Archive for May, 2006
In a unanimous vote, an FDA advisory committee recently voted to endorse the safety and effectiveness of Gardasil. The new vaccine developed by Merck Pharmaceuticals has been shown to protect women from two types of the human papilloma virus, responsible for about 70% of cervical cancer cases. The potential to cut worldwide deaths from the disease is huge.
HPV is the most common sexually transmitted disease, affecting an estimated 50% of sexually active adults. Each year, cervical cancer kills 290,000 women worldwide. About 3,500 of the annual deaths occur in the U.S., where many women have the opportunity for early detection through regular pap smears. Treatment for precancerous lesions and early cervical cancer greatly reduce mortality rates in the U.S..
Gardasil is the first vaccine known to prevent cervical cancer. If approved by the FDA, the Merck vaccine could be the biggest advance in eradicating cervical cancer since the pap test was introduced decades ago.
Merck recommends using the vaccine in females age 9 to 26. Gardasil can be most effective if young girls are vaccinated before they became sexually active. The vaccine is not intended to take the place of regular cervical screening.
The FDA is expected to endorse the use of the vaccine at a June meeting. If approval is given, a national Advisory Committee on Immunization Practices will decide whether to advocate routine vaccination with Gardasil.
Source: CNN.com
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May 30th, 2006
Women of childbearing age are advised to ask their doctor for an advance prescription so that it can be used in case of unprotected intercourse, according to a leading gynecologist group.
In case of rape, condom failure, or lapses in their birth control methods, women would be wise to have the prescription on hand. The Bush administration has refused to allow the pill to be sold over-the-counter nationwide.
The morning-after pill is safe and effective, and many physicians believe it should be available without a prescription. The pill, which contains a high dose of regular birth control pills, can cut the chances of pregnancy by up to 89% if used within 72 hours after unplanned or unprotected sex.
Having immediate access to the pill and taking it sooner rather than later increases its effectiveness. This medication does not cause an abortion and should not be confused with RU-486 used for that purpose during early pregnancy. If the woman is already pregnant, the drug has no effect.
Early access to add the morning-after pill could cut in half the nation’s 3 million annual unplanned pregnancies.
Finding a doctor to prescribe the pill on a weekend or holiday period is often difficult. An advance prescription can give women peace of mind and access to the pill at a time when they most need it.
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Source: MSNBC.com
May 25th, 2006
Women who are obese may experience longer labors than women of normal weight when their labor is induced. Recent findings of a study at Saint Louis University were presented at the American College of Obstetricians and Gynecologists in May.
In research conducted by OB/Gyn physician Erin Brousseau, obese women who elected to have labor induced appeared to be at higher risk of longer labor and may require a Cesarean section.
Dr. Brousseau indicated that obese women needed more medication to activate labor. Of the 195 patients taking part in the study, medication given to those who were obese also took longer to begin working. She recommended that their doctors wait for labor to begin spontaneously.
Obese women who wish to conceive would be wise to lose significant weight before attempting to get pregnant. They should be carefully checked by their physicians in a pre-pregnancy physical exam.
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May 21st, 2006
In April, the National Cancer Institute announced that raloxifene (evista) was as good as tamoxifen at preventing invasive breast cancer. Their conclusion was based on a study of 20,000 high-risk women in which half were given tamoxifen and half raloxifene for a five-year period.
Statistical results were roughly equal, although raloxifene was touted as having fewer unwanted side effects than tamoxifen. There were 163 cases of breast cancer in the group taking tamoxifen, compared to 167 in women taking raloxifene. With either group, the cases of breast cancer that developed during the study were about half as many as if the women had not been treated.
Like those on tamoxifen, a very small number got uterine cancer or developed blood clots, potential side effects of either drug. With those on raloxifene, these conditions developed at a slightly lower rate, but the numbers are small and therefore not very statistically significant. These conditions could have developed by chance and not have been related to taking the drug.
The principal difference found was that raloxifene lowered the risk of “invasive†breast cancer, but did not protect for lobular and ductal carcinomas in situ. These non-invasive cancers can develop into invasive cancers, which are the type that kill, but they can be effectively treated when found early. Tamoxifen appears to lower the risk for both invasive and non-invasive cancers.
Taking either drug is risk reduction, not prevention. You are treating a large number of healthy women, who might develop unwanted side effects, while helping only a small number to avoid breast cancer. In 1,000 high-risk women, approximately 20 women treated would avoid getting breast cancer, while another 20 would develop it despite taking the medications. This means that 980 women are exposed to the drugs’ risks but will get no cancer benefit.
Since there is no way to predict who will get breast cancer, high-risk women must choose whether they wish to take the medications that can have unpleasant side effects such as hot flashes and other menopausal symptoms.
At some point in the future, we may be able to pinpoint who is actually at high risk of breast cancer. Then, taking these medications will make more sense for women who are otherwise healthy.
Another development on the horizon is a study to test a class of drugs called aromatase inhibitors, which are used to treat breast cancer. They may do a better job of prevention than either tamoxifen or raloxifene.
Source:Â New York Times, May 9, 2006, by Denise Grady
May 15th, 2006
AÂ recent finding by scientists of a gene associated with prostate cancer may help doctors decide which patients are best suited to receive aggressive therapy. DeCode Genetics in Iceland made the discovery that may help explain why African Americans, who more commonly have this gene, may have higher rates of prostate cancer than some other populations.
The variant gene was discovered in men in Iceland, Sweden, and in two populations in the U.S. The gene variant, carried by about 13% of men of European ancestry, raises the risk of getting prostate cancer by 60%, compared with a 13% risk in those who did not carry it. Men with this recently found gene were discovered to make up about 8% of all cases of prostate cancer.
The variant in African-American men is twice as common as in men of other ancestry. For this reason, prostate cancer may be more prevalent and have a higher mortality rate in black males in the U.S. than in white males. Early detection and aggressive treatment could lead to better outcomes for black males.
According to Dr. Kari Stefansson, DeCode’s chief executive, this was the first major gene in prostate cancer found in widespread populations.
Source: Oakland Tribune, reprinted from New York Times writer Nicholas Wade’s article; May 8, 2006
Additional Resources:
What You Need to Know About Prostate Cancer
May 12th, 2006
Women who have abnormal Pap or cervical smear tests are usually sent for further investigation. Doctors use one of four different techniques to remove suspicious cells for further examination. All have been shown to be equally successful in preventing progression to cervical cancer. Women should be aware, however, that three of the techniques carry a small risk of complications with a future pregnancy.
In Great Britain, researchers from the Royal Preston Hospital in Lancashire analyzed results from 27 studies. They looked at various treatments used to remove abnormal cells and sometimes a margin of healthy cells around them. Their conclusions were published in the Lancet medical journal.
Laser ablation, which destroys the abnormal cells, was the only treatment not linked to any pregnancy risks. Cold knife conisation uses a scapel to remove a cone-shaped wedge of tissue, and laser conisation employs the laser to do the same thing. Researchers found that in subsequent pregnancies, cold knife conisation increased the risk of giving birth prematurely, of having a low birthweight baby, or needing a Caesarean. Laser conisation had similar risks, although not to the same extent.
The most common procedure, called LLETZ (large loop excision of the transformation zone), removes the area with abnormal cells from the cervix by employing a small tool and electric current. This procedure was also found to raise the risks of having a premature or small baby. In addition, it increased the chances of early rupturing of membranes.
Professor Peter Sasieni, a UK cancer research expert, stressed the importance of women being aware of potential side-effects. They should discuss various options with their doctor prior to treatment for cervical precancerous cells. The most important consideration is that a woman gets the treatment she needs to prevent cervical cancer. The chances of pregnancy risks are very small, he concluded.
Source:Â BBC News
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May 10th, 2006
In women treated for breast cancer, large numbers of them are not returning for annual mammograms. A new study at the University of Massachusetts Medical School looked at compliance with mammography guidelines in 797 breast cancer survivors over the age of 55.
Average age was 69, and 80% were Caucasian. Forty percent had one breast removed, while the others had a lumpectomy or other breast-conserving therapy.
About 80% of women had mammograms within the first year after surgery. By the fifth year, the percentage dropped to 63%. Women who had lumpectomies were more likely to get annual mammograms than those who received a mastectomy.
All taking part in the study had health insurance. For those who don’t, their mammography screenings are assumed to be even lower. Follow-up with imaging technology is vital, as women with cancer in one breast have three-times the risk of cancer recurring in the other breast.
Regular screening increases the survival rate for a breast cancer diagnosis. When a recurrence is detected earlier, the chances of successful treatment are improved.
• Although researchers in this study did not investigate reasons for low compliance, the answers are probably: fear of what may be found, complacency, or problems in communication between patient and health care providers.
Women who are five years or more past their diagnosis should not consider themselves “home free.†Breast cancer can recur in a breast or metastasize to other parts of the body many years later. For this reason, breast cancer survivors should be followed for life.
After the five-year marker, some HMOs have a policy that medical or radiation oncologists will discontinue their involvement in the woman’s care.
In that case, she needs to receive a thorough annual breast exam by her gynecologist, general practitioner or surgical oncologist. The American Cancer Society recommends that all women over age 40 get an annual mammogram, but less than two-thirds do.
Those who have undergone double mastectomies do not need mammogram follow-up. The blood test CA15-3 can give additional reassurance, although results are not completely reliable. If their doctor doesn’t offer it, women should ask for this simple lab test.
Breast cancer remains the most common cancer in women. In the U.S., 180,000 cases were diagnosed in 1994. About 41,000 die of the disease each year. Men can also get breast cancer but account for only 1% of total cases.
Sources:Â Medical News Today, editor, Christian Nordqvist;
MSNBC.Com
May 8th, 2006
