GynoFiles

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...

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 .

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...

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...

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,...

For women getting routine pap smear screening, alert, this basic tests have been shown to miss disease in about 50% of cases. Getting repeat testing, meaning at the intervals your gyno suggests helps to catch cancer before it gets to that stage, but we now know that we can do better.  If you have a Normal (Negative) Pap and a Negative  high risk HPV test your chance of getting CIN II or III (moderate or severe dysplasia) in the next three years is very remote. So good reason to get that test! And which test, now there are new test for just the most high risk of the cervix infecting HPV viruses, called the cobas HPV test will specifically test for the HPV 16,18 as well as the other viruses and it is both approved and in many laboratories. It is very important because women who have HPV 16+ are twice as likely to have high grade cervical dysplasia, a CIN 2 or worse than even women who had tested positive for the other high risk HPV viruses. Getting HPV testing, especially if y...

The more you read about HPV testing the more you will here these words: Primary Screening and Co-testing. A new study published in the Dec 15th issue of Lancet says that women should not get a pap test first, but they should just get an HPV test! This study looked at a specific set of women: ages 29 to 59 and the performance of HPV testing verses pap testing when done twice in 5 years.Scientists from our National Cancer Institute have said that this study, like many that are publishing their results, back up the fact that adding HPV testing to your cervical cancer screening does add value. What will be important is for women to discuss with their own gyno which test to do, when to do the tests, and then what sort of on going testing you need based on the results. Let us know if you have had HPV testing and if so , was it helpful?

October 26th,, 1977  is the anniversary of the last case of small pox , when will the last case of cervical cancer be? It is possible to prevent cervical cancer if we prevent the transmission of high grade HPV disease. Vaccination against high grade HPV disease is the best strategy we have at completely eliminating cervical cancer, so discuss with your gyno what would work the best for you.

HPV testing can help detect cervical cancer and cervical precancer. HPV infections are both common, and for the most part, not serious as most women rapidly clear their viral infection. According to current testing and an article by Schiffman and Wentzensen in Obstetrics and Gynecology in 2010, about half of infections no longer apparent within about 6 months and more than 90% unapparent by a few years. We have discussed much about the pap smear and the HPV tests that have arrived to be done in conjunction with the pap smear. A number of HPV tests are available. When to test and what test to use is a complex topic. A new concern for gynos about these tests has arrived.  Dr. Philip Castle, a brilliant researcher in the area of HPV disease and a member of the American Society for clinical pathology has accused physicians of abusing HPV DNA testing in fairly large numbers in a recent editorial. He bases his conclusions on looking at what tests are being ordered in a survey type r...

Pap test guidelines are changing rapidly, and you may not 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. Pap tests themselves are an actual sampling of the cervix. The pelvic examination checks you for conditions of the vagina, the vulva, the uterus and the ovaries. The pap smear can pick up abnormal ovarian and uterine lining cells, but that's not primarily what it is aimed to do. As for when to have the test: every year, every other year, every third year or every fifth year will depend on your age, your prior tests and whether you are getting an HPV test also. The guidelines as to when to have a pap do vary very slightly from one organization to the next and they have changed recently. So it's important if you are a mom of a young woman, ask your gyno what she currently recommends for your daughter, it's changed over what she recommended for you! The cur...

Genital warts come from viruses, and we catch a wart when we are in contact with and subsequently infected with a virus that causes them unless we have previously been protected by the vaccination. If you have a genital wart odds are it came from the HPV Virus Particle virus types 6, and 11 of the Human Papilloma Virus (HPV). And there are about another dozen HPV types that can cause these. These are highly infectious and studies show they have an with an incubation period which ranges from 3 weeks to 8 months. If you had sexual contact with some one only prior to that then you might be a case of virus reactivated. But for most women, the warts come from contact within the last 3 weeks-8 months. When you come in contact with some one who has the type of HPV virus that causes the genital warts or condyloma then you will likely, if you have acquired infection, do so fairly rapidly.  The main way that HPV is transmitted is sexually, but non-sexual contact is possible:...

Miller Park Zoo, W. Scifres About one in 4 Americans is registered in what is called the National Cancer Institute’s Surveillance, Epidemiology, and End Results study. As these Americans get cancer they get followed as to how they do. The study doesn’t formally group each patient, they get grouped according to how they were treated by their physicians. For instance, in a study published in the spring of 2010 in Obstetrics and Gynecology from the Columbia University College of Physicians and Surgeons they reported on 1400 women with the vary earliest forms of Cervical cancer, looking at both what they called Stage IA1 and IA2 cancers. Actually IA! Cancers, a cancer that is only 3 mm by 7 mm or less invasion past the surface’s basement membrane account for about 60 to 70% of all cervical cancers, so about 7000 cancers per year. So over the 9 years they gathered data for this study they probably looked at 1400/63,000 or as I estimate about 2% of all of those cancers that occurred....

The PATRICIA trial looked at women over 3 years after they had received the 2-HPV type vaccine Cervarix which is a vaccine against HPV-16 and HPV-18. We have already heard that these vaccines do prevent new acquisition of HPV types, and we've learned in prior reports from 2009 by the group including Dr. Mark Martens from Oklahoma State that high grade dysplasia were prevented. But now it is shown that over 58% fewer abnormal pap smears are in the prior vaccinated group. This is great news. It's always nice to pass your Gyno Exam! But remember girls, not getting tested is still not good with your Gyno!

At 3, 6, 12, 18 and 24 months Dr. Woo Dae Kang and researchers at the Chonnmam National Univeristy looked at women with high grade cervical dysplasia after LEEP and looked at the Human Papilloma Virus (HPV) viral persistance. Up to 30% have peristant disease of some nature, and understanding whethether the condition has been resolved has been a challenge for patients and their clinicians. The group used their very sensitive HPV chip test  and have determined that for women who continue to test + for High Risk HPV types have about 44+% chance of recurrance. Especially important were women who had persistance of HPV type 16 or 18. These tests are now available and can be requested from your provider, they are called type specific HPV tests.

Basil HPV exposure is almost universal, but even without vaccination, not everyone exposed tests positive and not everyone who tests positive will go on to develop abnormal pap smears or cancers. Other factors will determine whether you will test positive for HPV, and the list is mounting as to what these factors are. Smoking, menopause, poor immunity, frequent exposure to the HPV virus are just a few of the factors that have been associated with a positive HPV test.  Birth control pills have effects on the cervix and the uterus, and these effects have been well studied and discussed in many forums, they cause an enlargement of the sensitive t-zone area of the cervix that might make picking up an HPV infection easier. One group that has been particularly active in this research has been the International Agency for Reseach on Cancer . This group feels that taking birth control will increase your risk for cervical cancer by about double. But whether this directly is mediated ...

When we pick treatment strategies we like to think that we are giving patients a permanent  cure.And if you are the patient it's natural to believe you have been cured.  So if you have been diagnosed with CIN III also known as carcinoma-in-situ, a pre-invasive cervical condition due to HPV what is the risk of not treating and what is your risk if you have been treated. In general we say there is about a 2% chance that the condition will progress to invasive cervical disease each year if you do not treat. If you treat, and have complete excision, the risk becomes almost negligible, but it's still there. It's about a 3-4/1000 chance (0.3-0.4%) that the disease will progress to invasive cancer. So essentially, the principal still holds, prevention is far superior to treatment. We lowere our risks considerably by getting the treatment, but the inciting agent of the Human Papilloma Virus (HPV) is unlikely to have been eradicated in all cases, thus the risk persists. For more on ...

This may or may not be a case of premature cervical opening, but it's a case of the cervix dilated so that we see membranes bulging out of the cervix. If this happens at term, we're excited, labor is progressing. If it happens remote from term, it can be a problem. It can mean that the cervix is weak, and there are treatments that can save the baby, but action would have to be taken promptly. Cervical incompetence can come on very suddenly in pregnancy, with the only sign being subtle. There are some surgeries and some genetic predispositions that might make you more at risk. Prior to pregnancy make the cervix a discussion with your gyno! Women who become pregnant and have risk factors for this condition may need ultrasounds with cervical length measurements more frequently to measure the cervix and to check it's shape as well. If the cervix is getting short, or changing it's shape, or showing signs of opening, there are possible treatments, such as the use of vag...

This post was originally written in 2010, the best vaccine now is clearly the Gardasil 9 and all the current questions on HPV vaccination are nicely summarized by the CDC at this link. When deciding which HPV vaccine to get, be sure to use the one that will offer you the most protection. That is the Gardasil. Vaccine for Cervical Cancer the Cervarix by GSK was approved for use in the US in October of 2009. Thus joining the  more than 100 countries worldwide that already had this vaccine in use. It is a vaccine only for Cervical Cancer protection and it is known as a bivalent vaccine active against HPV viruses 16 and 18. About 30 to 40 types of HPV affect the genital tissues, so complete protection from either of these shots is not possible. Some cross protection for other viral types has been shown, mostly 31, 33 and 45. HPV types 16 and 18, which together are thought to be responsible for about 70% to 80% of all cervical cancer cases, and also responsible for a similar...