The FDA recently issued another report about drospirenone-containing birth control pills, stating that they remain concerned about the increased risk of blood clots with the use of these birth control pills.
The first FDA warning about drospirenone-containing birth control pills was issued in April 2010, when the administration explained that the pills had been linked to an increased risk for thromboembolic disorders and other vascular problems. The latest warning discusses the preliminary findings of the FDA’s examination of the two 2011 studies that looked at the risk of blood clots for women who use drospirenone-containing birth control pills; preliminary results suggest that women who use drospirenone-containing birth controls are at an approximately 1.5-fold increased risk of blood clots compared to women who use other hormonal contraceptives.
The FDA recommends that healthcare professionals who prescribe drospirenone-containing birth control pills be particularly aware of the risk factors for each patient when deciding whether to prescribe the medication. Factors that are known to increase the risk of blood clots include smoking, obesity and family history; the FDA recommends careful consideration of these factors before deciding to prescribe if a drospirenone-containing birth control pill. Yaz and Beyaz are two FDA-approved, drospirenone-containing birth control pills that have also been approved for the treatment of acne.
Wednesday, September 28, 2011
Monday, September 26, 2011
The most effective Vitamin for Dry Skin
Dry skin is an irritating problem that most commonly affects the arms, the lower legs, the thighs and the sides of the abdomen. Those suffering from dry skin problems generally experience itching, scaling, and cracks in the skin. Luckily, by using a vitamin for dry skin, this problem can be prevented and even reversed.
Causes of Dry Skin
Dry skin is a common problem, particularly during the winter months when it is cold outside and artificial heat is used indoors. The harsh outside weather combined with the lack of humidity indoors makes it hard for your skin to stay moist. Certain activities, such as gardening, can also dry out the skin. In addition, using harsh soaps or bathing too often can wash away your skin’s natural moisture.
Lifestyle Changes to Prevent Dry Skin
To help prevent dry skin from occurring, you should keep your baths and showers short and never use hot water. You should also use as little soap as necessary, using it primarily on the armpits, face, and genital region. Also, be sure to use mild soaps if dry skin is a problem for you. Adding bath oils to your water can also help moisturize your skin, just be sure to avoid ones with alcohol in them because alcohol dries the skin out. Using a humidifier to keep the air moist and drinking water throughout the day also helps prevent your skin from drying out.
Using A Vitamin For Dry Skin Prevention
There are several vitamins that can help prevent or heal dry skin when taken orally or used topically. One vitamin for dry skin is Vitamin A, or retinol. A diet with insufficient amounts of vitamin A can actually lead to dry skin because vitamin A is responsible for the maintenance of healthy skin, as well as hair. Therefore, be sure to include plenty of vitamin A in your diet. The US RDA recommends 700 RAE per day of vitamin A for women. Good sources of vitamin A include carrots, sweet potatoes, boiled kale, turnip greens, mango, papaya, raw spinach, red and green bell peppers, cantaloupe, apricot, milk, eggs, romaine lettuce, tomatoes, broccoli, and oranges. Research has shown that using vitamin A as a topical skin treatment also helps decrease signs of dryness and aging.
Another vitamin for dry skin is Vitamin B Complex. Like vitamin A, a diet deficient in vitamin B can lead to dry skin. Vitamin B is actually comprised of multiple vitamins: Thiamine (B-1), Riboflavin (B-2), Niacin (B-3), Pantothenic Acid (B-5), Pyridoxine (B-6), Biotin (B-7), Folic Acid (B-9), and Cyanocobalamin (B-12). For this reason, vitamin B is often referred to as B-Complex. One of the jobs of vitamin B is to help maintain healthy skin. Other health benefits of vitamin B is that it enhances the immune system, improves muscle tone, and promotes cell growth and division. B-Complex is also know to help reduce stress and depression when included in the diet, which can indirectly help your skin stay moist and healthy. B vitamins are often found together in foods, but the best way to ensure you are getting enough vitamin B in your diet is to take a B-Complex vitamin once or twice per day, depending on the dosage level and the recommendation of the manufacturer.
Vitamin C is another vitamin for dry skin. Vitamin C is necessary to produce collagen in the skin. Collagen helps new tissue develop and strengthens the blood vessels, both of which help your skin maintain proper circulation and moisture. The US RDA recommends 60-90 mg of vitamin C to be included in the diet per day. Good sources of vitamin c include citrus fruits, potatoes, tomatoes, black currants, papaya, brussel sprouts, broccoli, cauliflower, strawberries, cantaloupe, spinach, cranberries, kiwi, and red peppers. When used in topical moisturizers, vitamin C can also be beneficial in treating dry skin.
Vitamin E is another great vitamin for dry skin. Although vitamin E can be added to the diet through foods such as wheat germ, vegetables, and nuts, the best way to use vitamin E is topically. It has been shown to eliminate both dryness and itching skin. In addition, vitamin E creams can help fight against free radicals and minimize the appearance of wrinkles.
The best way to get enough of these vitamins for dry skin into your diet is to take a Multivitamin once or twice per day. If you make sure to purchase a multi-vitamin that contains B-Complex, you can take care of all of your dry skin needs with just one wonderful little pill!
Causes of Dry Skin
Dry skin is a common problem, particularly during the winter months when it is cold outside and artificial heat is used indoors. The harsh outside weather combined with the lack of humidity indoors makes it hard for your skin to stay moist. Certain activities, such as gardening, can also dry out the skin. In addition, using harsh soaps or bathing too often can wash away your skin’s natural moisture.
Lifestyle Changes to Prevent Dry Skin
To help prevent dry skin from occurring, you should keep your baths and showers short and never use hot water. You should also use as little soap as necessary, using it primarily on the armpits, face, and genital region. Also, be sure to use mild soaps if dry skin is a problem for you. Adding bath oils to your water can also help moisturize your skin, just be sure to avoid ones with alcohol in them because alcohol dries the skin out. Using a humidifier to keep the air moist and drinking water throughout the day also helps prevent your skin from drying out.
Using A Vitamin For Dry Skin Prevention
There are several vitamins that can help prevent or heal dry skin when taken orally or used topically. One vitamin for dry skin is Vitamin A, or retinol. A diet with insufficient amounts of vitamin A can actually lead to dry skin because vitamin A is responsible for the maintenance of healthy skin, as well as hair. Therefore, be sure to include plenty of vitamin A in your diet. The US RDA recommends 700 RAE per day of vitamin A for women. Good sources of vitamin A include carrots, sweet potatoes, boiled kale, turnip greens, mango, papaya, raw spinach, red and green bell peppers, cantaloupe, apricot, milk, eggs, romaine lettuce, tomatoes, broccoli, and oranges. Research has shown that using vitamin A as a topical skin treatment also helps decrease signs of dryness and aging.
Another vitamin for dry skin is Vitamin B Complex. Like vitamin A, a diet deficient in vitamin B can lead to dry skin. Vitamin B is actually comprised of multiple vitamins: Thiamine (B-1), Riboflavin (B-2), Niacin (B-3), Pantothenic Acid (B-5), Pyridoxine (B-6), Biotin (B-7), Folic Acid (B-9), and Cyanocobalamin (B-12). For this reason, vitamin B is often referred to as B-Complex. One of the jobs of vitamin B is to help maintain healthy skin. Other health benefits of vitamin B is that it enhances the immune system, improves muscle tone, and promotes cell growth and division. B-Complex is also know to help reduce stress and depression when included in the diet, which can indirectly help your skin stay moist and healthy. B vitamins are often found together in foods, but the best way to ensure you are getting enough vitamin B in your diet is to take a B-Complex vitamin once or twice per day, depending on the dosage level and the recommendation of the manufacturer.
Vitamin C is another vitamin for dry skin. Vitamin C is necessary to produce collagen in the skin. Collagen helps new tissue develop and strengthens the blood vessels, both of which help your skin maintain proper circulation and moisture. The US RDA recommends 60-90 mg of vitamin C to be included in the diet per day. Good sources of vitamin c include citrus fruits, potatoes, tomatoes, black currants, papaya, brussel sprouts, broccoli, cauliflower, strawberries, cantaloupe, spinach, cranberries, kiwi, and red peppers. When used in topical moisturizers, vitamin C can also be beneficial in treating dry skin.
Vitamin E is another great vitamin for dry skin. Although vitamin E can be added to the diet through foods such as wheat germ, vegetables, and nuts, the best way to use vitamin E is topically. It has been shown to eliminate both dryness and itching skin. In addition, vitamin E creams can help fight against free radicals and minimize the appearance of wrinkles.
The best way to get enough of these vitamins for dry skin into your diet is to take a Multivitamin once or twice per day. If you make sure to purchase a multi-vitamin that contains B-Complex, you can take care of all of your dry skin needs with just one wonderful little pill!
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What color is your vaginal discharge?
Most vaginal discharge is normal especially if you are of childbearing age.
Glands in the cervix produce a clear vaginal discharge that keeps the vagina walls moist. The purpose of normal vaginal discharge is to clean and moisten the vagina and help to prevent and fight infections - much the same way that saliva cleans and regulates the environment of the mouth.
Normal vaginal discharge is sometimes white in color but can turn yellow when exposed to the air and leaves a yellow stain on the underwear.
A normal vaginal discharge has no odor (or very mild odor), causes no irritation and, again, is usually whitish or clear. Although it's normal for the color, texture, and amount of vaginal fluids to vary, some changes in discharge may indicate a problem.
Normal vaginal discharges can vary somewhat in texture and color. They can be somewhat thin, sticky, and elastic or thick and gooey.
If you think you may have a problem, you should see a doctor as soon as possible. First, though, it helps to learn some of the differences between normal and abnormal vaginal discharge. This will help you to recognize changes that may occur.
Green vaginal discharge can be a sign of cervical disorder and requires the attention of your physician. A green vaginal discharge may be due to a sexually transmitted disease such as Trichonomis, particularly in women with multiple sexual partners. The vaginal discharge resulting from Trichonomis is often frothy and can range in color from gray to green to yellow, with a watery to milky consistency.
A yellow-green vaginal discharge could also be due to Gonorrhea, a sexually transmitted disease (STD) caused by a bacteria. The bacteria can be passed from one person to another through vaginal, oral, or anal sex, even when the person who is infected has no symptoms. They can also be passed from a mother to her baby during birth. A woman who has Gonorrhea may have no symptoms at all or her symptoms may be so mild that she doesn't notice them until they become more severe.
A thick white vaginal discharge that resembles cottage-cheese may signify Candida Yeast Infection. Candida Yeast is a treatable fungal infection of the vagina. Yeast infections result from an overgrowth of bacteria in the vagina — the most common being a fungus called Candida Albicans. The main symptom is itching, but you may have a white, thick vaginal discharge that resembles cottage cheese.
Dark brown vaginal discharge can be a sign of an infection, such as Vaginitis. Vaginitis is a broad term for a vaginal condition often characterized by swelling, itching, burning or infection in the vagina that can be caused by several different germs such as the germ that causes Trichonomis. A dark brown vaginal discharge can also be caused by an object such as a tampon that’s been lodged or forgotten in the vagina (yes, this has been known to happen!) It is therefore important that you check with your doctor so that you can determine the exact cause and receive treatment if necessary
Thick yellow vaginal discharge could be due to Cervicitis which is an inflammation or infection of the cervix. There are two types and either may be contagious. Cervicitis is very common, affecting many women at some point during their adult lives especially those with multiple sexual partners, a history of sexually transmitted disease or intercourse that began at an early age.
Many women with Cervicitis may not experience any symptoms at all, however those who do may experience the following:
*Yellow vaginal discharge, that may also be gray or white in color.
*Abnormal vaginal bleeding after intercourse, between periods or after menopause
*Sense of pelvic pressure or heaviness
*Painful sexual intercourse
A grayish vaginal discharge could also be due to Bacterial Vaginosis (BV) and may cause your discharge to be heavier than usual. Your vaginal discharge may become foamy or frothy and have an embarrassingly fishy odor. If your condition is due to BV, then you may want to try an effective natural alternative to antibiotics like Metronidazole that doctors give to patients when BV is the cause of feminine odor.
As you can see, the symptoms of these infections and the vaginal discharge which they produce can overlap quite a bit and can be very similar, so it is important to see a doctor if you have any of the symptoms of abnormal vaginal discharge so you can find out exactly what the cause is and treatment can begin.
Glands in the cervix produce a clear vaginal discharge that keeps the vagina walls moist. The purpose of normal vaginal discharge is to clean and moisten the vagina and help to prevent and fight infections - much the same way that saliva cleans and regulates the environment of the mouth.
Normal vaginal discharge is sometimes white in color but can turn yellow when exposed to the air and leaves a yellow stain on the underwear.
A normal vaginal discharge has no odor (or very mild odor), causes no irritation and, again, is usually whitish or clear. Although it's normal for the color, texture, and amount of vaginal fluids to vary, some changes in discharge may indicate a problem.
Normal vaginal discharges can vary somewhat in texture and color. They can be somewhat thin, sticky, and elastic or thick and gooey.
If you think you may have a problem, you should see a doctor as soon as possible. First, though, it helps to learn some of the differences between normal and abnormal vaginal discharge. This will help you to recognize changes that may occur.
Green vaginal discharge can be a sign of cervical disorder and requires the attention of your physician. A green vaginal discharge may be due to a sexually transmitted disease such as Trichonomis, particularly in women with multiple sexual partners. The vaginal discharge resulting from Trichonomis is often frothy and can range in color from gray to green to yellow, with a watery to milky consistency.
A yellow-green vaginal discharge could also be due to Gonorrhea, a sexually transmitted disease (STD) caused by a bacteria. The bacteria can be passed from one person to another through vaginal, oral, or anal sex, even when the person who is infected has no symptoms. They can also be passed from a mother to her baby during birth. A woman who has Gonorrhea may have no symptoms at all or her symptoms may be so mild that she doesn't notice them until they become more severe.
A thick white vaginal discharge that resembles cottage-cheese may signify Candida Yeast Infection. Candida Yeast is a treatable fungal infection of the vagina. Yeast infections result from an overgrowth of bacteria in the vagina — the most common being a fungus called Candida Albicans. The main symptom is itching, but you may have a white, thick vaginal discharge that resembles cottage cheese.
Dark brown vaginal discharge can be a sign of an infection, such as Vaginitis. Vaginitis is a broad term for a vaginal condition often characterized by swelling, itching, burning or infection in the vagina that can be caused by several different germs such as the germ that causes Trichonomis. A dark brown vaginal discharge can also be caused by an object such as a tampon that’s been lodged or forgotten in the vagina (yes, this has been known to happen!) It is therefore important that you check with your doctor so that you can determine the exact cause and receive treatment if necessary
Thick yellow vaginal discharge could be due to Cervicitis which is an inflammation or infection of the cervix. There are two types and either may be contagious. Cervicitis is very common, affecting many women at some point during their adult lives especially those with multiple sexual partners, a history of sexually transmitted disease or intercourse that began at an early age.
Many women with Cervicitis may not experience any symptoms at all, however those who do may experience the following:
*Yellow vaginal discharge, that may also be gray or white in color.
*Abnormal vaginal bleeding after intercourse, between periods or after menopause
*Sense of pelvic pressure or heaviness
*Painful sexual intercourse
A grayish vaginal discharge could also be due to Bacterial Vaginosis (BV) and may cause your discharge to be heavier than usual. Your vaginal discharge may become foamy or frothy and have an embarrassingly fishy odor. If your condition is due to BV, then you may want to try an effective natural alternative to antibiotics like Metronidazole that doctors give to patients when BV is the cause of feminine odor.
As you can see, the symptoms of these infections and the vaginal discharge which they produce can overlap quite a bit and can be very similar, so it is important to see a doctor if you have any of the symptoms of abnormal vaginal discharge so you can find out exactly what the cause is and treatment can begin.
Recognizing The Symptoms of Hormonal Imbalance in Women
Hormonal imbalance is caused by shifts in the body’s levels of progesterone and estrogen, two important hormones produced in the ovaries. The main function of these hormones is to regulate the menstrual cycle during a female’s reproductive years. The amount of hormones your body produces can vary from one day to the next and is affected by such factors as stress, nutrition, amount of sleep, exercise, and whether or not your body ovulates. Another major factor of hormonal imbalance includes chemicals found in the environment--encountered through air, food, and water--that mimic estrogen and upset the natural balance of estrogen and progesterone. If these hormones become imbalanced and are not produced in appropriate amounts, unpleasant symptoms are experienced. The symptoms of hormonal imbalance are varied and can become apparent as early as the late 20s and continue through the early 40s. If left untreated, symptoms of hormonal imbalance can increase in severity with age. Some symptoms of hormonal imbalance include:
Low Sex Drive
Joint pain
Stiffness
Fibrocystic Breasts
Endometriosis
Memory loss
Dry skin
Dry hair
Sugar cravings
Breast pain and tenderness
Irregular periods
Feelings of depression and anxiety
Fatigue
Hair loss
Hot Flashes
Growth of facial hair
Urinary tract infections
Incontinence
Weight gain
Bloating and water retention
Fuzzy thinking
Headaches and dizziness
PMS
Mood swings and irritability
Restless sleep
Insomnia
Night sweats
Vaginal dryness
Acne
Difficulty conceiving Osteoporosis (decrease in bone density)
Joint pain
Stiffness
Fibrocystic Breasts
Endometriosis
Memory loss
Dry skin
Dry hair
Sugar cravings
Breast pain and tenderness
Irregular periods
Feelings of depression and anxiety
Fatigue
Hair loss
Hot Flashes
Growth of facial hair
Urinary tract infections
Incontinence
Weight gain
Bloating and water retention
Fuzzy thinking
Headaches and dizziness
PMS
Mood swings and irritability
Restless sleep
Insomnia
Night sweats
Vaginal dryness
Acne
Difficulty conceiving Osteoporosis (decrease in bone density)
If you're suffering from the above symptoms, then you may want to have your hormones tested to be certain of the cause. Your doctor can do it for you, or you can have it done in the privacy of your home through websites which offer home testing kits, such as this one.
Various symptoms of hormonal imbalance can occur in women, including a deficiency in progesterone, which is the most common type of hormonal imbalance due to excess hormone in our food chain in such foods as meat and dairy products. Hormonal imbalance due to this reason has been linked to cases of girls 3 years old growing pubic hair and having menstrual cycles.
There are many treatments available to treat the causes and relieve the symptoms of hormonal imbalance. Many doctors have been prescribing recommending Hormonal Replacement Therapy (HRT) to women suffering from hormonal imbalance symptoms, however, studies have shown that HRT has had dangerous results on many women.
Abnormal Pap Smear Results: What they might mean
If you have received a report from your doctor’s office that includes an abnormal Pap smear result, the first course of action is often to panic. What does it mean? Do you have cancer? The first step in analyzing your abnormal Pap smear result is to relax, because in most cases, the findings do not indicate a malignancy. It is important to have a good idea of exactly what a Pap smear tests for before you can understand exactly what the results of your test mean.
What Exactly Is A Pap Smear?
A pap smear is a test that takes a collection of cells from the cervix for observation and evaluation under a microscope. When some of the cells appear to be unusual or atypical, you will have an abnormal Pap smear result. Abnormal cells can come from a variety of sources that include infections, inflammations or a virus like human papillomavirus or HPV. Sometimes the cause is as simple as the use of a douche or vaginal cream, or because of recent sexual activity prior to the exam itself. It can also be an indication of cancer or a precancerous condition, so it is important for you to talk to your doctor after getting an abnormal Pap smear result to determine what the next course of action should be, or if anything should be done at all.
The Cause Of Your Abnormal Pap Smear Results
Your next step may be determined by exactly what type of atypical cells was discovered to give you an abnormal pap smear result. The outcomes of these exams are graded by the laboratories that perform them, and generally fall into five categories. If your abnormal Pap smear result was on the lower end of the scale, your doctor may determine that the result was the cause of an infection or inflammation, and may simply recommend that you repeat the test in six months to a year. If the cells looked more ominous under the microscope, he may suggest a procedure called a colposcopy, which will allow him to look at the cells around the cervix a bit more closely and remove a sample for a biopsy if he determines that is necessary.
The Good News About Your Pap Smear Results
The good news about a pap smear is that the results are generally fairly accurate for this type of screening test. This means that if you have a good result, you can rest assured that you probably don’t need to worry about any problems until your next exam. If you receive abnormal Pap smear results, there are plenty of diagnostic tests that can be done to find and treat your problem. Most doctors will recommend that you get a Pap smear every year as a part of your annual exam, although some medical professionals will stretch that time frame out to every two years if you have had a number of normal pap smear results in succession.
Using A Herbal Remedy To Fight Yeast Candida
Keep in mind that a Pap smear, while an important test for women to have, is merely a screening device for your doctor. It does not diagnose any types of problems that you may encounter, so you may require additional testing if you receive an abnormal Pap smear result. The good news is that only about one in ten Pap smears that are conducted come up with abnormal results, and of that number, very few indicate something as serious as cancer.
Article by Wendy Travis
Monday, September 12, 2011
Cervical cancer: A preventable and treatable disease
Though cervical cancer is completely preventable, with screening exams and treatment, it continues to claim a considerable chunk of women population throughout the world. Considered the fifth most deadly cancer in women worldwide, cervical cancer affects about 16 per 100,000 women per year and kills about 9 per 100,000 per year, that is 800 women a day.
It remains unfortunate that about 83 per cent of the cases occur in developing countries, representing 15 per cent of female cancers. In Tanzania, cervical cancer ranks as the first most frequent cancer among women between 15 and 44 years of age. Tanzania is said to have a population of 10.97 million women aged 15 years and older who are at risk of developing cervical cancer. Current estimates indicate that every year 7,515 women are diagnosed with cervical cancer and 6,009 die from the disease though data is not yet available on the HPV burden in the general population of the country. However, in Eastern Africa, the region Tanzania belongs to, about 33.6 per cent of women in the general
population are estimated to harbour cervical HPV infection at a given time.
population are estimated to harbour cervical HPV infection at a given time.
Pap smear screening can identify potentially precancerous changes. Treatment of high grade changes can prevent the development of cancer. In developed countries, the widespread use of cervical screening programmes has reduced the incidence of invasive cervical cancer by 50 per cent or more.
Human papillomavirus (HPV) infection is a necessary factor in the development of nearly all cases of cervical cancer. HPV vaccine effective against the two strains of HPV that cause the most cervical cancer has been licensed in the US and the EU. These two HPV strains together are currently responsible for approximately 70 per cent of all cervical cancers. Since the vaccine only covers some high-risk types, women should seek regular Pap smear screening, even after vaccination.
Signs and symptoms
The early stages of cervical cancer may be completely asymptomatic. Vaginal bleeding, contact bleeding or (rarely) a vaginal mass may indicate the presence of malignancy. Also, moderate pain during sexual intercourse and vaginal discharge are symptoms of cervical cancer. In advanced disease, metastases may be present in the abdomen, lungs or elsewhere.
The early stages of cervical cancer may be completely asymptomatic. Vaginal bleeding, contact bleeding or (rarely) a vaginal mass may indicate the presence of malignancy. Also, moderate pain during sexual intercourse and vaginal discharge are symptoms of cervical cancer. In advanced disease, metastases may be present in the abdomen, lungs or elsewhere.
Symptoms of advanced cervical cancer may include: Loss of appetite, weight loss, fatigue, pelvic pain, back pain, leg pain, single swollen leg, heavy bleeding from the vagina, leaking of urine or faeces from the vagina, and bone fractures.
Causes
Human papillomavirus infection. The most important risk factor in the development of cervical cancer is infection with a high-risk strain of human papillomavirus. The virus cancer link works by triggering alterations in the cells of the cervix, which can lead to the development of cervical intraepithelial neoplasia, which can lead to cancer. Women who have many sexual partners (or who have sex with men who had many other partners) have a greater risk.
Human papillomavirus infection. The most important risk factor in the development of cervical cancer is infection with a high-risk strain of human papillomavirus. The virus cancer link works by triggering alterations in the cells of the cervix, which can lead to the development of cervical intraepithelial neoplasia, which can lead to cancer. Women who have many sexual partners (or who have sex with men who had many other partners) have a greater risk.
The medically accepted paradigm, officially endorsed by the American Cancer Society and other organizations, is that a patient must have been infected with HPV to develop cervical cancer, and is hence viewed as a sexually transmitted disease, but most women infected with high risk HPV will not develop cervical cancer. Use of condoms reduces, but does not always prevent transmission. Likewise, HPV can be transmitted by skin-to-skin-contact with infected areas. In males, HPV is thought to grow preferentially in the epithelium of the glans penis, and cleaning of this area may be preventative.
The American Cancer Society provides the following list of risk factors for cervical cancer: human papillomavirus (HPV) infection, smoking, HIV infection, chlamydia infection, dietary factors, hormonal contraception, multiple pregnancies, exposure to the hormonal drug diethylstilbestrol (DES) and a family history of cervical cancer. There is a possible genetic risk associated with HLA-B7.
Diagnosis
While the pap smear is an effective screening test, confirmation of the diagnosis of cervical cancer or pre-cancer requires a biopsy of the cervix. This is often done through colposcopy, a magnified visual inspection of the cervix aided by using a dilute acetic acid (e.g. vinegar) solution to highlight abnormal cells on the surface of the cervix. Further diagnostic procedures are loop electrical excision procedure (LEEP) and conization, in which the inner lining of the cervix is removed to be examined pathologically. These are carried out if the biopsy confirms severe cervical intraepithelial neoplasia.
Treatment
Microinvasive cancer (stage IA) is usually treated by hysterectomy (removal of the whole uterus including part of the vagina). For stage IA2, the lymph nodes are removed as well. An alternative for patients who desire to remain fertile is a local surgical procedure such as a loop electrical excision procedure (LEEP) or cone biopsy.
Microinvasive cancer (stage IA) is usually treated by hysterectomy (removal of the whole uterus including part of the vagina). For stage IA2, the lymph nodes are removed as well. An alternative for patients who desire to remain fertile is a local surgical procedure such as a loop electrical excision procedure (LEEP) or cone biopsy.
If a cone biopsy does not produce clear margins, one more possible treatment option for patients who want to preserve their fertility is a trachelectomy. This attempts to surgically remove the cancer while preserving the ovaries and uterus, providing for a more conservative operation than a hysterectomy. It is a viable option for those in stage I cervical cancer which has not spread; however, it is not yet considered a standard of care, as few doctors are skilled in this procedure.
Even the most experienced surgeon cannot promise that a trachelectomy can be performed until after surgical microscopic examination, as the extent of the spread of cancer is unknown. If the surgeon is not able to microscopically confirm clear margins of cervical tissue once the patient is under general anesthesia in the operating room, a hysterectomy may still be needed. This can only be done during the same operation if the patient has given prior consent.
Early stages (IB1 and IIA less than 4 cm) can be treated with radical hysterectomy with removal of the lymph nodes or radiation therapy. Radiation therapy is given as external beam radiotherapy to the pelvis and brachytherapy (internal radiation). Patients treated with surgery who have high risk features found on pathologic examination are given radiation therapy with or without chemotherapy in order to reduce the risk of relapse.
Larger early stage tumours (IB2 and IIA more than 4 cm) may be treated with radiation therapy and cisplatin-based chemotherapy, hysterectomy (which then usually requires adjuvant radiation therapy), or cisplatin chemotherapy followed by hysterectomy.
Advanced stage tumors (IIB-IVA) are treated with radiation therapy and cisplatin-based chemotherapy.
Prevention
The widespread introduction of the Papanicolaou test, or Pap smear for cervical cancer screening has been credited with dramatically reducing the incidence and mortality of cervical cancer in developed countries. Abnormal Pap smear results may suggest the presence of cervical intraepithelial neoplasia (potentially premalignant changes in the cervix) before a cancer has developed, allowing examination and possible preventive treatment. Recommendations for how often a Pap smear should be done vary from once a year to once every five years. The ACS recommends that cervical cancer screening should begin approximately three years after the onset of vaginal intercourse and/or not later than twenty-one years of age.
The widespread introduction of the Papanicolaou test, or Pap smear for cervical cancer screening has been credited with dramatically reducing the incidence and mortality of cervical cancer in developed countries. Abnormal Pap smear results may suggest the presence of cervical intraepithelial neoplasia (potentially premalignant changes in the cervix) before a cancer has developed, allowing examination and possible preventive treatment. Recommendations for how often a Pap smear should be done vary from once a year to once every five years. The ACS recommends that cervical cancer screening should begin approximately three years after the onset of vaginal intercourse and/or not later than twenty-one years of age.
The HPV test is a newer technique for cervical cancer triage which detects the presence of human papillomavirus infection in the cervix. It is more sensitive than the pap smear (less likely to produce false negative results), but less specific (more likely to produce false positive results) and its role in routine screening is still evolving.
HPV testing and Vaccination Could Cut Cervical Cancer Screening to Twice in a Lifetime
Women who have had the human papillomavirus (HPV) vaccine could need only two HPV screening tests for the rest of their lives according to new calculations being presented at the NCRI Cancer Conference in Liverpool. HPV testing is a more accurate cervical screening method than the current smear test, which looks for abnormal cells.
Professor Peter Sasieni, a Cancer Research UK scientist at Queen Mary, University of London, will urge the UK governments to consider making HPV testing the main method of cervical screening* across the health service as a priority. He believes women who have been vaccinated will no longer have to go for screening every three to five years, as is the current practice.
Research suggests that the HPV vaccine will prevent at least seven out of 10 cervical cancers and new vaccines currently being evaluated should prevent even more. It typically takes over 10 years for a cancer to develop after HPV infection. Research shows that cancer caused by HPV types not prevented by the current vaccines take even longer. This could allow the first cervical screen to be safely offered much later than at age 20 or 25.
Professor Sasieni said: “The UK cervical screening programme has done a fantastic job in reducing cervical cancer, but it is based on an old screening test. HPV testing could prevent an even greater proportion of cervical cancer with just half the number of screens over a lifetime. If HPV testing were to be rolled out from next year, it could be used nationally by 2015.
“With continued high coverage of HPV vaccination and targeting of screening resources towards unvaccinated women, cervical cancer should become a truly rare disease. And if the government plan for this change now, they could save hundreds of millions of pounds in the long run.”
Cervical cancer is the second most common cancer among women under the age of 35, and the majority of cases are caused by two strains of HPV, types 16 and 18.
In the UK, girls aged 12 to 13 are offered the HPV vaccine. Girls have three injections over six months given by a nurse. A two year catch up programme also started in autumn 2008 to vaccinate girls aged between 13 and 18.
Dr Lesley Walker, Cancer Research UK’s director of cancer information, said: “HPV vaccination has been a huge step towards reducing the number of women that will be diagnosed with cervical cancer in future years. And the very high uptake of the vaccine in the UK has been a real success story.
“This is exciting and poses interesting questions for the screening programme in terms of the best way to screen women in the future who have been vaccinated.
“But for now it remains vitally important that all women continue to take up the invitation to go for screening when they receive it.”
Notes
* If cervical cells test positive for HPV, the sample will then be tested using the current liquid based cytology method.
Professor Sasieni’s recommendations: Screening post vaccination
1. For women vaccinated aged 11 to 14, HPV testing at age 30 and 45
2. For women vaccinated aged 15-23, HPV testing at aged 25 to establish those not protected by vaccine, and further tests at age 35 and 50
3. For women who are not vaccinated or who have only received one dose, HPV testing at age 25, 30, 35, 45, and 55
Current cervical screening
In England:
- women aged 25-49 are invited for screening every 3 years
- women aged 50-64 are invited for screening every 5 years
- women aged 65 or over are only screened if they have not been screened since age 50, or have had recent abnormal results.
In Scotland, women aged 20-60 are invited for screening every 3 years.
In Wales and Northern Ireland, women aged 20-64 are invited for screening every 3-5 years.
NCRI Cancer Conference
Cancer in Malaysia
The incidence of cancer is on the rise in Malaysia. It can strike anyone regardless of colour, creed or status. Nearly 70,000 new cases were reported over a two-year period recently, with breast cancer the biggest threat.
The new cases were diagnosed among Malaysians in Peninsular Malaysia between 2003 and 2005, according to a report released in early 2008 on the incidence of the disease in West Malaysia.
The Cancer Incidence in Peninsular Malaysia 2003-2005 report, published by the National Cancer Registry (NCR), states that the total 67,792 new cases were diagnosed among 29,596 males (43.7 per cent) and 38,196 females (56.3 per cent). The annual crude rate for males was 100.2 per cent per 100,000 population, and 132.1 per cent per 100,000 for females.
The most frequent cancer during this period in Malaysians was breast cancer (18 per cent) followed by large bowel cancer (11.9 per cent) and lung cancer (7.4 per cent).
Despite a grim outlook, all hope is not lost. Between 30 and 50 per cent of cancer cases can be prevented if you practice a healthy lifestyle, undergo regular checks for early detection, and seek the right treatment when necessary.
Lung Cancer
Lung cancer is one of the main causes of cancer deaths in Malaysia. In fact, 95 per cent of lung cancer patients die within five years of diagnosis. A whopping 90 per cent of lung cancer is caused by cigarette smoking. The occurrence of lung cancer is also high among non-smokers who are exposed to second-hand smoke (passive smoking).
Lung cancer is one of the main causes of cancer deaths in Malaysia. In fact, 95 per cent of lung cancer patients die within five years of diagnosis. A whopping 90 per cent of lung cancer is caused by cigarette smoking. The occurrence of lung cancer is also high among non-smokers who are exposed to second-hand smoke (passive smoking).
Breast Cancer
The most common cancer and the number one cause of cancer deaths among women in Malaysia is breast cancer. This cancer is caused by an uncontrolled growth of cells within the breast tissue.
If not detected and treated promptly, breast cancer can metastasise, spreading to the lymph glands and other parts of the body, including lungs, bones and liver.
The most common cancer and the number one cause of cancer deaths among women in Malaysia is breast cancer. This cancer is caused by an uncontrolled growth of cells within the breast tissue.
If not detected and treated promptly, breast cancer can metastasise, spreading to the lymph glands and other parts of the body, including lungs, bones and liver.
Cervical Cancer
This is the most common gynaecological malignancy, and the second most prevalent cause of deaths among female cancer patients in Malaysia. With the number of cases diagnosed increasing over the years, the importance of early detection and treatment is becoming more apparent.
This is the most common gynaecological malignancy, and the second most prevalent cause of deaths among female cancer patients in Malaysia. With the number of cases diagnosed increasing over the years, the importance of early detection and treatment is becoming more apparent.
Leukaemia is a rare disease in children. However, it is the most common form of childhood cancer. According to the most recent Cancer Incidence in Peninsular Malaysia, 2003 – 2005 report, leukaemia remained the most frequent cancer incidence among male and female Malaysian children from birth up to 14 years. However, over the last decade, there have been major advances in the treatment of leukaemia in children. As a result, a considerable number of children can now be effectively cured. However, some forms of leukaemia can be treated more successfully than others.
MAKNA – Majlis Kanser Nasional
BG 03A & O5, Ground Floor,
Megan Ambassy,
No 225, Jalan Ampang,
50450 Kuala Lumpur,
Malaysia
Sunday, September 11, 2011
HPV vaccination: NIH study shown two doses is adequate as three doses
NIH STUDY FINDS TWO DOSES OF HPV VACCINE MAY BE AS PROTECTIVE AS FULL COURSE
Two doses of the human papillomavirus (HPV) vaccine Cervarix were as effective as the current standard three-dose regimen after four years of follow-up, according to researchers from the National Cancer Institute (NCI), part of the National Institutes of Health, and their colleagues. The results of the study, based on data from a community-based clinical trial of Cervarix in Costa Rica, appeared online Sept.9, 2011, in the Journal of the National Cancer Institute.
Worldwide, approximately 500,000 new cases of cervical cancer are diagnosed every year, and about 250,000 women die from the disease. An overwhelming majority of these new cases and deaths occur in low-resource countries. Virtually all cases of cervical cancer are caused by persistent infection with HPV. Cervarix is one of two vaccines approved by the U.S. Food and Drug Administration to protect against persistent infection with two carcinogenic HPV types, 16 and 18, which together account for 70 percent of all cervical cancer cases. The vaccine is intended to be administered in three doses given over the course of six months. To date, investigators have observed up to eight years of protection from persistent HPV infection with the vaccine. Studies are ongoing to determine the maximum length of protection.
The cost of the vaccine as well as the logistical difficulties of administering three doses to an adolescent population in resource-poor countries is greater than administering two doses. Even in wealthier countries such as the United States, few adolescent females complete the entire course of three vaccinations. According the Centers for Disease Control and Prevention, although approximately 49 percent of American girls ages 13 to 17 received one dose of the vaccine in 2010, only 32 percent received all three doses. In the United States, the predominately used HPV vaccine is Gardasil, which has a different formulation than Cervarix. Gardasil also protects against up to 90 percent of genital warts because it targets HPV strains 6 and 11 as well as 16 and 18.
The NCI-sponsored Costa Rica Vaccine Trial was designed to assess the efficacy of Cervarix in a community-based setting. Women ages 18 to 25 years were randomly assigned to receive the HPV vaccine or a Hepatitis A vaccine as the control treatment. Although the investigators intended to administer all three doses of the assigned vaccine to all 7,466 women in the study, about 20 percent of the participants received only one or two doses of the HPV or control vaccine. A third of women did not complete the vaccine series because they became pregnant or were found to have possible cervical abnormalities, reasons that would not likely bias the findings.
The investigators found that, after four years of follow up, two doses of the vaccine conferred the same strong protection against persistent infection with HPV 16 and 18 as did the full three-dose regimen. From just a single dose, they also observed a high level of protection, but they are cautious about the long-term efficacy of a single dose because other vaccines of this type usually require a booster dose. Additional studies are needed to evaluate the efficacy of a single dose, as well as the duration of protection for both one and two doses.
Our study provides evidence that an HPV vaccine program using two doses will work. It may be that vaccinating more women, with fewer doses for each, will reduce cervical cancer incidence more than a standard three-dose program that vaccinates fewer women," said Aimée R. Kreimer, Ph.D., lead author and investigator in NCI's Division of Cancer Epidemiology and Genetics. "The main question will be whether the duration of protection from fewer doses is adequate."
Kreimer emphasized that findings from this study of the Cervarix vaccine in women in Costa Rica may not be relevant for all populations, such as those in which HIV infection, malnutrition, or endemic diseases may influence the immune response. In addition, it is not known whether the same results would be obtained with the other FDA-approved HPV vaccine, Gardasil, because the vaccine formulations are different.
"Further studies are needed to confirm our findings in other populations as well as to quantify the duration of protection for fewer than three doses," said Kreimer. "If other studies confirm that fewer than three doses provide adequate protection against persistent cervical HPV 16 and 18 infection, we may be one step closer to prevention of cervical cancer, especially for women in resource-poor settings, where the need is greatest."
It is important to note that regulatory agencies have approved the HPV vaccine based on prevention of cervical precancers, not persistent infections. From studying the natural history of HPV and cervical cancer, experts know that persistent infections are first steps toward precancer. Furthermore, vaccine recommendations take into consideration many factors and studies. In the United States, the CDC's Advisory Committee on Immunization Practices determines federal recommendations regarding vaccination.
REFERENCE: AR Kreimer, et al. Proof-of-Principle Evaluation of the Efficacy of Fewer Than Three Doses of a Bivalent HPV 16/18 Vaccine. J Natl Cancer Inst. Epub ahead of print Sept. 9, 2011. In print Oct. 15, 2011.
Two doses of the human papillomavirus (HPV) vaccine Cervarix were as effective as the current standard three-dose regimen after four years of follow-up, according to researchers from the National Cancer Institute (NCI), part of the National Institutes of Health, and their colleagues. The results of the study, based on data from a community-based clinical trial of Cervarix in Costa Rica, appeared online Sept.9, 2011, in the Journal of the National Cancer Institute.
Worldwide, approximately 500,000 new cases of cervical cancer are diagnosed every year, and about 250,000 women die from the disease. An overwhelming majority of these new cases and deaths occur in low-resource countries. Virtually all cases of cervical cancer are caused by persistent infection with HPV. Cervarix is one of two vaccines approved by the U.S. Food and Drug Administration to protect against persistent infection with two carcinogenic HPV types, 16 and 18, which together account for 70 percent of all cervical cancer cases. The vaccine is intended to be administered in three doses given over the course of six months. To date, investigators have observed up to eight years of protection from persistent HPV infection with the vaccine. Studies are ongoing to determine the maximum length of protection.
The cost of the vaccine as well as the logistical difficulties of administering three doses to an adolescent population in resource-poor countries is greater than administering two doses. Even in wealthier countries such as the United States, few adolescent females complete the entire course of three vaccinations. According the Centers for Disease Control and Prevention, although approximately 49 percent of American girls ages 13 to 17 received one dose of the vaccine in 2010, only 32 percent received all three doses. In the United States, the predominately used HPV vaccine is Gardasil, which has a different formulation than Cervarix. Gardasil also protects against up to 90 percent of genital warts because it targets HPV strains 6 and 11 as well as 16 and 18.
The NCI-sponsored Costa Rica Vaccine Trial was designed to assess the efficacy of Cervarix in a community-based setting. Women ages 18 to 25 years were randomly assigned to receive the HPV vaccine or a Hepatitis A vaccine as the control treatment. Although the investigators intended to administer all three doses of the assigned vaccine to all 7,466 women in the study, about 20 percent of the participants received only one or two doses of the HPV or control vaccine. A third of women did not complete the vaccine series because they became pregnant or were found to have possible cervical abnormalities, reasons that would not likely bias the findings.
The investigators found that, after four years of follow up, two doses of the vaccine conferred the same strong protection against persistent infection with HPV 16 and 18 as did the full three-dose regimen. From just a single dose, they also observed a high level of protection, but they are cautious about the long-term efficacy of a single dose because other vaccines of this type usually require a booster dose. Additional studies are needed to evaluate the efficacy of a single dose, as well as the duration of protection for both one and two doses.
Our study provides evidence that an HPV vaccine program using two doses will work. It may be that vaccinating more women, with fewer doses for each, will reduce cervical cancer incidence more than a standard three-dose program that vaccinates fewer women," said Aimée R. Kreimer, Ph.D., lead author and investigator in NCI's Division of Cancer Epidemiology and Genetics. "The main question will be whether the duration of protection from fewer doses is adequate."
Kreimer emphasized that findings from this study of the Cervarix vaccine in women in Costa Rica may not be relevant for all populations, such as those in which HIV infection, malnutrition, or endemic diseases may influence the immune response. In addition, it is not known whether the same results would be obtained with the other FDA-approved HPV vaccine, Gardasil, because the vaccine formulations are different.
"Further studies are needed to confirm our findings in other populations as well as to quantify the duration of protection for fewer than three doses," said Kreimer. "If other studies confirm that fewer than three doses provide adequate protection against persistent cervical HPV 16 and 18 infection, we may be one step closer to prevention of cervical cancer, especially for women in resource-poor settings, where the need is greatest."
It is important to note that regulatory agencies have approved the HPV vaccine based on prevention of cervical precancers, not persistent infections. From studying the natural history of HPV and cervical cancer, experts know that persistent infections are first steps toward precancer. Furthermore, vaccine recommendations take into consideration many factors and studies. In the United States, the CDC's Advisory Committee on Immunization Practices determines federal recommendations regarding vaccination.
REFERENCE: AR Kreimer, et al. Proof-of-Principle Evaluation of the Efficacy of Fewer Than Three Doses of a Bivalent HPV 16/18 Vaccine. J Natl Cancer Inst. Epub ahead of print Sept. 9, 2011. In print Oct. 15, 2011.
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