GynoFiles

You need to come and discuss the ways you are at risk for cancer and the top ways you can prevent cancer. American Cancer Society States that 4/10 cancer cases today can be prevented . The Top Ways to Prevent Cancers come to Discuss: 1. Proper nutrition and Vitamin Therapy, this is sort of complex, takes a bit of work 2. Sunscreen 3. Exercise 4. Normalize Weight (preventing obesity goes a long way to eliminating uterine cancer) 5. Minimize Genetic Risks 6. Oral Contraceptives 7. (Chemo)prevention of Breast Cancer (Using Medication) 8. Stop Smoking (this is the single best way you can predict cancer. 9. Avoid HPV infection (get vaccinated young) and this will virtually eliminate cervical cancer in women and oral and throat cancers in men 10. Take oral contraceptives to eliminate ovarian cancer 11. Decrease alcohol intake Actually half of all cancers are in people with identifiable risk factors. It's a job for both you and your gyno to figure out if you have a risk f...

Cervical cancer is caused by the cancer causing infection with one of the high risk type of HPV viruses. The vaccine is recommended for girls at age 11. We may be one step closer to our dream of eliminating cervical cancer . On  the US Food and Drug Administration (FDA) in December of 2015 approved Gardasil 9 , a human papillomavirus (HPV) vaccine from Merck that prevents cancers and other lesions caused by nine HPV types, five more than the original Gardasil protected against. There is virtually 100% protection of the HPV type you get in a vaccine if you have not yet been exposed to that vaccine.It is critical that you are the one to be vaccinated, if you are the one that wants protection against HPV infection. Even though both boys and girls have been vaccinated for many years in the US, a new study indicates that if you were not vaccinated, your rate of getting HPV has not changed from your chances of getting HPV before the vaccine was invented. The study came o...

Pap tests can test for uterine cancer as well as cervical cancer. When to have your first test, how often to test, whether to also test for the HPV virus, and what this test might show including abnormal changes of the uterine lining or infections are all decisions to be made as an individual in consultation with your own provider. Pap smear guidelines have evolved rapidly in the past decade, and those who have had HPV testing, vaccination, or a series of negative tests do not necessarily need a test yearly. You should have a pap test when your gyno recommends that you have a pap test, and remember, pap tests are different than pelvic examinations. Women need yearly pelvic examinations even though they may not need the additional testing of a pap smear.  Pap tests themselves are an actual swabbing of the cervix so in addition to the sampling of the cervix, it will pick up cells from the uterus.. The pelvic examination checks you for conditions of the vagina, the vulva, the ut...

The high risk kind of human papillomavirus (HPV) are associated with 90-100% of cervical cancers and over 90% of anal cancers. We know that testing the anal region may be as important as testing the cervix and the vagina, but who and when to test is a very complex subject, and this post won't cover everything you will need to gab with your own gyno about .  Guidelines can be found in many organizations on line, such as the US Preventative Task Force , or the ASCCP . a question that comes up frequently is what about the "field effect" (the urethra, the clitoris, the anus, as well as the cervix and vagina and vulva) of the disease? Do you need actual pap tests of areas other than the cervix? USPT guidelines do recommend anal pap tests for HIV men who have sex with men, and for HIV women with prior cervical caner. The anal pap smears often will not get cells (about 13% of the time accordin to Dr Lamme et al in Obstetrics and Gynecology), so it may have to be repeated.  ...

A new report has been released by the CDC that highlights a new disastrous trend in the US: women are not getting their routine pap smears.  Over 10% of women with insurance and about 24% of women without insurance did not get a pap smear in the past 5 years. It is common for women to tell their provider "oh, it's really been that long". Guidelines for pap testing have changed , but one thing is sure, cervical cancer screening for pap tests is very accurate and successful and screened women do not have to die from cervical cancer. HPV vaccination protects many individuals, but not all cervical cancers have been associated with positive HPV test s. The CDC tracks many screening tests and the current data released is from the 2012 Behavioral Risk Factor Surveillance System survey. Although screening decreased the death rates has remained stable and relatively low. But should this trend of women not getting regular testing continue the death rate will climb. Not only do w...

We may be one step closer to our dream of eliminating cervical cancer . The HPV vaccination has gotten an upgrade! On December 10th the US Food and Drug Administration (FDA) today approved Gardasil 9 , a human papillomavirus (HPV) vaccine from Merck that prevents cancers and other lesions caused by nine HPV types, five more than the original Gardasil protected against. The Gardasil vaccine is still available now, and the newest version will be available in Feb 2015 for those who want to schedule appointments or consultations . There is virtually 100% protection of the HPV type you get in a vaccine if you have not yet been exposed to that vaccine. The first vaccine protected against  HPV types 6, 11, 16, and 18. Gardasil 9 covers these as well as types 31, 33, 45, 52, and 58. These latter five are currently responsible for roughly one in five cases of cervical cancer. In the earlier vaccine there was some cross protection of other viruses, and since there ar...

In a world wide study of over 17,00 young women looking at individuals ages 15-26 who received the HPV Vaccine , it has been shown that the vaccine works to reduce all HPV disease. This study was headed by researchers in Columbia, and looked at those young women who tested HPV negative at the time of receiving their vaccine. It was important that the individuals studied were negative for HPV disease as this vaccine is a prophylactic vaccine: it does not treat those exposed. They watched the patients closely for about 3 and a half to 5 years. and have proved the vaccine is 100% effective in reducing the risk of getting precancer of the cervix, the vulva, or the vagina and was highly effective in reducing the rates of warts as well. It is of critical importance to get the young men and women their vaccinations when they are young. If you have questions see your health care provider .

Pelvic examinations are critically important to rule out STD lesions, skin cancers, pelvic floor disorders, and so much more. But as a first step, especially for tests you need when you are asymptomatic, we have tried to improve testing for women (and men). Improved testing may be checking urine or blood, and it turns out that checking the urine is an excellent way to detect genital diseases. Gynos have been using urine tests for Chlamydia and Gonorrhea for a long time . A simple urine test for human papillomavirus (HPV) has now been shown to accurately detect HPV, which is now known to be present, at some time, in the lives of 2/3 individuals. The study was published online on September 16 in BMJ. You do need your gyno to validate the results however and to determine if you need a cervical cancer test, which cannot be done on urine. We also know that we have over 170 types of HPV that can be detected, but we worry the most about HPV 16 and 18, and type spec...

Cervical cancer detection is more than just a pap smear, it's getting regular pelvic examinations, following up episodes of bleeding or pain, and having a personal gyno to consult regarding how to lower your cancer risks. But, ultimately, most do rely on regular pap smear testing to determine their risk for cervical cancer. Pap smears are a sampling of the cervical cells to determine whether the cells are normal. As such pap tests don't treat cancer, they seek it, as in a simple screening test. Pap smear testing cannot detect all cancer, just most of it, yet who to test, and exactly how to test has been under debate as we try to further eliminate cervical cancer, but focus on safety and cost for American women. Many organizations have produced pap smear guidelines. American Cancer Society recommendations can be found at this lin k  . The American Society for Colposcopy and Cervical Pathology can be found at this link , where they discuss the guidelines that were put in pla...

Close to the May 13th birthday of Dr. George Papanicolaou's the FDA approves HPV test as the first line test for cervical cancer instead of getting a pap smear  At Women's Health Practice we are excited to thank our ATHENA study participants for leading the way to one of the momentous FDA decisions of the decade. US Food and Drug Administration (FDA) today approved the cobas HPV Test (Roche Molecular Systems, Inc) for primary cervical cancer screening in women aged 25 years or older. This decision heavily relied on this test for their ruling. We have been following the FDA's position on this test. It was the first human papilloma virus (HPV) DNA test approved alone to detect high-risk HPV. The test is recommended for first-line screening, and can specifically identify HPV genotypes 16 and 18, which are responsible for about 70% of all cervical cancers. It also concurrently detects 12 other high-risk genotypes (31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, ...

HPV is an important cause of cervical, vaginal, vulvar, urethral, rectal and anal cancers.  Vaccination is the best way for women and men to protect themselves from cervical and probably from penile cancer as well. First there there was a vaccine that will cover women for over half of all cervical cancers. Men and women need to be vaccinated, and the whole population at risk would need to be vaccinated, or the protection rates are not going to be as effective as that. But now, a new  9-valent human papillomavirus vaccine is available that is more effective than the first versions and can prevent up to 85% of invasive cervical cancer.. The current vaccine protects against 16,18, 6 and 11. The new vaccine will add in 31,33, 45, 52, and 58. Other than HPV strains 16 and 18, strain 45 is the most commonly the cause of infections that potentially could lead to cervical cancer. For men, HPV types seen with penile cancers are HPV 16,18 and 6. Penile cancers are rare and there...

Are you worried about your pap smear result? If so, gynos might be willing to bet that you are most worried about the uncertainty of what is the correct plan for your pap today. It is true that many new, newer, and now even the newest pap testing and treating guidelines have changed. If you have changed gynos, you may even find yourself getting different advice regarding a particular result. Be aware, that there are many changes and we are going to talk about a few.   The basic answer is that fewer women are going to colposcopy and biopsy, and fewer women after biopsy are going to definitive treatment. The issue is whether the abnormal test is actually cancer, or has a risk of cancer development quickly. If not the experts are urging you and your gyno to delay treatment. Experts have determined that even fairly high grade cervical disease, called CIN 2, or moderate dysplasia has a very high natural regression rate; and though there is no real cure for HPV, these pap problems d...

We track the major female reproductive cancers by a woman's lifetime risk of actually getting invasive disease 1/8: Brest Cancer 1/38 Endometrial (uterine lining) Cancer 1/70 Ovarian Cancer 1/135 Cervical Cancer Interestingly, we do use screening tests to see if you have one of these cancers, but remember about 7% of the women getting pap smears in any year are abnormal, and the rate of call backs on mammograms is even a bit higher. This is a far greater rate than the rate of actual invasive disease that these tests would track . So remember: if you get a call that your pap was abnormal, do follow your gyno's recommendations, but your chance of invasive disease, as you see, is still relatively remote.

Since protection against HPV disease by vaccination cannot protect us all, nor protect those who already have the virus you may want to take note that there is hope that the adverse effects of the virus may be able to be treated by a therapeutic vaccine which is now being developed Inovio Pharmaceuticals.  Merck's Gardasil and GlaxoSmithKline's Cervarix vaccine both protect young women and young men against picking up the infection that can lead to a number of cancers. Most HPV infections will resolve, of those that don't most will only develop into pre-cancerous changes, but it is the cause of many cancers. These vaccinations protect against cervical, vagina, vulvar, penile, as well as head and neck cancers, and they are known as preventative vaccines. Therapeutic vaccines target those who have progressed beyond the state of just being exposed to a disease, but now have the disease. The Inovio vaccine is triggers an immune system response which will kill cells that caus...

Knowing what to do next after an abnormal pap can be both confusing, anxiety producing and a matter of the prevailing gynecologic thought. Your own gyno may not be practicing according to the most recent guidelines. The guidelines are confusing, the possible alternatives may involve tests that are very expensive or are not available in your area, and your gyno may be taking factors in your case into consideration that do not adhere to the guidelines exactly. So if you thing your gyno has been changing her mind, you are lightly right, but you may also have choices. We are most concerned with women who have been diagnosed with the most severe pap smear changes that are not cervical cancers, but have to be carefully monitored.Moderate and severe dysplasia, also called CIN II and III is diagnosed in 500,000 American women each year. It is out of this group that cervical cancer will develop. So when advising as to follow up testing, we are trying to give you the best risk prediction re...

If you get an HPV vaccine, and the take is appropriate, you are basically immune to getting HPV. But the question is, are others immune as well? Antibodies can be in our system from infection or vaccination, and they can protect us from new infections. Naturally acquired antibodies (just after being exposed to the HPV) probably are not as strong as the ones that we get from being vaccinated, but actually researchers are not sure. About 50-70% of women exposed to a particular HPV type will develop what is called type-specific antibodies. Since there is not a routine test of our antibody level after we get an infection, its unclear whether naturally acquired antibodies provide complete future protection against new HPV infection. It's even more uncertain as to whether these antibodies can also help prevent the progression to precancerous disease of the cervix (also called CIN). Researchers in the PATRICIA HPV 16/18 trial. Published Costa Rica HPV 16/18 vaccine tr...

The HPV virus causes cervical cancer. You get it sexually or through skin to skin contact. If you have an HPV infection that doesn't resolve on it's own, then it's more likely to persist and become cervical cancer. But not just any HPV infections will do this, it has to be due to the infection of a high risk HPV virus, like HPV 16, which then stays and transforms the cell. Then if the cell's growth is unchecked the tissue will change into precancer called CIN or Cervical Intraepithelial Neoplasia. So if HPV virus causes pre-cancer, and much precancer will eventually become more severe, called CIN 3,  why doesn’t all CIN 3 progress to cancer? We know now that it is the way the HPV virus behaves in your system that determines whether it will progress to cancer. Cancer is more likely to be triggered when the HPV virus genes E6/7 are turned on. The newest way to figur find and treat them. And if you don’t treat the patient who has...

Currently if you have an early precancerous change of the cervix, or cervical intraepithelial neoplasia, or CIN, the treatment, is to watch if very early, and then if it advances to moderate or severe disease (II or III) is to surgically remove the abnormal area. This is done with a LEEP or a freezing called cryosurgery. A group of researchers from Bochum, Germany and Vienna Austria have looked into using Imiquimod for the treatment of pre-invasive cancer of the cervix. This is a medication used for the treatment of genital warts caused by HPV, and marketed as Aldura, and we have written on some of this progress in prior posts. Most of the topically applied medications for HPV caused genital warts are locally destructive medications that essentially burn off the warts. Imiquimod is different because it works locally on the immune system to enhance the body's ability to reverse the changes of the cells that HPV has induced to effectively resolve the infection. A group,...

We know that Cervical Cancer is caused by the HPV virus, and using condoms helps decrease your chance of picking up that virus. We know that the opening to a woman's cervix known as the transformation zone is the most sensitive area for the HPV virus to cause precancerous changes. By taking birth control pills that area of the cervix may be enlarged and thus making a woman on the pill more at risk for cervical cancer in some studies. So we have been counseling women to use condoms as their best protection against cervical cancer when it comes to contraception. But there is now evidence that copper IUDs can also, in addition to the protection condoms offer, help protect against cervical cancer. In an analysis of 26 large studies of the copper IUD it was found that the use of the IUD was associated with significantly less cervical cancer. The study done by French researchers and published in the Lancet Oncology in 2011 looked at 2200+ women and specifically showed that the IUD ...

The HPV vaccine was studied as a disease prevention strategy. The studies were designed specifically to look at individuals who had no exposure to HPV and their risk of acquiring HPV and getting HPV related disease. Future I and Future II Studies  were the research studies and the prescribing information and what is known about the safety and disease prevention is at the Gardasil website. Once a patient gets HPVvaccine they are protected for 10 years against HPV disease that they do not already have. But in a Study just reported in the British Medical Journal In the first reported look back analysis of individuals treated for any disease it has been shown that once treated with the vaccine you are less likely to get any related HPV disease. This was true for individuals up to age 45. The studies did still have women who progressed from mild to more severe cases of cervical disease, this is not perfect protection. This would mean that the vaccine may actually have usefulne...