cervical cancer

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Catching Cancer Early: Be Careful What You Screen For

By Richard Knox

True or false: It’s always better to catch cancer early.

Answer: False

But that absolutely doesn’t mean we should give up screening for early detection of cancer.

Yes, it’s confusing. But bear with me. Because two reports issued this week are a perfect illustration of why cancer screening is such a tricky topic.

Consider them both and you’ll have a better appreciation of the complexities of the issue. And why individuals and health policymakers need to think carefully about when to screen and what to do with the results.

One new report is about screening for thyroid cancer. It makes a strong case for why it’s not a good idea.

The other is about screening for cervical cancer. It’s an equally strong argument for why there’s not enough.

First, thyroid cancer screening. South Korea has gone in for it in a big way, as part of a national push for detecting all cancers for which there’s a screening test – cancer of the breast, uterine cervix, colon, stomach and liver.

Adenocarcinoma in Situ of the Cervix/Ed Uthman, flickr

Adenocarcinoma in Situ of the Cervix/Ed Uthman, flickr

South Korea is years ahead of the U.S in paying for cancer screening. Back in 1999, the government started providing free or very low-cost cancer screening, something that’s only now happening, and more cautiously, under the U.S. Affordable Care Act.

The Korean program doesn’t include thyroid cancer in its screening program. But so many hospitals and doctors have ultrasound machines – which can detect tiny thyroid tumors with a quick neck scan – that thyroid cancer screening has become routine in recent years, for a fee of $50 or less. It’s an easy sell, and an easy way to make money. Continue reading

The Checkup On Shots: Vaccine Updates, Facts And Fictions

Somehow, over the last few years, one of modern medicine’s greatest achievements has turned into one of modern American parents’ most fraught subjects.

In this episode of The Checkup, our podcast on Slate, we offer Shots: Vaccine Facts And Fictions, in which we attempt to have a rational, fact-based discussion about some of the vaccines you may encounter in the immediate future: the flu vaccine and, if you have pre-adolescent children, the HPV vaccine.

(To listen to The Checkup now, click on the arrow above; to download and listen later, press Download; and to get it through iTunes click here.)

This year’s flu vaccines offer consumers more choices than ever: there’s a nasal version, a quadrivalent (four-strain) option, a “short-needle” option and an egg-free vaccine for people with allergies, among others. And even though it still feels like summer in some parts of the country, doctors are urging people to get their flu shots early.

The HPV vaccine was introduced seven years ago but, according to the CDC, only about half of girls are getting one or more doses, and only about one-third are getting the full three-dose course. This despite word from public health officials that it’s highly effective for preventing HPV — the most common sexually transmitted infection in the U.S. and a principal cause of cervical cancer — and so far, pretty safe. (It’s recommended for boys as well as girls, both because boys can spread HPV and because there’s a notable rise in HPV-related cancers in older men. See: Michael Douglas and oral sex. )

Doctors say a variety of obstacles stand in the way of more widespread use of the HPV vaccine. There remains the stigma of a vaccine for a sexually transmitted infection.  Also, when you’re talking about an 11-year-old,  preventing cervical cancer may seem less urgent than, say, preventing measles. Finally, there’s a general sense of “vaccine fatigue” among parents bombarded with so many official recommendations and competing agendas.

 

For more info, check out this HPV fact sheet created by our intern, Rachel Bloom:

gardasil-fact-sheet-image

Readers, please let us know how you’re handling vaccines for your family this year. Anything we can learn from your experience?

Report: U.S. Cancer Screening Is Pricey, But With No Better Outcomes Than Public System

Is more screening worth the money?

A new report comparing cancer screening programs in the U.S. and the Netherlands comes up with this not-so-surprising conclusion: we screen more here — three to four times more in this case — but mortality rates are the same in both countries.

The analysis of cervical cancer screening programs, published in the Milbank Quarterly, makes the health system in the Netherlands look pretty darn rational. Not only does the publicly-run system focus on prevention, but it appears to implement its prevention plan in a way that saves money without undermining care, notably it limits cervical cancer screening to the group at highest risk, women between the ages of 30 and 60.

Here’s are some of the study details from the news release:

The team [led by by Dr. Martin L. Brown from the National Cancer Institute in the United States, alongside colleagues from the Erasmus MC University Medical Center in Rotterdam] focused on cervical cancer screening, which accounts for a small fraction of overall health care spending, but represents broader preventive health services. For comparison the authors carried out a cross-national study of cervical cancer screening intensity and mortality trends in the United States and the Netherlands.

The team used national cancer incidence and mortality data from both the United States and the Netherlands to estimate the number of Pap smears and the cervical cancer mortality rate since 1950. Their results revealed that even though three to four times more Pap smears per woman were conducted in the United States than in the Netherlands over a period of three decades, the two countries’ mortality trends were similar.

Five-year coverage rates for women aged thirty to sixty-four were comparable between the countries at 80 to 90 percent. However, because screening in the Netherlands was limited to ages thirty to sixty, screening rates for women under thirty and over sixty were much higher in the United States. Continue reading

HPV Vaccine: The View From Australia (Hint: They Like It There)

A teenager bares her band-aid after getting the HPV vaccine

It’s always good to get an outside perspective.

I was reminded of this recently, after posting a piece by Karen Weintraub about trying to decide whether her 14-year-old daughter should get the HPV vaccine. (She did.)

The story drew a bunch of comments from Australians — kind of unusual for CommonHealth — including this one on Facebook from an old school friend of mine, Devora Lieberman, who is now an ob/gyn in Sydney:

“Australian data already showing a decline in high grade Pap abnormalities among the age group that was eligible for the free vaccine. An Australian invention, and our former Prime Minister’s wife had cervical cancer, so perhaps we’re biased, but I think the early results are in and are irrefutable.”

Continue reading

So Should My Daughter Get The HPV Vaccine?

A young girl after getting the HPV vaccine

By Karen Weintraub
Guest Blogger

For three years, I’ve given my daughter a pass on the HPV vaccine, which prevents infection from the cancer-causing human papilloma virus.

The vaccine approved in 2006 was too new, I thought. I didn’t want to expose her to a shot that hadn’t been tested in millions of people for years and years. And she was too young for me to be concerned. HPV is passed sexually, and though the federal government recommends girls get the vaccine as young as age 9, my pediatrician agreed we should wait a few years.

My daughter started high school this month, though, and is scheduled for her 14-year-old physical in a few weeks.

I hope it’s still a few decades until she brings home her first boyfriend, but I can’t justify putting off my vaccine decision any longer.

That was already on my mind when presidential candidate Michele Bachmann wrongly suggested the vaccine caused mental retardation earlier this month. (Last night during another debate, Bachmann backed away slightly, saying she was simply recalling a story a mother had told her.)

So this week I looked at the data, and talked it over with my pediatrician, and I’ve decided she should get the vaccine.

Hoping my research might help someone else facing the same question, I thought I’d spell out what I’ve done and why I came to this conclusion: Continue reading

Study: IUD Cuts Risk Of Cervical Cancer In Half

The IUD may offer protection against cervical cancer

IUD’s have gotten a bad rap over the years, due to their checkered history (see: Dalkon Shield) and the fact that many women don’t want a medical device implanted their bodies if they can avoid it. But as my CommonHealth colleague Carey Goldberg has written, a newer, safer version of the IUD is currently enjoying a mini-renaissance.

Now there’s another excellent reason to consider (or reconsider) the IUD for birth control: In a study involving more than 20,000 women from different countries, researchers report that the IUD may offer protection against cervical cancer. Interestingly, they suggest that the annoying process of inserting and removing the device might be the very thing that destroys precancerous lesions or triggers a protective immune response. The study was published in The Lancet Oncology.

Here’s more from the press release:

The results show that women who uses IUD halved the risk of developing cervical cancer compared to those that had not ever used [the device]. These results are contrary to popular belief that IUD could be a risk factor of cervical cancer. Previous studies on possible effects of IUDs use on the development of this cancer have yielded inconsistent results…

IUD use did not affect the risk of HPV infection, but was associated with a significantly lower risk of cervical cancer for both major cervical cancer types —reducing the likelihood of developing squamous-cell carcinoma by 44% and adenocarcinoma or adenosquamous carcinoma by 54%. Continue reading