Science Today Online http://www.sciencetodayonline.com from Bench to Bed. Tue, 17 Apr 2012 18:26:59 +0000 en hourly 1 http://wordpress.org/?v=3.3.1 HPV vaccination and cervical cancer prevention http://www.sciencetodayonline.com/hpv-vaccination-and-cervical-cancer-prevention.html http://www.sciencetodayonline.com/hpv-vaccination-and-cervical-cancer-prevention.html#comments Tue, 17 Apr 2012 18:24:32 +0000 joenny http://www.sciencetodayonline.com/?p=4490 Ideally, patients should be vaccinated before onset of sexual activity, when they may be exposed to HPV.

Patients who have been infected with one or more HPV types still get ... Continue reading]]> Ideally, patients should be vaccinated before onset of sexual activity, when they may be exposed to HPV.

Patients who have been infected with one or more HPV types still get protection from the vaccine types they have not acquired.

Among women who had not been previously exposed to a targeted HPV type, the clinical trials demonstrated 93% vaccine efficacy in preventing cervical precancers due to HPV 16 or 18.  In all studies of the bivalent HPV vaccine, more than 99% of females developed an HPV 16 and 18 antibody response 1 month after completing the 3-dose series. Also, the vaccine protection is long-lasting.

HPV Vaccine Recommendations

  • Either HPV vaccine (bivalent or quadrivalent) is routinely recommended for 11- or 12 year-old girls.
  • The vaccine series can be started beginning at age 9 years.
  • Catch-up vaccination is recommended for 13- through 26 year-old females who have not completed the vaccine series.

The bivalent HPV vaccine is recommended for protection against HPV types 16 and 18, for the prevention of cervical cancers and precancers.

Vaccination with the quadrivalent HPV vaccine is recommended for protection against HPV types 16, 18, 6 and 11, for the prevention of cervical cancers and precancers, as well as genital warts. The quadrivalent vaccine has also been licensed to prevent vulvar, vaginal and anal cancers in females. The 3-dose series of quadrivalent vaccine is also safe and effective for males ages 9 through 26 years for prevention of anal cancer and genital warts.

HPV vaccines can be given to the following:

  • Lactating women.
  • Patients with minor acute illnesses, such as diarrhea or mild upper respiratory tract infections, with or without fever.
  • Women who have had an equivocal or abnormal Pap test, a positive HPV test, or genital warts. However, these patients should be advised that data do not indicate that the vaccine will have any therapeutic effect on existing Pap test abnormalities, HPV infection or genital warts.
  • Patients who are immunocompromised, either from disease or medication. However, the immune response to vaccination and vaccine efficacy might be less than in immunocompetent people.

HPV vaccines should not be given to:

  • Patients with a history of immediate hypersensitivity to any vaccine component.
  • Patients with moderate or severe acute illnesses. In these cases, patients should wait until the illness improves before getting vaccinated.
  • Pregnant women.
]]> http://www.sciencetodayonline.com/hpv-vaccination-and-cervical-cancer-prevention.html/feed 0 Recommendation of cervical cancer screening http://www.sciencetodayonline.com/recommendation-of-cervical-cancer-screening.html http://www.sciencetodayonline.com/recommendation-of-cervical-cancer-screening.html#comments Tue, 17 Apr 2012 18:09:52 +0000 joenny http://www.sciencetodayonline.com/?p=4487 The American Cancer Society (ACS) and the US Preventive Services Task Force (USPSTF) recommend that all women should begin screening for cervical cancer at 21 years, regardless of sexual history.

... Continue reading]]> The American Cancer Society (ACS) and the US Preventive Services Task Force (USPSTF) recommend that all women should begin screening for cervical cancer at 21 years, regardless of sexual history.

The ACS and USPSTF 2012 guidelines do not address special populations (eg, women with a history of cervical cancer, women who were exposed in utero to diethylstilbestrol (DES), women who are immunocompromised) who may require more intensive or alternative screening.

ACOG recommends annual screenings for immunocompromised patients; women with history of CIN2, CIN3, or cancer; and women who were exposed to DES in utero. HIV-positive women should be screened twice in the first year following diagnosis and yearly thereafter. Screening should continue for at least 20 years after treatment of CIN2 or worse.

Table: Summary of 2012 Screening Guidelines from the American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology

ACS Recommendations
Age to start screening
  • Begin screening with cytology at 21 years old, regardless of sexual history
Screening interval age 21–29
  • Screen with cytology alone every 3 years.
  • HPV testing should not be used in this age group.
Screening interval age 30-65
  • Screen with a combination of cytology and HPV testing every 5 years (preferred) or cytology alone every 3 years.
  • Screening by HPV testing alone is generally not recommended.
Age to stop screening
  • Age 65, if the woman has adequate negative prior screening and is not otherwise at high risk for cervical cancer
Screening after hysterectomy
  • Not indicated for women without a cervix and without a history of a high-grade precancerous lesion (eg, CIN2 or CIN3) in the past 20 years or cervical cancer ever
HPV-vaccinated women
  • Screen according to the same recommendations as for unvaccinated women
]]> http://www.sciencetodayonline.com/recommendation-of-cervical-cancer-screening.html/feed 0 Interpretation of Pap smear results http://www.sciencetodayonline.com/interpretation-of-pap-smear-results.html http://www.sciencetodayonline.com/interpretation-of-pap-smear-results.html#comments Tue, 17 Apr 2012 17:55:19 +0000 joenny http://www.sciencetodayonline.com/?p=4481 Following description might be shown on Pap smear results:

1) Negative for intraepithelial lesion or malignancy, which might have infections and inflammation. A Pap smear might be repeated to see ... Continue reading]]> Following description might be shown on Pap smear results:

1) Negative for intraepithelial lesion or malignancy, which might have infections and inflammation. A Pap smear might be repeated to see if the inflammation has improved or cleared up completely.
  • Observed organisms (eg, Trichomonas, Candida, bacteria) and cellular changes consistent with herpes simplex virus.
  • Reporting other non-neoplastic findings such as inflammation, atrophy
2) Atypical squamous cells (ASC)
  • ASC of undetermined significance (ASCUS): These changes are usually not serious and may be caused by a vaginal infection or infection with a virus called HPV (human papillomavirus). Your doctor may want to do a follow-up examination such as a repeat Pap smear or HPV testing.
  • ASC, cannot exclude high-grade squamous intraepithelial lesion (ASC-H): Some of cells are not normal and may be precancerous. A colposcopy might be ordered to more closely examine the cervix.
3) Glandular cell and atypical glandular cells (AGC): A colposcopy might be performed to examine any irregular tissue.
  • Atypical glandular cells (AGC): People who have AGC can have a higher risk for cervical cancer.
  • AGC, favor neoplastic: These changes are usually more serious.

4) Mild dysplasia: A colposcopy, HPV testing or recommend a repeat Pap smear might be ordered.

  • Low-grade squamous intraepithelial lesion (LSIL): There are early changes in the size and shape of the cells. LSILs are often associated with the presence of HPV.
  • Cervical intraepithelial neoplasia (CIN) 1

5) Moderate-grade dysplasia: A colposcopy could be ordered to determine how at risk you are for cancer.

  • High-grade squamous intraepithelial lesion (HSIL): High-grade means the cells are very different from normal cells, and usually precancerous.
  • CIN 2
6) Severe dysplasia: A colposcopy could be ordered to determine how at risk you are for cancer.
  • CIN 3

7) Carcinoma in situ (CIS): CIS is considered a pre-cancerous problem, coloscopy is used to confirmed the diagnosis. This lesion is usually treated with local ablative or extricative measures such as cryosurgery, laser ablation, and loop excision.

  • There are abnormal cancer cell-like cells extending the full thickness of the skin, but have not invaded through basal membrane.
  • If the cells were invading through the basement membrane into the underlying tissues, they would be considered cancer.
  • Endocervical adenocarcinoma in situ (AIS)
8 Invasive squamous cell carcinoma
  • This is an apparent cancerous condition, and aggressive treatments will be offered by your doctor
9) Adenocarcinoma: A rare condition which is usually surgically treated
]]> http://www.sciencetodayonline.com/interpretation-of-pap-smear-results.html/feed 0 Classification and subtypes of cervical cancer http://www.sciencetodayonline.com/classification-and-subtypes-of-cervical-cancer.html http://www.sciencetodayonline.com/classification-and-subtypes-of-cervical-cancer.html#comments Tue, 17 Apr 2012 17:23:07 +0000 joenny http://www.sciencetodayonline.com/?p=4476 According to pathological exam, invasive cervical carcinoma can be classified into the following histologic subtypes:

squamous cell carcinoma (about 80-85%) adenocarcinoma (about 15%) adenosquamous carcinoma (the incidence is steadily increasing) ... Continue reading]]> According to pathological exam, invasive cervical carcinoma can be classified into the following histologic subtypes:

  • squamous cell carcinoma (about 80-85%)
  • adenocarcinoma (about 15%)
  • adenosquamous carcinoma (the incidence is steadily increasing)
  • small cell carcinoma
  • neuroendocrine tumour
  • glassy cell carcinoma
  • villoglandular adenocarcinoma
]]> http://www.sciencetodayonline.com/classification-and-subtypes-of-cervical-cancer.html/feed 0 Metastasis (spread) of cervical cancer http://www.sciencetodayonline.com/metastasis-spread-of-cervical-cancer.html http://www.sciencetodayonline.com/metastasis-spread-of-cervical-cancer.html#comments Tue, 17 Apr 2012 17:17:29 +0000 joenny http://www.sciencetodayonline.com/?p=4473 The tumor grows by extending upward to the endometrial cavity, downward to the vagina, and laterally to the pelvic wall.

The cervical cancer can invade the bladder and rectum directly, ... Continue reading]]> The tumor grows by extending upward to the endometrial cavity, downward to the vagina, and laterally to the pelvic wall.

The cervical cancer can invade the bladder and rectum directly, causing constipation, hematuria (blood in urine), fistula, and ureteral obstruction.

The following triad suggests pelvic wall involvement:

  • leg edema
  • pain
  • hydronephrosis

The common sites for distant metastasis include:

  • extrapelvic lymph nodes: leg edema is the most common consequence
  • liver: liver enlargement
  • lung: pleural effusion or bronchial obstruction appears at late stage
  • bone: bone pain
]]> http://www.sciencetodayonline.com/metastasis-spread-of-cervical-cancer.html/feed 0 Symptoms and signs of cervical cancer http://www.sciencetodayonline.com/symptoms-and-signs-of-cervical-cancer.html http://www.sciencetodayonline.com/symptoms-and-signs-of-cervical-cancer.html#comments Tue, 17 Apr 2012 17:08:54 +0000 joenny http://www.sciencetodayonline.com/?p=4470 Most of patients are asymptomatic, and their cervical cancer is most commonly found during routine Pap smear.

If the early stage cervical cancer is not detected and progresses, the ... Continue reading]]>

Most of patients are asymptomatic, and their cervical cancer is most commonly found during routine Pap smear.

If the early stage cervical cancer is not detected and progresses, the first clinical symptom is usually abnormal vaginal bleeding, usually postcoital (after sex).

Other symptoms could include:

  • Vaginal discomfort
  • malodorous vaginal discharge
  • dysuria (difficult sexual intercourse)
]]> http://www.sciencetodayonline.com/symptoms-and-signs-of-cervical-cancer.html/feed 0 Clinical outcome (prognosis) of cervical cancers http://www.sciencetodayonline.com/clinical-outcome-prognosis-of-cervical-cancers.html http://www.sciencetodayonline.com/clinical-outcome-prognosis-of-cervical-cancers.html#comments Tue, 17 Apr 2012 17:02:22 +0000 joenny http://www.sciencetodayonline.com/?p=4467 Due to the early screening of Pap smear, the clinical outcomes of cervical cancer is relatively good.

The American Cancer Society estimated that 4,210 women would die of cervical ... Continue reading]]>

Due to the early screening of Pap smear, the clinical outcomes of cervical cancer is relatively good.

The American Cancer Society estimated that 4,210 women would die of cervical cancer in the United States in 2010. This represents 1.3% of all cancer deaths and 6.5% of deaths from gynecologic cancers.

In general, prognosis of cervical cancer depends on disease stage. Eearly detection means a benign clinical outcome.

The 5-year survival rates are as follows:

  • Stage I – Greater than 90%
  • Stage II – 60-80%
  • Stage III – Approximately 50%
  • Stage IV – Less than 30%
]]> http://www.sciencetodayonline.com/clinical-outcome-prognosis-of-cervical-cancers.html/feed 0 human papillomavirus (HPV) and cervical cancer http://www.sciencetodayonline.com/human-papillomavirus-hpv-and-cervical-cancer.html http://www.sciencetodayonline.com/human-papillomavirus-hpv-and-cervical-cancer.html#comments Tue, 17 Apr 2012 16:57:08 +0000 joenny http://www.sciencetodayonline.com/?p=4463 Continue reading]]> Human papillomavirus (HPV) is a DNA virus, and its infection is now considered to be the major cause of cervical cancer.
  • HPV has been detected in more than 90% of premalignant and malignant cervical lesions compared with a consistently lower percentage in controls.
  • To date, 77 different genotypes of HPV have been identified
  • HPV 16 and 18 are deemed to be high-risk types and found in 50-80% of pre-cancerous cervical lesions and in up to 90% of invasive cancers.
  • Also, types 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73, and 82 are also considered carcinogenic.

Most of these infections disappear spontaneously within months to a few years, and only a small proportion persist and lead to cancer, due to high-risk HPV types and compromise host immunity, such as multiparity or poor nutritional status; and environmental factors such as smoking, oral contraceptive use, or vitamin deficiencies.

High-risk HPV can integrate their genome into the host DNA and activate oncogenes (cancer gene) or inactivate anti-cancer genes (such as Rb and p53), ultimately resulting into malignancy.

HPV infection occurs in a high percentage of sexually active women.For example, following are risk factors for HPV infection:

  • sex at a young age
  • multiple sexual partners
  • promiscuous male partners
  • history of sexually transmitted diseases
]]> http://www.sciencetodayonline.com/human-papillomavirus-hpv-and-cervical-cancer.html/feed 0 Causes and risk factors of cervical cancer http://www.sciencetodayonline.com/causes-and-risk-factors-of-cervical-cancer.html http://www.sciencetodayonline.com/causes-and-risk-factors-of-cervical-cancer.html#comments Tue, 17 Apr 2012 16:52:54 +0000 joenny http://www.sciencetodayonline.com/?p=4461 Continue reading]]> Human papillomavirus (HPV) is a DNA virus, and HPV infection occurs in a high percentage of sexually active women.For example, following are risk factors for HPV infection:
  • sex at a young age
  • multiple sexual partners
  • promiscuous male partners
  • history of sexually transmitted diseases
Most of these infections disappear spontaneously within months to a few years, and only a small proportion persist and lead to cancer, due to high-risk HPV types and compromise host immunity, such as multiparity or poor nutritional status; and environmental factors such as smoking, oral contraceptive use, or vitamin deficiencies.
HPV infection is now considered to be the major cause of cervical cancer. Furthermore, HPV has been detected in more than 90% of premalignant and malignant cervical lesions compared with a consistently lower percentage in controls.
To date, 77 different genotypes of HPV have been identified, and HPV 16 and 18 are deemed to be high-risk types and found in 50-80% of pre-cancerous cervical lesions and in up to 90% of invasive cancers. Also, types 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73, and 82 are also considered carcinogenic.

High-risk HPV can integrate their genome into the host DNA and activate oncogenes (cancer gene) or inactivate anti-cancer genes (such as Rb and p53), ultimately resulting into malignancy.

]]> http://www.sciencetodayonline.com/causes-and-risk-factors-of-cervical-cancer.html/feed 0 Facts and statistics of cervical cancer http://www.sciencetodayonline.com/facts-and-statistics-of-cervical-cancer.html http://www.sciencetodayonline.com/facts-and-statistics-of-cervical-cancer.html#comments Mon, 16 Apr 2012 17:04:20 +0000 joenny http://www.sciencetodayonline.com/?p=4456 In 2007:

12,280 women in the United States were diagnosed with cervical cancer. 4,021 women in the United States died from cervical cancer. Incidence Rates by Race & Ethnicity

“Incidence ... Continue reading]]> In 2007:

  • 12,280 women in the United States were diagnosed with cervical cancer.
  • 4,021 women in the United States died from cervical cancer.

Incidence Rates by Race & Ethnicity

“Incidence rate” means how many women out of a given number get the disease each year (how many women out of 100,000 got cervical cancer each year). In year 2007, hispanic women had the highest incidence rate for cervical cancer. Black women had the second highest rate of getting cervical cancer, followed by white, American Indian/Alaska Native, and Asian/Pacific Islander women.

Death Rates by Race & Ethnicity

From 1999–2007, the rate of women dying from cervical cancer has varied, depending on their race and ethnicity. In 2007, black women were more likely to die of cervical cancer than any other group. Hispanic women had the second highest rate of deaths from cervical cancer, followed by women who are American Indian/Alaska Native, white, and Asian/Pacific Islander.

Rates of Getting Cervical Cancer by State

Incidence refers to the number of women who get a disease each year (how many women out of 100,000 got cervical cancer each year).

Incidence

Rate

States

4.5 to 6.2

 Alaska, Idaho, Iowa, Massachusetts, Minnesota, Montana, New Hampshire, South Dakota, Utah, Virginia, Washington, Wisconsin and Wyoming

6.3 to 7.5

 Arizona, Colorado, Connecticut, Hawaii, Indiana, Kansas, Maine, Maryland, New Mexico, North Carolina, Ohio, and Rhode Island

7.6 to 8.4

 California, Georgia, Illinois, Michigan, Missouri, Nebraska, New York, Oregon, Pennsylvania, South Carolina, and Tennessee

8.5 to 11.2

 Alabama, Arkansas, Delaware, District of Columbia, Florida, Kentucky, Louisiana, Mississippi, New Jersey, Oklahoma, Texas, and West Virginia

Deaths from Cervical Cancer by State

Rates of dying from cervical cancer also vary from state to state.

Mortality

Rate

States

1.0 to 2.0

Arizona, Colorado, Connecticut, Hawaii, Kansas, Massachusetts, Michigan, Minnesota, Nevada, Oregon, and Wisconsin

2.1 to 2.4

 California, Iowa, Maine, Maryland, New Hampshire, New Jersey, New Mexico, North Carolina, Pennsylvania, and Washington

2.5 to 2.8

 Florida, Idaho, Illinois, Indiana, Missouri, New York, Ohio, Oklahoma, Tenneesee, and Virginia

2.9 to 4.2

 Alabama, Arkansas, Georgia, Kentucky, Louisiana, Mississippi, South Carolina, Texas, and West Virginia

Rates were suppressed*

 Alaska, Delaware, District of Columbia, Montana, Nebraska, North Dakota, Rhode Island, South Dakota, Utah, Vermont, and Wyoming

Pap Test Percentages by Race and Ethnicity

The table below shows the percentage of women aged 18 years and older who had a Pap test in the last three years, grouped by race and ethnicity.

Race or Ethnicity

2005

2008
White only

77.7

74.9
Black only

81.1

80.1
American Indian/Alaska Native only

75.2

69.4
Asian only

64.1

65.6
Hispanic or Latina†

75.5

75.4

Pap Test Percentages by Education Level

Women with the most years of schooling are most likely to have had a Pap test in the last three years. The table below shows the percentage of women aged 25 years and older who had a Pap test in the last three years, grouped by their highest level of education.

Education Level 2000 2003 2005 2008
No high school diploma or GED 69.9 64.9 64.1 60.6
High school diploma or GED 79.8 75.9 73.8 69.5
Some college or more 88.0 86.2 84.6 82.6

Pap Test Percentages by Age

Women aged 18 to 44 years are most likely to have had a Pap test in the last three years, followed by older women. The table below shows the percentage of women aged 18 years and older who had a Pap test in the last three years, grouped by age.

Age Group 2000 2003 2005 2008
18 to 44 years 84.9 83.9 83.6 81.8
45 to 64 years 84.6 81.3 80.6 78.8
65 years and older 64.5 60.8 54.9 50.0

Cervical cancer used to be the leading cause of cancer death for women in the United States. However, in the past 40 years, the number of cases of cervical cancer and the number of deaths from cervical cancer have decreased significantly. This decline largely is the result of many women getting regular Pap tests, which can find cervical precancer before it turns into cancer.

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