GynoFiles

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...

The numbers of men and women who have HPV is staggering, the numbers of people who have had it at some time in the past, makes the affected population be so high as to consider this disease almost universal.  The current prevalence of HPV: who has it in our population is according to the newest study is over two thirds of the population; and the incidence: who has had HPV at any time in their life (cumulative incidence) is therefore almost everyone. In this new study presented showed that 69% of Americans have the HPV virus, they looked at all strains of the HPV virus, including those that cause warts and throat cancer.   Not just the strains that cause cervical cancer. This study looked at a wide range of ages, and looked at many tissues, including skin and gut that aren't traditionally thought of as the HPV harboring organs. Our immune system can keep this virus quiet for years. Newer, more accurate, testing has been able to identify these viruses as we never have be...

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...

Cryosurgery of the cervix is used for treatment less often than in the past, but it still can be effective at reducing inflammation, bleeding after sex or dysplasia. Here's the look of the cervix immediately after it was performed. Cryosurgery of cervix with iceball formation  

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...

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,...

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...

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...