporate this model of care with their delivery of primary care.

Care Coordination services are currently available for eligible patients of the Health Center. Those without insurance or a primary care provider can become a patient of the Health Center. Plans are underway to make the services available across Cape Cod and Martha’s Vineyard through the community health center network and other participating providers.

For more information about the Care Coordination program, call 508 477-7090, ext. 158 or 159.

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