Cancer Archives - Bill Chesnut MD

Adult HPV Vaccine Age, Guidelines

“The HPV vaccine is having a significant effect of decreasing cervical cancer. More recently HPV is associated with oral cancer and anal cancer.

HPV goes through latex And many of other sexually transmitted diseases do not. Many adults don’t know that the “safe sex” procedures they use may not work with HPV.

This recent review of this CDC information says that the vaccine has a low side effect rate in adults. The CDC data is established up to age 26. The CDC cannot recommend the vaccines for older adults. Adults older than 26 years who are sexually active should examine this data and balance that with their HPV risks.

Gardasil 9 has the broadest range of efficacy. The Prevents infection by 9 different types of HPV virus. These 9 types account for 90% of cervical cancers.” Bill Chesnut M.D.

Return to New Health News, http://billchesnutmd.com/new-health-news/

· Why Adults Should Get the HPV Vaccine
· When Should Adults Get the HPV Vaccine?
· Are There Any Adults Who Should Not Receive the HPV Vaccine?
· What Are the HPV Vaccine Ingredients?
· What Are the Risks and Side Effects of the HPV Vaccine?
Human papillomavirus (HPV) is the virus that causes cervical cancer in women and genital warts in men and women. The HPV vaccine effectively prevents infection with the HPV types responsible for most cervical cancers and can also prevent genital warts. HPV vaccination is most effective during childhood or adolescence, but adults can also benefit from the HPV vaccine.

Why Adults Should Get the HPV Vaccine

HPV infection is extremely common; most sexually active people will be infected with HPV at some point in life. HPV infection usually causes no symptoms, but can cause genital warts and anal cancer in both women and men. HPV can also cause throat cancer.

In women, HPV infection can cause cells in the cervix to grow abnormally. In a small fraction of women, these HPV-induced changes will develop into cervical cancer. About 12,000 women are diagnosed with cervical cancer each year and about 4,000 women die from the condition.

The HPV vaccine prevents infection by the HPV types responsible for most cervical cancers. There are three available forms of the HPV vaccine:

Cervarix: Prevents infection by HPV-16 and HPV-18. These two HPV types cause 70% of all cervical cancers. It is used for the prevention of cervical cancer and precancers.
Gardasil: Prevents infection by HPV-16, HPV-18, and also HPV-6 and HPV-11, the two HPV types that cause 90% of genital warts. It is used to prevent cancers and precancers of the cervix, vulva, vagina, anus, penis, and throat.
Gardasil 9: Prevents infection by the same HPV types as Gardasil, plus HPV-31, HPV-33, HPV-45, HPV-52, and HPV-58. Collectively, these types are implicated in 90% of cervical cancers.
All HPV vaccines are extremely effective at preventing infection by the HPV types they cover. Getting the HPV vaccine reduces a woman’s risk of cervical cancer and precancerous growths substantially. Men cannot develop cervical cancer, but the HPV vaccine may prevent genital warts, anal cancer, and the spread of HPV to sexual partners. Gardasiland, Gardasil 9 are approved for males ages 9 through 26.

The HPV vaccine does not treat or cure an HPV infection in women or men who are already infected by one of these HPV types.

When Should Adults Get the HPV Vaccine?

The CDC recommends that all women ages 26 years and younger receive three doses of the HPV vaccine. The CDC recommends that all men ages 21 years and younger receive three doses of the HPV vaccine. It is an option for all men, but is recommended for men who have sex with men or who have a compromised immune system (including HIV) who are ages 26 and younger.

CDC guidelines recommend the three doses of the HPV vaccine should be given as follows:

First dose: ideally at ages 11 or 12
Second dose: one to two months after the first dose
Third dose: six months after the first dose
Some adults may have received doses of the HPV vaccine in childhood or adolescence. All three doses should be given to get the most protection from HPV infection. Re-vaccination in adulthood is recommended if the vaccination schedule was not completed.

Are There Any Adults Who Should Not Receive the HPV Vaccine?

Certain people should not get the HPV vaccine or should wait before getting it:

Anyone who has had a life-threatening allergic reaction to a previous dose of the HPV vaccine
Anyone who has had a previous life-threatening allergic reaction to an ingredient in the HPV vaccine
Pregnant women
Anyone with a moderate or severe illness; people who feel mildly ill may still receive the HPV vaccine.
The HPV vaccine is not known to be harmful to pregnant women or their babies. However, until more information is known, pregnant women are advised not to receive the HPV vaccine. Women who are breastfeeding can safely receive the HPV vaccine.

The HPV vaccine’s safety and effectiveness have not yet been studied in adults older than age 26. Until that information is available, the HPV vaccine is not recommended for adults older than age 26.

What Are the HPV Vaccine Ingredients?

The HPV vaccine contains no viruses and is not made from human papillomavirus. The active ingredients in the HPV vaccine are proteins that are similar to those found in the human papillomavirus. Genetically modified bacteria produce the proteins, which are then purified and mixed into a sterile, water-based solution.

What Are the Risks and Side Effects of the HPV Vaccine?

In clinical trials and in real-world use, the HPV vaccine appears to be very safe. More than 40 million doses of the vaccine — mostly Gardasil, which was approved in 2006 — have been given in the U.S. Cervarix was approved in 2009 and Gardasil 9 was approved in 2014.

From 2006 to 2014, there were about 25,000 reports to the government of HPV vaccine side effects. Over 90% of these were classified as nonserious. The most common side effects of the HPV vaccine are minor:

About one in 10 people will have a mild fever after the injection.
About one person in 30 will get itching at the injection site.
About one in 60 people will experience a moderate fever.
These symptoms go away quickly without treatment. Other mild-to-moderate side effects resulting from the HPV vaccine include:

Nausea
Fainting
Headache
Arm pain

Severe side effects, or adverse events, are uncommonly reported and have included:

Blood clots
Seizures
Guillain-Barre syndrome
Chronic inflammatory demyelinating polyneuropathy
Systemic exertion intolerance disease (formerly called chronic fatigue syndrome)
Death
Government, academic, and other public health investigators could not identify the HPV vaccine as the cause of any severe adverse event. There were 117 deaths as of September 2015, none of which could be directly tied to the HPV vaccine. The conclusion of public health investigators was that the HPV vaccine was unlikely to be the cause of these events. Such events occur at a certain rate in any group of tens of millions of people. The vaccination before each adverse event seemed to be a simple coincidence.

Exercise linked to reduced risk of several cancers

“I love any article that says I can do something to decrease the risk of cancer. The researchers pooled data from 12 prospective US and European cohorts (baseline 1987-2004). They used self-reported exercise level in Leisure-Time Physical Activity With Risk of 26 Types of Cancer in 1.44 Million Adults.” Bill Chesnut, MD

(Return to New Health News, http://billchesnutmd.com/new-health-news/)
Exercise linked to reduced risk of several cancers

ABC World News Tonight (5/16, story 11, 0:25, Muir) reported, “The National Cancer Institute confirms that moderate exercise, all the way up to intense exercise, lowers the risk of” cancer “in many forms.”

The Los Angeles Times (5/16, Healy) reports that the research, published in JAMA Internal Medicine, suggests “exercise is a powerful cancer-preventive.” Investigators found that “physical activity worked to drive down rates of a broad array of cancers even among smokers, former smokers, and the overweight and obese.”

US News & World Report (5/16, Esposito) reports that investigators “analyzed data from participants in 12 US and European study groups who self-reported their physical activity between 1987 and 2004.” The researchers “looked at the incidence of 26 kinds of cancer occurring in the study follow-up period, which lasted 11 years on average.” The data indicated that “overall, a higher level of activity was tied to a 7 percent lower risk of developing any type of cancer.”

TIME (5/16, Park) reports that “the reduced risk was especially striking for 13 types of cancers.” Individuals “who were more active had on average a 20% lower risk of cancers of the esophagus, lung, kidney, stomach, endometrium and others compared with people who were less active.” Meanwhile, “the reduction was slightly lower for colon, bladder, and breast cancers.”

AMA News 5.17.16

Taking low-dose aspirin while undergoing cancer treatment may increase survival

“This is a clever research protocol. My hat is off to the originator for considering the bacteria we live with may be related to some of our maladies.” Bill Chesnut, MD

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Taking low-dose aspirin while undergoing cancer treatment may increase likelihood of survival, study suggests

Newsweek (4/20, Firger) reports that research suggests “taking low-dose aspirin while undergoing cancer treatment may increase a patient’s chance of survival by as much as 20 percent.” The findings (4/21) were published in PLOS ONE. Researchers looked at data from “five randomized trials and 42 observational studies on patients with breast, prostate and colorectal cancers.” The investigators “found there was a significant reduction in mortality in patients who took daily low-dose aspirin.”

Medical Daily (4/20, Baulkman) reports that aspirin also “helped stop the cancer from spreading.” These “findings echo findings from previous studies.”

AMA wire newsletter, April 21, 2016.

One-third of advanced-melanoma patients given nivolumab in study are alive five years after starting treatment

“You have got to read this. Using a stomach feeding tube to treat obesity? How about that.The treatments for medical conditions in severe obesity are not ideal. The surgery is complicated. This website explains the details of the types of gastrointestinal operations developed to try to reverse obesity safely. https://asmbs.org/resources/story-of-obesity-surgery This simple idea of inserting a tube to drain the stomach appears to produce excellent results with minimal complications. The report of a new procedure was April 11, 2016 at a conference of Interventional Radiologists. It is not FDA approved yet. Expect it will be approved and cost effective. This is great news for obese patients with severe degeneration in their backs, hips, knees and feet.” Bill Chesnut, MD

To go back to New Health News: http://billchesnutmd.com/new-health-news

Reversible Gastrostomy Tube May Be an Alternative to Bariatric Surgery: Presented at SIR

Created 04/11/2016 – 16:21

By Lorraine L. Janeczko

VANCOUVER — April 11, 2016 — A tube running from the stomach directly out the body through the abdomen may be an alternative to bariatric surgery for obese patients, according to research presented here at the 41st Annual Scientific Meeting of the Society of Interventional Radiology (SIR).

“This is a safe, easy, relatively low-risk procedure that can be removed when desired and can result in high weight loss,” said Shelby Sullivan, MD, Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri. “Right now, very few patients are optimally treated for obesity, and we need to be able to treat more patients with additional tools like this device that have lower risk than bariatric surgery but that achieves higher weight loss than lifestyle therapy alone.”

The AspireAssist Aspiration Therapy System consists of a percutaneous gastrostomy tube with one end placed inside the stomach and the other end connected to a port outside the abdomen, as well as a removable siphon that facilitates aspiration. The device allowed each patient to expel roughly 30% of their most recent meal before it was digested. Although the study was planned to run for 1 year, 12 patients chose to remain implanted for 3 years.

To evaluate the weight-loss efficacy and safety of the endoscopically placed device, lead author Stephen Solomon, MD, Department of Radiology, Cornell University, New York, New York, and colleagues enrolled 25 obese patients with a mean body mass index (BMI) of 39.8 kg/m2 in a pilot study at Blekinge County Hospital, Karlskrona, Sweden, between July and September 2012.

Of these, 22 patients completed 1 year, 15 completed 2 years, and 12 completed 3 years. For the 12 who completed 3 years, the mean weight loss was 26 kg with a mean excess weight loss of 58%. The mean weight loss at the end of years 1, 2, and 3 was 48% (19 kg), 46% (18 kg), and 45% excess weight loss (19 kg), respectively, on an intent-to-treat basis using the last observation carried forward method.

“The misconception is that you can eat anything and then aspirate it,” explained Dr. Sullivan. “In reality, patients must eat less than before. The food particles have to be smaller than 5 mm in size to fit through the tube. To get good aspiration, patients have to chew their food until it disintegrates in their mouth.”

“People not only get tired of chewing and stop eating earlier in the meal than before, they eat more slowly, can sense feeling full and push away from the meal,” he said. “The patients also need to drink a lot of water with their meal to create a slurry that can be aspirated. This reduces the amount of food they can fit into their stomach.”

The device is available on a limited basis in Europe and select additional regions. It is not approved by the US Food and Drug Administration (FDA) yet.

Breast Cancer Reoperation Rate Is Nearly Halved When MRI Findings Are

“Using bilateral MRI when planning surgery of breast cancer improves results in 1,926 patients.” Bill Chesnut, MD

To go back to New Health News: http://billchesnutmd.com/new-health-news

Reoperation Rate Is Nearly Halved When MRI Findings Are Included in Planned Surgical Treatment DG News_March 8, 2016 By Jenny Powers

VIENNA, Austria — March 8, 2016 — A comparison between two cohorts of patients who did and did not receive magnetic resonance imaging (MRI) in addition to mammography or ultrasound before breast cancer surgery revealed that MRI detected additional contralateral lesions and provided information that significantly altered surgical plans, researchers reported here on March 3 at the 2016 Annual European Congress of Radiology (ECR).

The study included women with newly-diagnosed breast cancer who were not candidates for neoadjuvant therapy. Surgical treatment was pre-planned for all women in the study based on mammography and or ultrasound, but one cohort received an MRI prior to surgery and one group did not.

To date 4,295 women have been enrolled in the ongoing study. The current analysis included data from 1,926 women aged 18 to 80 years, of whom 972 received MRI and 954 did not.

“The cohorts were not homogenous and significant differences in age and breast density were seen in the groups,” noted Giovanni Di Leo, MD, Radiology Unit, IRCCS Policlinico, Milan, Italy.

Patient age was 56 years in the MRI group versus 61 years in the non-MRI group and ACR breast density was 12% versus 18%, respectively (P < .001 for both).

The mastectomy rate was significantly higher in patients having MRI in addition to mammography or ultrasound (20.1% vs 14.0%; P < .001).

Pre-planned breast conserving surgery based upon MRI results was unchanged in 74% of women in the MRI cohort, altered to less extensive surgical treatment in 13%, and to a broader surgical treatment in 13% of women.

The rate of MRI-detected new contralateral cancers was (2%).

Importantly, the number of subsequent surgeries was significantly reduced in patients receiving MRI. The reoperation rate for positive margins was 7% in the MRI group compared with 13% in the non-MRI group (P < .001).

“The order for an MRI was made by a radiologist in 67% of the cases and by a surgeon in 40% of cases,” said Dr. Di Leo. “More mastectomies had already been planned on the basis of mammography or ultrasound in patients receiving MRI; this higher rate is due to a selection bias. One could say MRI is a confirmation tool for mastectomy.”

The European Congress of Radiology is sponsored by the European Society for Radiology.

Prolonged Nightly Fasting and Breast Cancer Prognosis

“This study in JAMA Oncology is a sophisticated look at the research of 2413 women studied for 12 years. The finding is that fasting over 13 hours while sleeping reduces the risk of recurrence in women with breast cancer. There will be more study of this first look at fasting affecting our health positively. There isn’t anything harmful about fasting for 13 hours a day. It is a matter of eating your dinner earlier and not snacking later. Clever idea.” Bill Chesnut, MD

To go back to New Health News: http://billchesnutmd.com/new-health-news

Prolonged Nightly Fasting and Breast Cancer Prognosis Catherine R. Marinac, BA^1,2,3; Sandahl H. Nelson, MS^1,2; Caitlin I. Breen, BS, BA¹; Sheri J. Hartman, PhD^1,3; Loki Natarajan, PhD^1,3; John P. Pierce, PhD^1,3; Shirley W. Flatt, MS¹; Dorothy D. Sears, PhD^1,3,4; Ruth E. Patterson, PhD^1,3

JAMA Oncol. Published online March 31, 2016.

Importance Rodent studies demonstrate that prolonged fasting during the sleep phase positively influences carcinogenesis and metabolic processes that are putatively associated with risk and prognosis of breast cancer. To our knowledge, no studies in humans have examined nightly fasting duration and cancer outcomes.

Objective: To investigate whether duration of nightly fasting predicted recurrence and mortality among women with early-stage breast cancer and, if so, whether it was associated with risk factors for poor outcomes, including glucoregulation (hemoglobin A_1c), chronic inflammation (C-reactive protein), obesity, and sleep.

Design, Setting, and Participants Data were collected from 2413 women with breast cancer but without diabetes mellitus who were aged 27 to 70 years at diagnosis and participated in the prospective Women’s Healthy Eating and Living study between March 1, 1995, and May 3, 2007. Data analysis was conducted from May 18 to October 5, 2015.

Exposures Nightly fasting duration was estimated from 24-hour dietary recalls collected at baseline, year 1, and year 4. Main Outcomes and Measures Clinical outcomes were invasive breast cancer recurrence and new primary breast tumors during a mean of 7.3 years of study follow-up as well as death from breast cancer or any cause during a mean of 11.4 years of surveillance. Baseline sleep duration was self-reported, and archived blood samples were used to assess concentrations of hemoglobin A_1c and C-reactive protein.

Results The cohort of 2413 women (mean [SD] age, 52.4 [8.9] years) reported a mean (SD) fasting duration of 12.5 (1.7) hours per night. In repeated-measures Cox proportional hazards regression models, fasting less than 13 hours per night was associated with an increase in the risk of breast cancer recurrence compared with fasting 13 or more hours per night (hazard ratio, 1.36; 95% CI, 1.05-1.76).

Nightly fasting less than 13 hours was not associated with a statistically significant higher risk of breast cancer mortality (hazard ratio, 1.21; 95% CI, 0.91-1.60) or a statistically significant higher risk of all-cause mortality (hazard ratio, 1.22; 95% CI, 0.95-1.56). In multivariable linear regression models, each 2-hour increase in the nightly fasting duration was associated with significantly lower hemoglobin A_1c levels (β = –0.37; 95% CI, –0.72 to –0.01) and a longer duration of nighttime sleep (β = 0.20; 95% CI, 0.14-0.26).

Conclusions and Relevance Prolonging the length of the nightly fasting interval may be a simple, nonpharmacologic strategy for reducing the risk of breast cancer recurrence. Improvements in glucoregulation and sleep may be mechanisms linking nightly fasting with breast cancer prognosis.

Reoperation Rate For Breast Cancer Is Nearly Halved When MRI Findings Are Included in Planned Surgical Treatment

“Using bilateral MRI when planning surgery for breast cancer improved results in 1,926 patients.” Bill Chesnut, MD

To return to New Health News: http://billchesnutmd.com/new-health-news

Reoperation Rate Is Nearly Halved When MRI Findings Are Included in Planned Surgical Treatment Doctors Guide News__March 8, 2016 By Jenny Powers

To date 4,295 women have been enrolled in the ongoing study. The current analysis included data from 1,926 women aged 18 to 80 years, of whom 972 received MRI and 954 did not.

“The cohorts were not homogenous and significant differences in age and breast density were seen in the groups,” noted Giovanni Di Leo, MD, Radiology Unit, IRCCS Policlinico, Milan, Italy.

Patient age was 56 years in the MRI group versus 61 years in the non-MRI group and ACR breast density was 12% versus 18%, respectively (P < .001 for both).

The mastectomy rate was significantly higher in patients having MRI in addition to mammography or ultrasound (20.1% vs 14.0%; P < .001).

The rate of MRI-detected new contralateral cancers was (2%).

Return to New Health News, http://billchesnutmd.com/new-health-news

Long-term Use of Aspirin and the Risk for Cancer

“This is part of an abstract of original research publish in the Journal of American Medical Association (JAMA) Oncology. The researchers studied 136,000 healthcare professionals for 26 years. Keep in mind there are side effects of chronic aspirin intake in some people. Consult your primary care physician about taking aspirin chronically if you have other health conditions.” Bill Chesnut, MD

Population-wide Impact of Long-term Use of Aspirin and the Risk for Cancer

Two large US prospective cohort studies, the Nurses’ Health Study (1980-2010) and Health Professionals Follow-up Study (1986-2012), followed up 135 965 health care professionals (88 084 women and 47 881 men, respectively) who reported on aspirin use biennially. The women were aged 30 to 55 years at enrollment in 1976; the men, aged 40 to 75 years in 1986. Final follow-up was completed on June 30, 2012, for the Nurses’ Health Study cohort and January 31, 2010, for the Health Professionals Follow-up Study cohort, and data were accessed from September 15, 2014, to December 17, 2015.

Key Points

Question: What are the potential benefits of aspirin for the prevention of cancer?
Findings: In 2 large, prospective cohort studies, regular use of low doses of aspirin for at least 6 years was associated with a significantly lower risk for overall cancer, primarily tumors of the gastrointestinal tract. Although aspirin may prevent colorectal cancers irrespective of screening, substantially more cases appear to be prevented among those who do not undergo screening.
Meaning: Long-term aspirin use was associated with a modest but significantly reduced risk for cancer, especially gastrointestinal tract cancer, and may complement the benefits of colorectal cancer screening.

Scientists may be able force cancer into dormant state

“This medical breakthrough is exciting. New technology development in other fields, nanochemistry, is used in a lab experiment to cause a cancer to stay dormant. This is the full discussion from UPI. I also included a Tel Aviv University Faculty Information paragraph describing what this scientist is doing.” Bill Chesnut, MD

Scientists may be able force cancer into dormant state Prof. Ronit Satchi-Fainaro ______________UPI Report 2.24.16.

Based on the knowledge that healthy people can live full lives with dormant cancer cells in their bodies never causing a health problem, scientists in Israel found a method to turn the cells off by using a drug that blocks their ability to grow. The proof-of-concept drug prevents osteosarcoma, or bone cancer, cells from communicating with healthy cells around them, stopping growth in lab experiments, ‘Tel Aviv’ University researchers report. The researchers found three microRNAs at low levels in aggressive tumors but at much higher levels in dormant tumors. In a dish, the researchers introduced selected microRNAs to cancer cells, finding they had less of ability to communicate with normal cells. We saw that the osteosarcoma cells treated with the selected microRNAs were unable to recruit blood vessels to feed their growth, Dr. Ronit Satchi-Fainaro, head of the cancer angiogenesis and nanomedicine laboratory at ‘Tel Aviv’ University, said in a press release. In order to keep these microRNAs stable in the blood, we needed to encapsulate them in a nanoparticle that circulates in healthy blood vessels, but that disembark and deliver the drug therapy at the leaky blood vessels that exist at tumor sites. We designed a nanomedicine that would have a special activation method at the tumor site in the target cell. For the study, published in ACS Nano, the researchers tested the nanoparticle wrapper method of delivering the microRNAs to the tumor site in mice. Mice treated with the drug survived for six months with the cancer, which Satchi-Fainaro said is the equivalent of 25 years of human life. In addition to planning for clinical trials using the nanomedicine developed at her lab, Satchi-Fainaro said research for similar ways to send other cancers into a dormant phase is underway. We wanted to understand what causes the cancer cells to ‘switch on’ in these cases, Satchi-Fainaro said. As long as cancer cells remain asymptomatic and dormant, cancer is a manageable disease. Many people live with thyroid lesions without their knowledge, for example. Ours is a very optimistic approach, and we believe it could apply to other cancers as well. .

____________________________________________________________

FROM TEL AVIV UNIVERSITY FACULTY INFORMATION:

Angiogenic Switch Using Rationally-Designed Theranostic Nanomedicines

Our research interests include investigations related to tumor biology, tumor dormancy, mechanism of action of angiogenesis inhibitors, self-assembly of polymeric architectures and novel approaches to target cancer. Throughout, we have maintained an interest in understanding the biological rationale for the design of polymer therapeutics suitable for transfer into clinical testing. Our primary interests are the molecular basis of tumor angiogenesis and the rational design of polymer therapeutics. Our research includes identification and characterization of genes and microRNAs associated with the switch from a dormant avascular tumor phenotype to a fast-growing angiogenic tumor in human cancers and their corresponding mouse models. We focus on the design and characterization of novel drug delivery platforms, including dendrimers and hyperbranched polymer–based nanoparticles, and the design of highly-selective targeting molecules integrating biology, chemistry, protein engineering, computational approaches, material sciences and nanotechnology to selectively guide drugs into pathological sites. Our vision is that novel approaches to target anticancer, anti-angiogenic drugs, miRNA and siRNAs to endothelial and tumor cells to potentially treat angiogenesis-dependent diseases could transform cancer into a chronically-manageable disease.

HPV infections falling among young women

“Great news here that needs to be widely disseminated in my view. We should encourage the use of the HPV vaccine in children 11-12 years of age. This post is from AMA News and links to the original article. I posted the original article abstract below for your information. As parents, it is easy to forget this information. Secondly it may be difficult to explain to the child it a necessity to prevent cancers in young adults. Important.” Bill Chesnut, MD

HPV infections falling among young women, study shows

USA Today (2/22, Painter) reports a study published in Pediatrics suggests that “thanks to a vaccination program that began a decade ago, fewer U.S. women are entering adulthood infected with” HPV. This study “is the first to show falling levels of dangerous strains of the” virus “among women in their early 20s.”

The Pittsburgh Post-Gazette (2/22, Sostek) reports that the study found “girls between 14 and 19 years old saw infection rates on the four types of HPV covered by the Gardasil vaccine fall 64 percent from the rate prior to the vaccine’s introduction — from 11.5 percent in 2003-2006 to 4.3 percent between 2009 and 2012.” Meanwhile, “in women ages 20 to 24, prevalence of the infection declined 34 percent in those years, from 18.5 percent to 12.1 percent.”

Pediatrics ___________________________________

March 2016

Prevalence of HPV After Introduction of the Vaccination Program in the United States

Lauri E. Markowitz, Gui Liu, Susan Hariri, Martin Steinau, Eileen F. Dunne, Elizabeth R. Unger

BACKGROUND: Since mid-2006, human papillomavirus (HPV) vaccination has been recommended for females aged 11 to 12 years and through 26 years if not previously vaccinated.

METHODS: HPV DNA prevalence was analyzed in cervicovaginal specimens from females aged 14 to 34 years in NHANES in the prevaccine era (2003–2006) and 4 years of the vaccine era (2009–2012) according to age group. Prevalence of quadrivalent HPV vaccine (4vHPV) types (HPV-6, -11, -16, and -18) and other HPV type categories were compared between eras. Prevalence among sexually active females aged 14 to 24 years was also analyzed according to vaccination history.

RESULTS: Between the prevacccine and vaccine eras, 4vHPV type prevalence declined from 11.5% to 4.3% (adjusted prevalence ratio [aPR]: 0.36 [95% confidence interval (CI): 0.21–0.61]) among females aged 14 to 19 years and from 18.5% to 12.1% (aPR: 0.66 [95% CI: 0.47–0.93]) among females aged 20 to 24 years. There was no decrease in 4vHPV type prevalence in older age groups. Within the vaccine era, among sexually active females aged 14 to 24 years, 4vHPV type prevalence was lower in vaccinated (≥1 dose) compared with unvaccinated females: 2.1% vs 16.9% (aPR: 0.11 [95% CI: 0.05–0.24]). There were no statistically significant changes in other HPV type categories that indicate cross-protection.

CONCLUSIONS: Within 6 years of vaccine introduction, there was a 64% decrease in 4vHPV type prevalence among females aged 14 to 19 years and a 34% decrease among those aged 20 to 24 years. This finding extends previous observations of population impact in the United States and demonstrates the first national evidence of impact among females in their 20s.

Accepted October 30, 2015.

New blood test improves prostate cancer screening

“This report is from a European medical news source. I include it here because the research is done at the Karolinska Institute in Sweden. This prestigious organization has been at the forefront of many medical discoveries for at least 50 years. I included the URL below so you can read the original report and research further. Detection of prostate cancer aggressiveness is a core area of research for many reasons. One reason is so we don’t over-treat prostate malignancies that are not aggressive and not life threatening. If you have a prostate and are at least middle-aged, keep up with this new information.”
Bill Chesnut, MD.

New blood test improves prostate cancer screening

http://www.euronews.com/2015/11/12/new-blood-test-improves-prostate-cancer-screening/

Researchers from the Karolinska Institutet in Sweden have developed a new blood test for prostate cancer, which they claim is more reliable and better at detecting aggressive cancer than PSA, the test usually performed.

According to the scientists, the new test, which has been tried on some 60,000 men, detects aggressive cancer earlier and reduces the number of false positives and unnecessary biopsies.

Hans Gustafson took part in the trial, and the blood test changed his life — he received treatment on time and is now healthy: “This test meant a better and longer life for me. I can also enjoy seeing my grand-children grow up. That’s something I’m very happy about,” he said.

Current testing for prostate cancer relies on measuring blood levels of a protein called prostate specific antigen (PSA). But this can be unreliable, resulting in some men having unnecessary biopsies and can lead to men being diagnosed and treated for harmless forms of cancer.

To develop a more accurate test, the Swedish scientists combined PSA measurement with the analysis of some 200 genetic markers as well as clinical data such as age, family history and previous prostate biopsies. Their findings were published in the scientific journal The Lancet Oncology)00361-7/abstract.

Second most common cancer

“There’s huge interest abroad and we’ve been in contact with several countries, the U.S, Britain, Norway and Denmark. They’re prepared to start trying it (the test) as early as next year,” said Henrik Grönberg, professor of cancer epidemiology at Karolinska Institutet.

More than 1 million men worldwide are diagnosed with prostate cancer each year. After lung cancer, it’s the second most common form of the disease in men.

As they grow older the numbers are rising quickly and it’s estimated that within 20 years, the global burden of prostate cancer “will have doubled”: http://www.nature.com/pcan/journal/v18/n3/full/pcan20159a.html#bib2 to more than 2 million cases.

Scientists hope the new test will improve detection and allow earlier treatment.

Nearly one-third of all cancer cases may be linked to inherited genes

“This report needs wide dissemination and understanding. There are several common sense conclusions. One is that not all cancers can be prevented, so searching for cancer proactively is warranted. Some of the searches involve blood tests that are usually negative, leading some to conclude they aren’t necessary as a part of prevention. Another conclusion is to know your family cancer history, first and second generation, including aunts, uncles and cousins. Tell you providers that you have this family history and want to be carefully managed. Know the list of common inheritable cancers listed here.” Bill Chesnut, MD

Nearly one-third of all cancer cases may be linked to inherited genes, research finds

On its website, NBC News (1/6, Fox) reports that research published in the Journal of the American Medical Association suggests that approximately one-third “of all cancer cases can be blamed on inherited genes.”

STAT (1/6, Swetlitz) reports that investigators looked at data on “identical and fraternal twins in Denmark, Finland, Norway, and Sweden, who were part of the Nordic Twin Study of Cancer.”

Newsweek (1/6, Firger) reports that the researchers found that “overall heritability for cancer was 33 percent among the entire study population, and notably higher for certain types of cancers.” Newsweek adds, “Significant heritability was found in 58 percent of diagnosed skin melanomas, 57 percent of prostate cancers, 43 percent of non-melanoma skin cancers, 39 percent of ovarian cancers, 38 percent of kidney cancers, 31 percent of breast cancers and 27 percent of uterine cancers.”

HealthDay (1/6, Thompson) reports that the researchers also “identified a set of cancers in which genetics play a very small role.” This group includes “lung cancer (18 percent), colon cancer (15 percent), rectal cancer (14 percent), and head and neck cancer (9 percent).”

JAMA Newsletter 1.7.16.

Mammograms with computer-aided detection may not be more accurate than those without.

“This article may be correct, but the method of the investigation is not right. To prove that “computer-aided detection of breast cancer in mammograms” is not more accurate than with using the computer detection requires a lot more work than was done here. The proof that will stand the tests of use over time is by proper research in the lab and radiology suites by dedicated experts. Reviewing the old records of 324,000 women, called researching by meta-analysis, is suspect. Computers are drawing conclusions because they can combine large numbers of different medical reports. Those findings should not be considered proof, just interesting.” Bill Chesnut, MD

Mammograms with computer-aided detection may not be more accurate than those without.

The AP (9/29, Tanner) reports that research suggests that “computer-assisted detection used in most U.S. mammograms adds no benefit to breast cancer screening while substantially increasing costs.” The study was published in JAMA Internal Medicine. The research “involved nearly 324,000 women who had digital mammograms from 2003 to 2009.”

TIME (9/29, Sifferlin) reports that “there were 495,818 mammograms with CAD and 129,807 without and the results were interpreted by 271 radiologists from 66 different facilities.” The investigators “concluded that CAD did not improve diagnostic accuracy and overall there was no beneficial impact of CAD on mammography interpretation.”

Sparing ovaries and removing fallopian tubes may cut cancer risk, but few have procedure

“This is important for women and their families to understand. They might think that removing the Fallopian tubes is an unnecessary additional surgery. There is an important reason patients facing hysterectomy should research this more. For the average person to be able to go to the Internet and find good explanations of complicated medical advances is another blessing of these last 20 years.” Bill Chesnut, MD

Sparing ovaries and removing fallopian tubes may cut cancer risk, but few have the procedure.

YALE NEWS. January 21, 2016. By Karen N. Pear, January 21, 2016

During hysterectomies for non-cancerous conditions, removing both fallopian tubes while keeping the ovaries may help protect against ovarian cancer while preserving hormonal levels, but few women receive this surgical option, according to a new study by Yale School of Medicine researchers.

Published in the February issue of the journal Obstetrics & Gynecology, the study was led by Xiao Xu, assistant professor in the Department of Obstetrics, Gynecology & Reproductive Sciences at Yale School of Medicine.

In hysterectomies to treat benign conditions, removing both of the ovaries in addition to the fallopian tubes has been used as a way to reduce ovarian cancer risk. But this practice can induce surgical menopause, which adversely affects cardiovascular, bone, cognitive, and sexual health. New evidence suggests that ovarian cancer often originates from the fallopian tube, rather than from the ovaries. This led the American College of Obstetricians and Gynecologists (ACOG) to issue a statement in 2015 suggesting that the practice of bilateral salpingectomy with ovarian conservation — surgical removal of both fallopian tubes while retaining the ovaries — may be a better option for ovarian cancer prevention in women at low risk for ovarian cancer.

Xu and her co-author, Dr. Vrunda Bhavsar Desai, conducted the study using data from the 2012 National Inpatient Sample. The team studied 20,635 adult women undergoing hysterectomy for benign conditions who were at low risk for ovarian cancer or future ovarian surgery.

“We found that among women undergoing inpatient hysterectomies in 2012 who were at low risk for ovarian cancer, very few of them received bilateral salpingectomy with preservation of the ovaries,” said Xu. “The rate of bilateral salpingectomy with ovarian conservation was 5.9% in this population. This study provides important baseline information on national practice patterns prior to the ACOG recommendation.”

Xu added that the rate of bilateral salpingectomy with ovarian conservation varied widely among 744 hospitals across the country, ranging from 0% to 72.2%.

“The wide variation in hospital practice may result in differential access to prophylactic procedures depending on where patients access care,” said Xu. “This can have longer-term health implications given the benefits of ovarian conservation.”

Could Chronic Stress Increase Your Risk of Getting Cancer?

“Recent reports show changes in Interleukin in human saliva change with stress levels. Interleukin is bad. See reference below.” Bill Chesnut, MD

Could Chronic Stress Increase Your Risk of Getting Cancer? by Mladen Golubic, M.D., Ph. D. Cleveland Clinic Wellness

Chronic stress has been associated with increased risk of cancer. How could stress impact your risk of getting cancer? Here’s how it works: Stress leads to hyper activation of the sympathetic nervous system – otherwise known as the “fight or flight response” – and the release of stress hormones, such as epinephrine, norepinephrine, cortisol and neuropeptide Y (NPY). In test tube experiments, norepinephrine and epinephrine may contribute to cancer progression by preventing cancer cell death. And in recent studies, NPY was shown to stimulate cell division (needed for cancer growth) and cell motility (needed for cancer spread) of human breast cancer cells. Cancer survivors who practice relaxation techniques like meditation or yoga, show a decrease in stress response, have less anxiety and better mood and quality of life. To what degree these desirable and beneficial effects are related to modulation of stress hormones remains to be examined. Regardless of the mechanisms involved, low-tech but highly beneficial interventions like yoga and meditation can be practiced by any cancer survivor. Needless to say, such practices do not interfere at all with any cancer treatment modality. Having good social support (friends, friends, friends) and being physically active are other ways to diminish the negative effects of chronic stress.

Ann N Y Acad Sci. 2012 Jul;1261:88-96. doi: 10.1111/j.1749-6632.2012.06634.x.

Role of interleukin-6 in stress, sleep, and fatigue..

Rohleder N¹, Aringer M, Boentert M.

Chronic low-grade inflammation, in particular increased concentrations of proinflammatory cytokines such as interleukin (IL)-6 in the circulation, is observed with increasing age, but it is also as a consequence of various medical and psychological conditions, as well as life-style choices. Since molecules such as IL-6 have pleiotropic effects, consequences are wide ranging. This short review summarizes the evidence showing how IL-6 elevations in the context of inflammatory disease affect the organism, with a focus on sleep-related symptoms and fatigue; and conversely, how alterations in sleep duration and quality stimulate increased concentrations of IL-6 in the circulation. Research showing that acute as well as chronic psychological stress also increase concentrations of IL-6 supports the notion of a close link between an organism’s response to physiological and psychological perturbations. The findings summarized here further underscore the particular importance of IL-6 as a messenger molecule that connects peripheral regulatory processes with the CNS. (emphasis mine. BC.)