Screening women for cervical cancer every single year may do more harm than good.

For fifty years an annual Pap smear has been the gold standard of screening for cervical cancer in women. Now a federal advisory group and the nation’s leading cancer organization have changed their tune. They no longer recommend that women have a Pap test each year.

The recommendations do not apply to women who are at very high risk for cancer, such as those who have been diagnosed with a high-grade precancerous cervical lesion or who have weakened immune systems.

The US Preventive Services Task Force, (USPSTF) a panel of independent experts convened by the government, and the American Cancer Society (ACS) have each released new guidelines for cervical cancer screening that recommend against routine yearly testing. Instead, the guidelines recommend testing every 3 years for women aged 21 to 65.

New Guidelines

For women aged 30 to 65, the new guidelines recommend screening every 5 years with both a Pap smear and a test for the human papillomavirus (HPV). That recommendation is based on data showing that less frequent screening with both tests provides a comparable benefit in cancer detection to more frequent Pap testing alone. Routine screening of women younger than 21 and older than 65 is not advised under the new guidelines.

Pap testing has been responsible for a dramatic reduction in cervical cancer deaths.

The updated recommendations apply to women, regardless of sexual history, who have a cervix and show no signs or symptoms of cervical cancer. The recommendations do not apply to women who are at very high risk for cancer, such as those who have been diagnosed with a high-grade precancerous cervical lesion or who have weakened immune systems.

Both the USPSTF and ACS emphasize that Pap screening continues to be a important diagnostic tool. Since its widespread introduction, Pap testing has been responsible for a dramatic reduction in cervical cancer deaths in the United States. Among current cervical cancer deaths, most occur in women who have never been screened or who have not been screened in the last 5 years.

According to Dr. Wanda Nicholson, an ob/gyn at the University of North Carolina and a member of the USPTS, bringing those groups of women into the screening process remains an important public health objective.

Why Test Less Frequently?

The groups based their updated recommendations on research demonstrating that Pap testing every year provides little or no benefit compared to testing every 3 years, but that more frequent testing carries potential harm. false positives — that is, a test indicates the existence of disease when in fact none is present — are very common and often lead to invasive testing that can produce long-term complications, including difficulties with pregnancy and delivery.

Pap testing every year provides little or no benefit compared to testing every 3 years, but that more frequent testing carries potential harm.

Debbie Saslow, ACS’s director of breast and gynecologic cancer, sums it up this way: “We now know that annual screening causes more harm than good because it leads to many extra invasive procedures without increasing the number of cancers detected.”

A new Attitude toward Screening

The new Pap guidelines reflect a shift in medical thinking about the advisability of frequent and routine disease screening in the general population. Recommendations advocating more limited screening for both breast and prostate cancer have also been issued within the past several years.

This new attitude reflects a growing realization that the benefits of screening healthy people may not be as great as previously believed, and that screening is not without potential risk. however, more frequent screening of vulnerable, older people for a condition such as osteoporosis can bring benefits.

Screening produces winners (those whose lives are saved) and losers (those who are subjected to unnecessary intervention). while the winners win big, they are relatively few; many more will lose.

Those risks include the possibility of false positives, as well as the detection of early-stage abnormalities that might resolve themselves over time without medical intervention. The consequences of these scenarios include unnecessary invasive testing, complications and side effects from drugs or surgery, and pain and emotional distress.

Dr. Gilbert Welch, a professor of medicine at Dartmouth and a well-known writer and lecturer on the subject of disease screening, frames the matter in gambling terms: Screening produces winners (those whose lives are saved) and losers (those who are subjected to unnecessary intervention). while the winners win big, they are relatively few; many more will lose.

Those who take a minimalist or skeptical view of medical intervention can be reassured that they are not unduly risking their health. There is no one right answer for everyone. (Those who want to hear more about the pros and cons of screening can check out this interview of Dr. Welch.)

Even Doctors Are Confused

Despite the shift among clinical experts, most Americans continue to believe unquestionably in the benefit of routine annual screening. It’s easy to understand why the public might overestimate the value of such tests. Even many doctors are confused about the degree of benefit conferred by screening exams and fail to advise patients correctly.

For example, when asked in a recent survey to choose between two tests of different hypothetical benefit, nearly all of the physician respondents chose the one that was less meaningful in terms of saving lives. Other research has shown that many doctors continue to perform screening more often than recommended.

One recent study found that breast cancer screening resulted in a rate of over-diagnosis of 18-25 percent. this points to a need for more physician education, but also highlights the importance among patients of becoming better informed about why, when and for whom screening makes the most sense.

The idea of annual screenings is alluring: Have a test, find disease and treat it early. But this is too simplistic. although there’s no doubt that screening is advisable in certain situations, the correlation between routine screening for everyone and subsequent health benefit is not cut and dried. The medical establishment has begun to recognize the limitations of screening. Health care consumers should take note as well.

This article originally appeared on TheDoctorWillSeeYouNow.com, an Atlantic partner site.

New research suggests that long-term use of any type of hormones to ease menopause symptoms can raise a woman’s risk of breast cancer.

It is already known that taking pills that combine estrogen and progestin – the most common type of hormone therapy – can increase breast cancer risk. but women who no longer have a uterus can take estrogen alone, which was thought to be safe and possibly even slightly beneficial in terms of cancer risk.

The new study suggests otherwise, if the pills are used for many years. it tracked the health of about 60,000 nurses and found that use of any kind of hormones for 10 years or more slightly raised the chances of developing breast cancer.“There’s a continued increase in risk with longer durations of use, and there does not appear to be a plateau,’’ said study leader Dr. Wendy Chen of Brigham and Women’s Hospital in Boston.

The hormone picture has been confusing, and the absolute risk of breast cancer for any woman taking hormone pills remains small. Doctors say women should use the lowest dose needed for the shortest time possible.

“It’s hard to be surprised that if you keep taking it, sooner or later it’s going to raise risk,’’ said Dr. Robert Clarke of Georgetown University’s Lombardi Comprehensive Cancer Center.

The study was discussed Sunday in Chicago at a conference of the American Association for Cancer Research.

Another study presented at the conference might help explain why black women are so much more likely than whites to develop and die from cervical cancer: they seem to have more trouble clearing HPV, the virus that causes the disease.

Doctors have long thought that less access to screening and follow-up health care were the reasons black women are 40 percent more likely to develop cervical cancer and twice as likely to die from it. the new study involving young college women suggests there might be a biological explanation for the racial disparity, too.

If further study confirms this novel finding, it would make the HPV vaccine even more important for black women, said Worta McCaskill-Stevens, a prevention specialist at the National Cancer Institute. the vaccine is recommended for all girls starting at age 11.

Certain strains of HPV, the human papillomavirus, cause cervical cancer, but brief infections are very common in young women. they usually go away on their own within a year or so and only pose a cancer risk when they last long-term.

Researchers at the University of South Carolina in Columbia studied 326 white and 113 black students taking part in a wider federal health study. All were given Pap tests – lab exams of cells scraped from the cervix – and HPV tests every six months throughout their years in school.

Although the groups were similar in how many new HPV infections were detected and risk factors such as how many sex partners they had, doctors saw striking differences in how long their infections lasted.

At any checkup, black women were 1.5 times more likely to test positive for infection with one of the HPV strains that raise cancer risk, said study leader Kim Creek.

“the African-American women weren’t clearing the virus as fast,’’ he said. “they were actually holding onto it about six months longer,’’ for 18 months versus 12 months for white women. ten percent of black women had abnormal Pap tests versus 6 percent of whites.

Two years after initial infections were found, 56 percent of black women were still infected but only 24 percent of white women remained infected.

The government’s National Institute on Minority Health and Health Disparities sponsored the study.

Well, now I know for sure what my answer will be when my almost 11-year-old daughter‘s pediatrician asks if we want the HPV vaccine at her next check-up: An emphatic “NO.” I was leaning in that direction anyway, for various reasons (more on those in a minute), but the latest news on Gardisil pretty much sealed the deal — and if you have a tween girl, it might do the same for you.

In a study of 900 girls and young women between the ages of 11 and 26 who received the HPV vaccine, it was the 11- to 12-year-old group who experienced the worst side effects, from pain, dizziness, bruising, and swelling at the injection site to (in rare cases) fainting. These symptoms generally showed up about two weeks after the vaccine was administered.

What bothers me about these findings isn’t that any of the side effects are so horrific or life-threatening — though of course it doesn’t help that my daughter happens to be at the riskiest age. what bothers me is that researchers are still in the process of finding out what Gardisil is capable of doing to kids, but the CDC and the American Academy of Pediatrics are acting like it’s perfectly safe.

Maybe it is perfectly safe. Unfortunately, we don’t know that yet. Unlike all of the other vaccines my kids have gotten so far, the HPV vaccine is new — so new that it’s impossible to tell at this point what the long-term “side effects” could be. and like I said, maybe there aren’t any. But why should I allow my daughter to be a guinea pig?

Are you concerned about Gardisil’s potential side effects?

Image via Adrian Clark/Flickr

Cadmium in diet raises breast cancer risk

Houston: Women whose diet contain higher levels of cadmium, a toxic heavy metal, are at greater risk of developing breast cancer, a new study has claimed. the study which is published by the American Association for Cancer Research found that among 55,987 post-menopausal women, the one-third with the highest cadmium intakes were 21 per cent more likely to develop breast cancer.

Cadmium, which is identified as a carcinogen, leaches into crops from fertilizers. Whole grains, potatoes, other vegetables and shellfish are key dietary sources of cadmium, which also becomes airborne as a pollutant when fossil fuels are burned, and is inhaled as well as ingested.

Circumcision may lower prostate cancer risk

Houston: Men who have been circumcised are at lower risk of developing prostate cancer, a study published in the journal Cancer has suggested. the study, conducted by Fred Hutchinson Cancer Research Centre in Seattle, has found that men circumcised before their first sexual encounter have a 15 per cent lower incidence of prostate cancer. Researchers say that because circumcised men are slightly less likely to contract herpes and human papillomavirus (HPV), which previous studies have linked to a higher incidence of prostate cancer, circumcision might offer protection.

?The problem with prostate cancer studies is that a large number of cases will stay confined to the prostate, causing few, if any symptoms,? said Ron Gray, a researcher at Johns Hopkins University?s Bloomberg School of Public Health. ?Trying to find an underlying cause for that type of cancer is difficult and often pointless,? he added.

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by Tenth Id

CAMP PANACAN, Davao City- The Philippine Army recently held its first set of free anti-cervical cancer vaccination congruent to its program for Gender and Development.

Major Rosa Ma Cristina R Manuel, Executive Officer of 10th CMO Battalion receives the 1st Doze of Cervical Cancer Vaccine from a military nurse, Pvt Ersel Filipinas of the 10th Medical Dispensary. one of the Philippine Army’s program on GAD, is to ensure that its Female Soldiers receives the appropriate health care by providing Cervical Cancer Vaccine among its Female Soldiers who are performing field and garrison duties. this effort is also in line with the upcoming celebration of the International Womens Month on March 2012. A total of 84 female soldiers and 12 female civilian employees from 10th ID and EastMinCom received the 1st doze of the cervical cancer vaccine at the Old Agila Blg, Panacan, Davao City administered by Maj Romel Kho, CO of 10ID Medical Dispensary and Dr. Carol Flavier after a brief orientation.

On Wednesday, a total of 84 female soldiers and 12 female civilian employees were vaccinated in the hope to protect them from possible transmission of human papillomavirus known to many as HPV.In a discussion, Dr. Carol Flavier of Davao Doctors Hospital said that HPV infections are common. however, it is generally unknown due to lack of information and education. “Twelve women die every day with HPV because they are unaware that they have it”, she said. She added that most infections occur without any symptoms and sometimes go away within two years. She clarified though that those who have strong immune system often have higher chance to tolerate the symptoms and eventually get away with it.according to her, there are over 100 types of HPV which are viruses that can infect many parts of the body. Some types are sexually transmitted causing warts and sometimes cancer. Thus, she said, it is important for women to follow the ABCD’s in avoiding and preventing said virus. First, is abstinence since it is sexually transmitted in common; second is being faithful to sexual partner; third are circumcision and the use of condom and lastly is doctor’s call.“We also encourage women who are sexually active to have Pap smear once a year since they are more prone to HPV”, she said.  She added that among the types of cancers, so far only lung and cervix cancer has the vaccine.PA will have another schedule for those who missed the vaccination aiming to fully accommodate 36 female officers, 52 enlisted women and 12 civilian employees coming both from the Eastern Mindanao Command and 10th Infantry Division.for those who received the first doze of the vaccine, the next set will be on March 25 and July 25 comprising the three sets of vaccination which is in line with the upcoming celebration of the International Women’s Month on March. Released by: Maj. Rosa Ma. Cristina R. ManuelBattalion Executive Officer10th CMO Battalion

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Monday, November 7, 2011

On Hatteberg’s People, last night we learned about anal cancer and Michele Longabaugh’s two-year battle with this rare disease. following treatment, her health improved, but she lives life four months at a time. That’s the time between her CT scans. last night, we watched as she received her latest scan to see if the cancer had returned. Tonight, she gets the results.

The hardest part is always waiting for the news of what the scan did or did not show. Michele keeps busy with small things, like wrapping a birthday present for her mother in law.

“I guess when you are faced with the fact that there is a chance that you could die, you realize how much you under appreciate the little things that are enjoyable to do,” said Longabaugh.

A week after her CT scan, Dr. Johnson will tell her if the cancer is back.

“A lot of times you can tell by the patients facial expression how they feel. You walk in, get their weight, see how the patients demeanor is doing, so you get an idea of how they are doing and how that fits in with the test results,” said Johnson.

With professional subtlety a near art form, Dr. Johnson tells Michele and her husband Jerry the scan results.

“You look great, your weight looks good, and your scan looks negative,” said Johnson.

This was the best news. Michele’s scan is clear and shows she is cancer free, but there will be another scan in four months.

“I just try to fly under the radar and stay cancer free,” said Longabaugh.

But as all cancer patient’s know, living with it and not knowing if it will return is difficult. Since she was diagnosed, Michele has kept an intimate blog. It’s called “I Have Butt what?!” in it, she shares the innermost details of her feelings and thoughts. in one entry, Michele remembers when they first got the cancer diagnosis:

“Jerry and I look at each other in stunned silence, I begin to cry and so does he. We hold each other. This is a precious moment in my life. I know that sounds odd, but it is. Me and my husband on the same emotional ground….with nothing to cling to but each other.”

While her sister took care of her during treatment, Michele shared these words:

“Sometimes I was heaving and retching so hard my sister said she expected to see my body invert on itself and disappear into the toilet. I felt such despair and anger at those moments… out of control. Scared. I would sob between heaves, begging God and anyone who would listen for mercy. my sister would stand by me her hand on my back whispering encouragement, murmuring words of comfort and crying with me.”

Michele says she hopes her blog helps others understand.

“I think that is why my blog is so important. I’m able to articulate it so if somebody reads it, they know who I am as a person and not just as that ‘lady’ that had anal cancer,” said Longabaugh.

Living between CT scans has changed Michele’s outlook on life.

“We’ll take what we can get., four months at a time, and it’s the best four months we’ve ever had… We live it like it is the last four months we’ve got, and then if my cancer comes back we know that times are going to get tough again… I’m not afraid to die, I’m not afraid. I just don’t want to.”

Sunday, November 6, 2011

“When you say you have anal cancer, you really shut down a room. All people want to do is change the subject.”

Her name is Michele Longabaugh. she has anal cancer. so, this is a special Hatteberg’s People two-part series. I met Michele when I was told I was on her bucket list of people she wanted to meet in case she died. That’s never happened to me before. so we met. When I heard her story, I thought she should share it. All cancers are bad, anal cancer seems to be worse because of its location and stigma, but Michele is incredibly open about it because she wants to help others. for two years she’s been living with it and with an uncertain future.

Michele grew up in Johnson City, New York. she had a normal childhood with the usual fond memories. she is one of those people you immediately like with a warm out-going personality and a reality-based optimist with a sense of humor. Married with three children, Michele’s life was following the script.

“People get married and you stand up there for better and for worse, in sickness and in health. they don’t know what they are saying until you are really in it for sickness and in health,” said Michele Longabaugh.

Michele had what she thought was a bleeding hemorrhoid. the doctor disagreed.

“I will never forget the look on his face and he said, this is not a hemorrhoid.”

It wasn’t. it was Stage 4 Anal Cancer.

“It was a speechless moment for my husband and I. I remember literally my mouth hanging open and not being able to shut it.”

Michele’s husband, Jerry Longabaugh, is Principal at Eisenhower Middle School in Goddard.

“But as for that day, that was perhaps the worst day of my life… At that point in time, we only had each other. That’s how tough it was. it’s like getting hit with a Mack truck,” said Jerry Longabaugh.

“It was the lowest I felt like I had ever been. I felt so hopeless just at that moment,” said Michele Longabaugh.

Anal cancer is rare. it affects about 5,000 people in the U.S. each year. Dr. David Johnson, of Wichita, is Michele’s oncologist.

“The interesting thing about anal cancer is the treatment is relatively short but very intense… but it’s a tough, tough go.” said Johnson.

According to the Mayo Clinic, risk factors for the disease include old age, multiple sexual partners, anal sex, smoking and the HPV virus. Michele says, that doesn’t describe her. she doesn’t have a single risk factor for the disease.

“When they told me that there was a possibility that, in three years, I wasn’t going to be here I made up my mind at that minute. I wasn’t going to waste any more time. it is being in the moment, not just going through the motions,” said Michele Longabaugh.

Recovering from the chemotherapy, Michele wanted to get back to life as usual. She’s a nurse and a businesswoman. she and a business partner sell sophisticated medical devices to doctors and hospitals. getting back into the swing helps, but not knowing the future is difficult especially with her college age kids.

“When you get cancer, everyone in your family gets cancer. I said you can do something for me to make me better, and they said, ‘What mom, we’ll do anything.’ I said stay in school, get good grades and don’t give me anything to worry about. and all three of them did that.”

Michele lives four months at a time. That’s how long she has between scans that will tell her if the cancer has returned.

“One bad scan can mean Michele’s life,” said Jerry Longabaugh.

I went with Michele to her last CT scan. the barium didn’t go down well, but it’s necessary. she made the best of it.

“I just think to myself, there is nothing I can do to change what’s going to be on that scan. there is not one thing I can do… I feel that I buried my head one because of ignoring the symptoms, and to not do a scan would be like a relief. But I can’t bury my head. I have to know,” said Michele Longabaugh.

Now the wait for results begins. Monday at 10, we go to the doctor with Michele to get the results of the latest scan to find out if the cancer has returned. We’ll also take a look at her intimate personal blog where her emotions are laid bare.

Symptoms for anal cancer can include bleeding that is sometimes confused with a hemorrhoid, pain in the anus area, a growth in the anal canal and anal itching. If you have any of these symptoms contact your doctor. Early diagnosis is key.

Oh, Discover. You’re such a tease. You have Ed and Carl and Razib and Phil and Sean, an (all-male, ahem) cluster of science bloggy goodness. But then you also fawn over HIV deniers Lynn Margulis and Peter Duesberg. Why can’t you just stick with the science and keep the denial out?*

But no, now they’ve let it spill into their esteemed blogs. I was interested to see a new blog pop up there, The Crux, a group blog “on big ideas in science and how these ideas are playing out in the world. the blog is written by an outstanding group of writer/bloggers and scientist/writers who will bring you the most compelling thoughts throughout the world of science, the stuff most worth knowing.” Sounds ok, let’s see what stories are up…oh, one on HPV! right up my alley. And hey, a woman! Bonus.

Ohhhhh, it’s actually one on HPV vaccine misinformation, written by the author of the fawning Duesberg article referenced above. Faaantastic.

The author, Jeanne Lenzer, poses the question, Should boys be given the HPV vaccine? and answers herself that “the science is weaker than the marketing.”

What does she base this conclusion on? a recent paper examining HPV vaccine in boys, maybe? No, of course not. she uses the 4-year-old NEJM study demonstrating the efficacy of the then-new vaccine as the main basis of her claim, and it’s a house of cards from there. Let’s look at what she says, shall we?

First, let’s start with the 2007 NEJM paper. this paper tested the multivalent HPV vaccine, which contains HPV types 6 and 11 (these cause warts and aren’t further examined in this particular paper) and 16 and 18 (cause cancer, focus of this research). the goal was to “assess the prevention of cervical intraepithelial neoplasia grade 2 or 3, adenocarcinoma in situ, and cervical cancer caused by HPV-16 or HPV-18.” this makes sense that they’re looking at cancer outcomes only due to types 16 and 18–after all, while other HPV strains can cause cancer, HPV 16 and 18 are the only cancer-causing types included in the vaccine. They even note in the introduction that HPV 16 and 18 cause about 70% of all HPV-related cervical cancers, but that’s still not 100%. I mean, they state this right in the paper: “The primary hypothesis stated that, as compared with placebo, the vaccine would reduce the incidence of high-grade cervical intraepithelial neoplasia related to HPV-16 or HPV-18 in the per-protocol susceptible population.” I spell this out because this is one of Lenzer’s criticisms, which I’ll come to in a bit.

So they have this vaccine. who did they test it on? In this trial, it was women ages 15-26, and the mean age of this group was approximately 20 years old. Age at sexual debut was 16–so on average, women in this trial had been having sex for about 4 years with 2 sexual partners by the time they were vaccinated. Now, for those of you familiar with the vaccine, that age range may seem a bit odd–because the vaccine is currently recommended to be given to girls starting at around age 11. But you see, this is one way they ended up at that recommendation–because of SCIENCE! (I’ll also come to that in a minute).

All right, they have young women, initially just a bit over 12,000 of them in 13 countries. Let’s look at their eligibility criteria (who could actually participate):

Women were eligible to participate in the study if they were not pregnant, did not report abnormal results on a Papanicolaou smear, and had had a lifetime number of no more than four sex partners.

That’s it, and it’s an important thing to note. for initial enrollment, they didn’t have to be HPV negative. this becomes important later.

The eligible women were randomized into the treatment or placebo groups, and then received 3 doses of the vaccine (or placebo), and were asked to report any serious adverse events for up to 15 days post-vaccination. the women also underwent pap smears and HPV testing at this point. They also had a number of follow-up visits to be re-tested, up to 4 years post-vaccination.

About those baseline tests. even though they enrolled a bit over 12K women, they found that at baseline, pap smears were abnormal for 11.8% of subjects in the vaccine group and 11.1% in the placebo group. In other words, they were already infected with a strain of HPV at the beginning of the study. They further examined everyone using both DNA and serological testing for HPV 16 and 18, and found that about 10% of their cohort was already positive for HPV 16, and about 3-4% for HPV 18. thus, they analyzed their data in several different ways, including doing an analysis including the pre-existing HPV 16 & 18 positive participants, and another one without them.

They also analyzed by eliminating participants who hadn’t fully followed or completed the protocol, including getting only one or two doses instead of the targeted three; having missing samples; or “general protocol violations,” which apparently consisted largely of not getting the month 7 swab at the right time, or administration of IgG, immunosuppressive drugs, or blood products–all things that could affect study outcomes.

Now the numbers. When they looked at women who’d followed protocol *and* were susceptible (ie not already infected with HPV 16 or 18 upon entry into the study), efficacy was 98% at preventing HPV-16/18-related high-grade cervical lesions. And what are “high-grade cervical lesions,” you might ask? according to the NCI:

High-grade means that there are more evident changes in the size and shape of the abnormal (precancerous) cells and that the cells look very different from normal cells. HSILs are more severe abnormalities that have a higher likelihood of progressing to cancer. HSILs include lesions with moderate or severe dysplasia or carcinoma in situ.

This is basically the step before cancer, and as noted above, one of the endpoints of the study, yet Lanzer calls them “innocent cellular abnormalities” and cites this paper, which doesn’t match her claim. if she’s referring to the line that “most HPV infections are easily cleared by the immune system,” I hate to break it to her that the ones that are “easily cleared” aren’t usually the ones causing the more serious dysplasia and carcinoma in situ. Rather, those HPV-caused lesions typically are examined via colposcopy and biopsy of the area to check for cancer. (Bonus scavenger hunt for the phrase “coffee ground-like discharge!”). Next, a woman with abnormal cells can expect to undergo a LEEP procedure, where portions of your cervix are removed with a burning electric wire under local anesthetic, and the foul smoking remains of your cells are sucked up into the smoke shark, “a sleep, powerful, smoke-eating machine.” after that one, side effects include infection, hemorrhage and possibly cervical incompetence. these are rare, but if we’re talking vaccine side effects versus possible outcomes from HPV infection, these types of outcomes need to be considered as well–not just death from cervical cancer.

What I’m trying to say here is that Lanzer may be minimizing these “innocent” non-cancer findings just a wee bit.

OK, so 98% efficacy in their target population who followed the study perfectly. what about if they included everyone? for that, they do what’s called an “intent to treat” analysis, basically putting everyone back in the pot. As Lanzer notes, this is when efficacy falls to a reported 44%, but she completely fails to note that the bulk of this was because the women had pre-existing HPV 16/18 infections and/or lesions. Like almost all vaccines, getting it isn’t going to help you if you’re already infected and showing symptoms. As I mentioned before, SCIENCE! this is why it’s so strongly recommended now to get the vaccine prior to the onset of sexual activity–if you’re already HPV-infected, the vaccine will not do you as much good. Hence, the current recommendation to receive the vaccine prior to the onset of sexual activity (ages 11-12ish).

OK, I’ve had about all I can take and this is getting to be a post of Oracian lengths. to jump to the end–why didn’t they just wait 20 years or so to see if there would be more cancers in the placebo versus unvaccinated group? besides the whole waiting 20+ years thing, maybe because that would be totally unethical? I’ll take this right from the discussion section:

Although prevention of invasive cervical cancer is the main goal of prophylactic HPV vaccination, it is ethically unacceptable to use invasive cancer as the end point in efficacy trials. Cervical intraepithelial neoplasia grade 3 and adenocarcinoma in situ, which the International Federation of Obstetrics and Gynecology classifies as stage 0 noninvasive cervical cancers, are clinically important outcomes because they are likely to persist and may become invasive without treatment.

Thing is, even if they had followed these women for 20 years, doing checkups say every 6 months, they would have to follow standard treatment protocols (like the LEEP nastiness I mentioned above) and as such, would be doing everything they could to prevent cervical cancer in any case. so, these precancer endpoints are more ethical substitutes, and still show the ability of the vaccine to prevent abnormal cell changes that can lead to cancer.

Finally–Lenzer uses her supposed refutation of HPV vaccine efficacy in girls to then argue that we’re looking to give this vaccine to boys unnecessarily. she cites first that there are only 300 anal cancer deaths in the US every year (one of the cancers the HPV vaccine should reduce in men–and women, I might add). Small potatoes–why give the vaccine to boys over 300 deaths, right? But oddly enough (or, not?), she gives the barest of lip service to a group of HPV-associated cancers which affect men more than women, head and neck cancers. Guess what–there’s a lot more of those than anal cancers, and several studies suggest that HPV-associated head and neck cancers are actually increasing in incidence.

Even when she does mention oral cancers, she asks rhetorically, “what about the claim that Gardasil might prevent anal and oral cancers men may get from having sex with other men?” Um….why focus only on men having sex with men? perhaps it hasn’t occurred to Lenzer that oral and anal cancers in men can also be transmitted to them by female partners, and vice versa–so we’re not just talking about “gay” cancers in men. I wonder if her wording was purposeful, though, as it’s easier for many in society to dismiss concerns about diseases that are transmitted via homosexual sex acts.

To wrap up, some drama. Lenzer frets about the possibility of developing Guillain-Barré syndrome from the HPV vaccine:

given this, is it worth the risk of exposing millions of youth to the as yet uncertain harms of the vaccine? the CDC states that in rare instances, some vaccines may trigger the potentially fatal and paralyzing condition Guillain-Barré, and Nizar Souayah, MD, of the University of Medicine and Dentistry of New Jersey in Newark, says he and his colleagues found “clear evidence from our database of an increased incidence of Guillain-Barré syndrome in the first six weeks, especially the first two weeks, after [HPV] vaccination.” Guillain-Barré is very rare, even among people who are HPV vaccinated, but the problem is emblematic of the downsides of subjecting millions of people to any medical treatment.

The link takes you to a WebMD article from the 2009 American Academy of Neurology meeting reporting on a study by Nizar Souayah. the WebMD article states:

overall, the vaccine does not raise the odds of developing Guillain-Barre syndrome (GBS), a disorder of the peripheral nervous system, says Nizar Souayah, MD, of the University of Medicine and Dentistry of New Jersey in Newark.

“But there is clear evidence from our database [the VAERS database--TS] of an increased incidence of Guillain-Barre syndrome (GBS) in the first six weeks, especially the first two weeks, after vaccination,” he tells WebMD.

Still, the risk is extremely low: 26 in 10 million in the first two weeks and 30 in 10 million in the first six weeks after vaccination. That compares to 5 in 10 million odds in the general population, Souayah says.

Leznar bills herself as an investigative reporter, but didn’t even bother to dig up the published version of this research. the numbers are fairly similar, so even if we accept that your chance of developing GBS from the HPV vaccine are 30 in 10 million (which are a bit sketchy coming from the VAERS database), that would still be only 3-6 times higher than those who didn’t receive the vaccine, with a condition that’s extremely rare to begin with. (To put it in perspective, the likelihood that you’d be struck by lightning in any year are about 1 in 750,000 according to NOAA). You have much better odds of contracting GBS from eating a poorly cooked chicken breast, as Campylobacter infections are a bigger cause of GBS than vaccinations. even influenza infections cause more GBS than vaccines.

To sum up, in case it’s not painfully obvious by now, Leznar’s article is full of half-truths and omitted facts–so many that it would take me an entire series of articles to go through the rest of her post, and I haven’t even gotten into any post-2007 HPV vaccine research! to top it all off, she doesn’t even try the “fair and balanced” journalist approach, instead quoting only vaccine “skeptics” but not those who are in favor of HPV, and of then ends on the “I’m not anti-vaccine” note–she can’t be, as she thinks smallpox is bad! (Of course you’re not, neither is anti-vaccine advocate Barbara Loe Fisher. Is there a drinking game for that somewhere?)

I’ll end with my own addendum.

My 11-year old daughter is vaccinated for HPV. my 9-year-old son will be vaccinated. I wish they’d had the vaccine when I was younger, so I didn’t have first-hand knowledge of the Smoke Shark, who still haunts my dreams.

*And yes, I know that Discover is owned by the Gucciones, who have ties to another HIV denialist besides Duesberg and Margulis. [UPDATE: Turns out Guccione doesn't appear to own Discover any longer, and that it was sold last year to Kalmbach publishing. Thanks to Ed & Razib for the correction.]

Andrew Wakefield’s discredited theory linking vaccination and autism stirred public fears.L. MACGREGOR/REUTERS

It is one of the most serious allegations that could be made about a doctor: manipulating patients’ histories to make money. so it is no wonder that the charges, levied by editors of the British Medical Journal (BMJ) in January against medical researcher Andrew Wakefield, are still getting close scrutiny. now an American whistleblower advocacy group has joined the fray over Wakefield, who in 1998 hypothesized a link, now scientifically disproven, between the measles, mumps and rubella vaccine (MMR) and autism.

On 9 November, David Lewis of the National Whistleblower’s Center in Washington DC published a letter in the BMJ (bmj.com) arguing that Wakefield did not commit research fraud. Lewis told Nature that he thinks the combination of public charges and a slow, secretive investigation has left the public not knowing whom to believe and is unfair to the accused researcher. “[The system] throws people like Andy into a no-man’s-land,” Lewis says.

Wakefield was the lead author of a 1998 paper in the Lancet (A. J. Wakefield et al. Lancet 351, 637–641; 1998) reporting on the case histories of 12 children who had received the MMR vaccine and developed symptoms of autism or inflammatory bowel disease.

The paper inflamed public fears about vaccines, but it was retracted in 2010 after the UK General Medical Council (GMC) concluded that Wakefield had a charge of serious professional misconduct to answer, in part because it found that his team did not have proper ethical approval for tests performed on the children. later in the year, the GMC found him guilty of the misconduct charge and revoked his licence to practice as a doctor. By then, more than 12 large-scale epidemiological studies had failed to find evidence of the hypothesized link (J. S. Gerber and P. A. Offit Clin. Infect. Dis. 48, 456–461; 2009) and the MMR vaccine is today regarded as safe.

But was the paper merely mistaken, or a deliberate fraud? Articles by medical journalist Brian Deer published in the BMJ in 2010 and 2011 accused Wakefield of reporting histories for the children that were not consistent with their records and their parents’ recollections, at a time when Wakefield was also being paid by lawyers intending to sue MMR manufacturers. Deer’s articles themselves did not allege fraud, but on their basis a BMJ editorial in January 2011 called the paper fraudulent.

Wakefield has always denied allegations of manipulating data or having a financial motive in the Lancet paper, but no institution has yet ruled on the matter. in March, University College London (UCL), which took over divisions of the Royal Free Hospital where Wakefield worked, said it had launched an investigation.

In the meantime, Lewis, a microbiologist and former whistleblower who says he was falsely accused of misconduct after alleging links between human illness and the spreading of sewage sludge, asked Wakefield for the chance to review his files. His claims are not likely to challenge the conclusion based on much other evidence that the vaccine does not trigger autism. but they could complicate the debates about Wakefield’s integrity and the UCL investigation.

The documents that Lewis reviewed include confidential forms describing biopsies from the guts of children. the forms were filled out by pathologists Andrew Anthony and Paul Dhillon, who worked with Wakefield at the Royal Free. these documents, Lewis says, are relevant to Deer’s charge that records he obtained do not support Wakefield’s claims in the Lancet paper that the children had nonspecific colitis, a supposed element of an MMR-induced syndrome. on sheets for three of the children graded by Anthony, the handwritten word “colitis” appears, and Dhillon checked a box labelled “non-specific” on 10 forms. Anthony’s sheets are dated after the Lancet publication, whereas Dhillon’s are dated before.

Lewis believes that the sheets show that Anthony and Dhillon were making good-faith diagnoses of colitis. Anthony, who has left UCL, could not be reached by Nature, and Dhillon indicated that UCL had told him not to comment. (Neither has been accused of manipulating data.)

Before publishing Lewis’s letter, the BMJ asked Ingvar Bjarnason, a gastroenterologist at King’s College Hospital, London, to review the materials. Bjarnason says he doesn’t believe they are sufficient to support claims in the Lancet paper of a new disease process. He also questions whether “non-specific” on the grading sheets refers to colitis, saying it could refer to any kind of gut changes. but he says that the forms don’t clearly support charges that Wakefield deliberately misinterpreted the records. “The data are subjective. It’s different to say it’s deliberate falsification,” he says.

Deer notes that he never accused Wakefield of fraud over his interpretation of pathology records. but he says that records read to him from the Royal Free pathology service clearly stated that the children’s gut biopsies were within normal limits, even though they were reported in the Lancet paper as having enterocolitis.

Fiona Godlee, the editor of the BMJ, says that the journal’s conclusion of fraud was not based on the pathology but on a number of discrepancies between the children’s records and the claims in the Lancet paper. she says she will be calling for a public inquiry into the matter, noting that it has been more than a year since she first informed UCL about concerns over Wakefield’s work.

Wakefield denies charges of data manipulation. He says that UCL has yet to officially request his response to any charges and he isn’t convinced that the inquiry will give him a fair hearing. A UCL spokesman says that the investigation will be “thorough, fair and wide-ranging”. but eight months after announcing its inquiry, the university is still looking for a suitable external chairman. 

RENEE MONTAGNE, host: It’s MORNING EDITION from NPR News. I’m Rene Montagne.

STEVE INSKEEP: And I’m Steve Inskeep. Good morning.

Today in Your Health, vaccinating boys against HPV, the virus linked to cervical cancer. We’ll hear why that is not as controversial as vaccinating teenage girls.

MONTAGNE: Let’s turn first to a different concern – babies who cry and spit up a lot. more and more are getting prescription drugs, drugs used to treat reflux in infants. NPR’s Allison Aubrey reports on why a few doctors are pushing back.

ALLISON AUBREY: Babies have been crying and spitting up from time immemorial. But now it turns out parents of really fussy infants are increasingly asking, isn’t there medicine for this?

DR. ERIC HASSALL: Parents come in often demanding medication. And if they don’t get it from one physician, they often will get it from another.

AUBREY: That’s Dr. Eric Hassall, a specialist who has long treated children with stomach problems. He says some parents have picked up on the idea that heavily advertised medicines for reflux can help.

(SOUNDBITE OF TV ADVERTISEMENTS)

UNIDENTIFIED MAN: Ask if Nexium is right for you.

UNIDENTIFIED WOMAN: Prevacid 24 hour – when you’ve had it with heartburn.

AUBREY: Now, these medicines are not approved for infants with reflux. Doctors have been prescribing them off-label, and Hassall says this practice is fine in cases when babies are very sick. for instance, when they’re spitting up so much they’re not gaining weight.

HASSALL: The great majority of infants spit up and they cry, but very, very few of them actually have reflux disease and deserve medication.

AUBREY: In fact, four clinical trials show that these medicines work no better than a placebo pill – or sugar pill – in treating infants with reflux. And yet prescriptions for these drugs have shot up significantly. one study documented a 16-fold increase in prescriptions for one acid suppressing medication, which is sold in a child-friendly formulation.

HASSALL: there hasn’t been a sudden 16-fold increase in the incidence of reflux disease. it hasn’t suddenly become the scourge of otherwise healthy infants.

AUBREY: so what does Hassall recommend when the parents of inconsolable babies who are spitting up all the time come in for help? well, one of his patients is Tara Cree, who was at her wit’s end with her infant daughter.

TARA CREE: She was spitting up a lot, crying. it just didn’t seem right. She was incredibly irritable.

AUBREY: The worst of it came just after breast-feedings. when she described these symptoms to Hassall, he told Tara to change her diet to remove certain protein from her breast-milk.

CREE: He said I’m going to suggest that you try elimination of certain foods and it’s often the cause of reflux. so I eliminated dairy, soy and wheat from my diet.

AUBREY: Cree says it was a radical change. But she says right away her daughter’s symptoms started to improve.

CREE: Two days of me eliminating that from diet that I started to see a positive impact and by day three or four she was a different baby.

AUBREY: Now, not every baby will get the same relief from a mother’s diet change or by switching to a non-dairy baby formula, though Hassall says he usually starts with this approach, so he doesn’t need to use medicine.

But not all doctors are on the same page on this issue. Pediatric gastroenterologist Benjamin Gold says prescriptions for infants may have escalated, but he says he doesn’t want parents to be left with the wrong message.

DR. BENJAMIN GOLD: there are infants who do benefit from the drugs. And yes, it’s a small proportion of the spitty, irritable, fussy babies. But we have to be careful that we don’t swing the pendulum back the other way by saying, oh, these drugs are all bad.

AUBREY: Gold says what’s needed are better diagnostic tools to determine which babies truly need the medicine. And this requires more research. for now, he says, sometimes you have to try a baby on the medicine.

GOLD: The problem is that right now we are not able to clearly determine which children are going to benefit and which aren’t.

AUBREY: Advisors to the Food and Drug Administration have been looking at this issue. they say the limited data in infants suggests the medicines are fairly safe, but there are reports of intestinal inflammation and one study found an increased risk of pneumonia. FDA advisors say given the evidence that the medicines are not effective in treating babies with reflux, prescriptions should be reserved for infants who’ve been diagnosed with problems such as erosive esophagitis, a serious condition that afflicts relatively few babies.

Allison Aubrey, NPR News.

Meet Deepak Chopra

Acknowledged as one of the world’s greatest leaders in the field of… more »

Acknowledged as one of the world’s greatest leaders in the field of mind body medicine, Deepak Chopra, M.D. continues to transform our understanding of the meaning of health. Chopra is known as a prolific author of over 49 books with 12 best sellers on mind-body health, quantum mechanics, spirituality, and peace. a global force in the field of human empowerment, Dr. Chopra’s books have been published in more than 35 languages with more than 20 million copies in print. « less