American Cancer Society opens up new guidelines for cervical cancer screening

The American Cancer Society (ACS) has changed its guidelines for cervical cancer, saying self-collected vaginal swab tests are now acceptable.

 

But according to a recent story by Allyson Chiu in The Washington Post, clinician-collected cervical samples “are still preferred.”

 

The tests are aimed at human papillomavirus (HPV), a sexually transmitted infection that “causes nearly all cervical cancers,” the article maintains

 

Jane Montealegre

Self-collection could be "a game-changer for increasing screening, Chiu quotes Jane Montealegre, associate prof in the  department of behavioral sciences at the University of Texas MD Anderson Cancer Center, as saying.

Roughly 13,000 new cases of the disease are diagnosed in the United Staters annually, and about 4,000 women die, according to the Centers for Disease Control and Prevention (CDC).

 

Chiu writes that data shows that screening rates have declined in the past 20 years — although cancer incidence had been cut by more than half since the mid-1970s.

 

Montealegre — who also claims that most insurance should cover HPV testing, including self-collected — says a self-collected test could be a good option for women who aren’t comfortable getting as pelvic exam or don’t have access to one. 

 

But, she adds, if you’re interested in self-collection, you should ask your physician to make the option available, and you should make sure the test you use has received Federal Drug Administration (FDA) approval.

 

“If they’re not FDA-approved, I wouldn't trust that as a valid screening test,” the Post quoted her again.

More information on new medical guidelines can be found in Rollercoaster: How a man can survive his partner's breast cancer, a VitalityPress book that I, Woody Weingarten aimed at male caregivers. My other books are MysteryDates — How to keep the sizzle in your relationship; The Roving I, a compilation of 70 of my newspaper columns; and Grampy and His Fairyzona Playmates, a whimsical fantasy intended for 6- to 10-year-olds that I co-authored with my then 8-year-old granddaughter. Check out my website at https://woodyweingarten.com for details.

Columnist suggests three strategies that could possibly reduce your risk of contracting cancer

By employing three strategies, you may reduce your cancer risk. 

That, at least, is the opinion of Dr. Jerry Saliman, whose Senior Life column in an earlier-this-month edition of j. the Jewish News of Northern California, focused on those strategies — being on the lookout, catching symptoms early, and paying attention to risky behavioral factors.

Dr. Jerry Saliman

Regarding the first strategy, Saliman writes that unfortunately only four types of cancer screening have received a high-level record recommendation from a U.S. task force: colon, lung, breast, and cervix.

As to the second line of reasoning, the columnist, a Bay Area physician who retired from Kaiser South San Francisco after a 30-year career and now is a volunteer internist at Samaritan House Medical Clinic in San Mateo, suggests that "by catching cancer early, the survival rates may be four times higher compared with later-stage detection."

Saliman adds, about the last strategy, that the American Cancer Society's prevention studies have been crucial in detailing risk factors — including, in the 1950s, being the first to identify smoking as a major reason for cancer. The ACS has since, via its ongoing research, "found that older age and smoking have the highest relative risk for developing any cancer for both men and women."

Additional risks for men, his column says, "are family history of cancer, red meat consumption, alcohol intake, and physical inactivity."

More information on risks can be found in Rollercoaster: How a man can survive his partner's breast cancer, a VitalityPress book that I, Woody Weingarten, aimed at male caregivers.

HPV shots might save thousands of lives

Vaccines, screenings, treatments could severely cut deaths from cervical cancer, N.Y. Times says

Cervical cancer last year killed more than 311,000 women, one every two minutes, but early detection might have prevented thousands of those deaths around the world.

Such detection, it's believed, could have resulted in expanded screenings and treatments.

In addition, an increase in HPV vaccinations for teenage girls may have helped a great deal.

At least those are the conclusion drawn by Mia Armstrong in a recent story in The New York Times. 

Dr. Kirsten Austad

Armstrong quotes Dr. Kirsten Austad, director of women's health for the Maya Health Alliance, as saying, "Almost no one needs to die of cervical cancer."

Of the more than 300,000 annual deaths from cervical cancer, the fourth most common cancer for women globally, the Times piece notes, more than 85 percent were in low- and middle-income countries.

The story also mentions a World Health Organization estimate of 570,000 new cases in 2018, the same year that Dr. Tedros Adhanom Ghebreyesus, director general of WHO, "called for coordinated global action" to eliminate the disease.

Armstrong cites, too, the words of Dr. Silvia de Sanjosé, director of women's cancer for PATH, a nonprofit focused on global health, to the effect that such a coordinated effort "was crucial to elevating the issue," which had previously received little attention.

"I would not say that that's enough," she said, the story continues. "But it's clearly a turning point." 

She also told the Times about a couple of big challenges: The vaccine needs to be given after age nine, which is later than most routine vaccines, and the price tag, which in the lowest-income countries costs approximately $4.50, jumps to $150 in some places.

WHO recommends that 9- to 14-year-old girls receive two does of the [HPV vaccine, which protects] against HPV infections responsible for 70 to 90 percent of cervical cancers."

The difficulty is, however, that, according to the story, WHO estimates indicate that "only around 25 percent of 10-year-olds live in counties that have introduced the HPV vaccine."

Other calls to action about diseases can be found in "Rollercoaster: How a man can survive his wife's breast cancer," a VitalityPress book that I, Woody Weingarten, aimed at male caregivers.

Can laparoscopic surgery spread cancer cells?

New data shows less invasive operation causes more deaths for women with cervical cancer

In news that may appear counter-intuitive, two studies have shown a higher death rate for a less invasive version of a cancer operation in women.

According to a recent Associate Press story by Carla K. Johnson, the new evidence challenges standard practice "and the 'less is more' approach to treating cervical cancer."

The article notes that the unexpected findings already "are prompting changes at some hospitals that perform radical hysterectomies for early-stage disease."

Dr. Pedro Ramirez

Dr. Pedro Ramirez of the University of Texas MD Anderson Cancer Center in Houston, who led the more rigorous study, says that after the results became known "we immediately as a department changed our practice and changed completely to the open approach."

Findings from his study, which was conducted at more than 30 sites in a dozen countries and were published in the New England Journal of Medicine, showed "women who had the less invasive surgery were four times more likely to see their cancer return compared to women who had traditional surgery."

Dr. Jason Wright of New York-Presbyterian Hospital, a co-author of the other study, says "we're rethinking how we approach patients. There's a lot of surprise around these findings."

And Dr. Amanda Fader of Johns Hopkins Kimmel Cancer Center, explaining that the Baltimore hospital "has stopped doing less invasive hysterectomies for cervical cancer until there is more data," is quoted as saying the new research "is 'a great blow' to the [newer] technique and the findings are 'alarming.'"

Surgeons, she adds, ""should proceed cautiously."

In both studies, Johnson's story says, "researchers compared two methods for radical hysterectomy, an operation to remove the uterus, cervix and part of the vagina. The surgery cost around $9,000 to $12,000 with the minimally invasive version at the higher end."

Traditional surgery involves a cut in the lower abdomen; in the newer method, laparoscopic surgery, from which patients recover more rapidly, small incisions are made for a camera and instruments.

Some experts believe the reason for the higher death rate is because "there may be something about the tools or technique that spreads the cancer cells from the tumor to the abdominal cavity," AP's article reports.

More information on research into cancer for both men and women can be found in "Rollercoaster: How a man can survive his partner's breast cancer," a VitalityPress book that I, Woody Weingarten, aimed at male caregivers.

Fighting the virus that spreads through sex

Federal regulators boost their OK on use of cervical cancer vaccine from age 26 to age 45

U.S. regulators have expanded the use of Merck's cervical cancer vaccine, Gardasil 9, to adults up to age 45.

The vaccine, according to a recent story by Linda A. Johnson of the Associated Press, was previously approved only for preteens and young adults through 26.

Johnson's article notes that the vaccine protects against the human papilloma virus, or HPV, which can cause cervical cancer, certain other cancers and genital warts — and that the virus is "very common and is spread through sex."

HPV, it goes on to say, "doesn't cause any problems, but some infections persist and eventually lead to cancer."

Johnson also writes that the Centers for Disease Control and Prevention estimated about 14 million people become newly infected with HPV each year, mostly teens and young adults" — and adds that 33,700 are diagnosed annually with a cancer caused by an HPV infection.

The latest version of the pharmaceutical giant's vaccine protects "against nine strains of HPV, four more than the original" did in 2006, the story indicates.

Details about other new vaccines and drug, and other Federal Drug Administration action, can be found in "Rollercoaster: How a man can survive his partner's breast cancer," a VitalityPress book I, Woody Weingarten, aimed at male caregivers.

Is 'co-testing' for disease on the way out?

HPV tests may replace Pap smears regarding cervical cancer changes, study suggests

Pap smears may be on the way out, replaced by a test for HPV, when it comes to detecting cancerous cervical changes.

At least that's what a new decade-long study involving some 19,000 women suggests might happen (because the Human PapillomaVirus test apparently is more sensitive and more accurate).

The study, published yesterday in the Journal of the American Medical Association, was reported in a Laurie McKinley story in The Washington Post.

Dr. Gina Ogilvie

Dr. Gina Ogilvie, a professor at the University of British Columbia in Vancouver and lead author of the study, has cited a particular benefit — the research showing "women who received HPV testing have more reassurance with a negative test and can likely get screened less frequently."

Mark Schiffman of the National Cancer Institute, an HPV researcher himself, confirmed "that it's important to move from the Pap smear to the HPV test alone," according to the Post article. 

He also reportedly maintains that the Pap smear, which he calls "crude and inaccurate," worked only because women were tested often and because cervical cancer grows slowly.

HPV, the Post piece says, "is the most common sexually transmitted infection and is usually eliminated by the immune system. But when an infection persists, it can cause cellular changes that develop into precancerous lesions and eventual malignancies."

McGinley's story notes that "about 13,240 new cases of invasive cervical cancer will be diagnosed in the United States in 2018, according to the American Cancer Society. About 42,000 women will die of the disease."

In recent years, the article continues, "most medical groups have recommended that women in the United States get both the HPV test and the Pap smear — a practice called 'co-testing.'"

Now, however, many experts are saying the Pap smear should be dropped. That position is still challenged by others who claim "that the Pap smear can catch a small number of cases of abnormal cells that might be missed by the HPV test."

The conventional Pap smear has already been replaced to a large degree by liquid-based Pap cytology tests.

The Post piece contends that "most medical groups," including the American Cancer Society and the American College of Obstetricians and Gynecologists, urge "that women of average risk get both HPV tests and Pap smears every five years between age 30 and 65, though they say a Pap test alone every three years is an acceptable alternative."

McGinley's story also notes that "about 80 million people in the United States are infected with HPV [although] most never develop any health problems because most infections go away by themselves, according to the Centers for Disease Control and Prevention."

Doctors have long urged children and young adults be vaccinated against HPV with a shot approved in 2006 by the Food and Drug Administration.

More details about cancer research can be found in "Rollercoaster: How a man can survive his partner's breast cancer," a VitalityPress book I, Woody Weingarten, aimed at male caregivers.

Similar to females in poor developing nations

Racial gap widening in cervical cancer deaths — to the detriment of black women

A widening racial gap has been found in regard to cervical cancer deaths.

With black women being on the short end of the stick.

Over all, according to an article in The New York Times by Jan Hoffman late last month, a study published in the journal Cancer has determined that "the death rate…is considerably higher than previously estimated."

Hoffman's story says researchers have reported that "the rate which black American women are dying from the disease is comparable to that of women in many poor developing nations" in Latin America, Asia and Africa.

The article notes that "what makes the findings especially disturbing…is that when screening guidelines and follow-up monitoring are pursued, cervical cancer is largely preventable."

Some experts say the expected repeal of the Affordable Care Act, which covers screening, is likely to make matters worse.

The new study, which looked at data from 2000 to 2012, showed the mortality rate for blacks was 10.1 per 100,000, compared to 4.7 for white women.

Anne F. Rositch, Ph.D.

Anne F. Rositch, Ph.D., lead author and an assistant epidemiology prof at Johns Hopkins Bloomberg School of Public Health, explained that women who'd had hysterectomies — which almost always remove cervixes — were excluded from the study.

The racial disparity, it was speculated, reflected "unequal access to screening, ability to pursue early-warning test results, and insurance coverage."

"Rollercoaster: How a man can survive his partner's breast cancer," a VitalityPress book I, Woody Weingarten, aimed at caregivers touches on studies that show other racial disparities.