HPV testing following excisional therapy for cervical neoplasia can identify high-risk patients: presented at IPC

Source: www.docguide.com Author: Louise Gagnon About one-quarter of women continue to have high-risk human papillomavirus (HPV) after excisional therapy for cervical intraepithelial neoplasia (CIN) 2/3, a study presented here at the 26th International Papillomavirus Conference (IPC) has found. Women with CIN are at increased risk for developing invasive cervical cancer, and persistent infection of high-risk HPV is a main risk factor for treatment failure, said Wendy Mei, BSc, MLT, the study's presenting investigator and clinical trials coordinator at the British Columbia Centre for Disease Control, Vancouver, British Columbia. HPV testing and Pap smear together are more sensitive than using Pap smear alone, noted Mei. "We wanted to evaluate the impact of implementing ASCCP [American Society for Colposcopy and Clinical Pathology] guidelines in British Columbia," Mei told attendees here at an oral presentation on July 7. "We also wanted to determine the genotype distribution of women with higher risk HPV to gain insight on vaccine and diagnostics evaluation." Researchers used ThinPrep to collect cervical brushings, instead of conventional Pap smear, to permit an aliquot to be tested to determine if the HPV types were high-risk using a DNA test. Mei and colleagues collected 1,007 specimens and found 25.4% (n = 256) were positive for high-risk HPV. They found HPV 16 in 29.7% of specimens and HPV 18 in 5.5% of specimens. "HPV 18 was lower than expected, but the treatment options are more effective for HPV 18," said Mei in an interview. Investigators found single and multiple high-risk HPV genotypes were [...]

HPV vaccine reduced further disease in women treated for cancer precursors

Source: www.hemonctoday.com Author: staff HPV vaccine quadrivalent (types 6, 11, 16 and 18) decreased HPV-related disease in women previously treated for cancer precursors, according to the post-hoc analysis of findings from two trials. Warner Huh, MD, associate professor in the department of obstetrics and gynecology at the University of Alabama at Birmingham, presented these findings at The Society for Gynecologic Oncologists’ 2010 Annual Meeting on Women’s Cancer in San Francisco. Although the HPV4 (Merck, Gardisil) has been shown to prevent cervical intraepithelial neoplasia (CIN), vulvar intraepithelial neoplasia, vaginal intraepithelial neoplasia, genital warts and adenocarcinoma, it is unclear if the vaccine may benefit patients who have already been exposed to the virus and had subsequent surgery. Researchers analyzed data from 17,622 women who were randomly assigned to the HPV4 or placebo. Overall, 587 women assigned to the vaccine and 763 assigned to placebo underwent cervical definitive therapy. Patients in the placebo group were at higher risk for incidence of CIN, vulvar intraepithelial neoplasia, vaginal intraepithelial neoplasia, genital warts and adenocarcinoma at a rate of 11.1 per 100 person-years, with an average of 1.4 years after surgery, compared with patients assigned to HPV4. Regardless of causal HPV type, patients who were vaccinated had a reduced risk for developing further disease, with a rate of 45% (95% CI, 21-62). Women treated for vulvar intraepithelial neoplasia, vaginal intraepithelial neoplasia and genital warts assigned to placebo had the highest risk for further disease, with a rate of 33.7 per 100 person-years. The risk for further [...]

Two doctors explain their support of the Gardasil vaccine

Source: www.huffingtonpost.com Author: Marcia G. Yerman As parents contemplate whether or not they should have the Gardasil vaccine administered to their daughters, one of the first places that they turn is to their doctors. In this segment, I posed questions to two doctors supporting the vaccine. Dr. Margaret Lewin, M.D., F.A.C.P., is the Medical Director of Cinergy Health, an insurance benefits provider. She advises the board on patient related issues and public health concerns. Lewin is board-certified in Internal Medicine, Hematology, and Medical Oncology. Lewin is affiliated with New York Presbyterian Hospital and the Hospital for Special Surgery. Dr. Alan Gibstein, M.D., F.A.C.S., F.A.C.O.G., is a Clinical Assistant Professor of Obstetrics and Gynecology at NYU School of Medicine. He is board-certified in Obstetrics and Gynecology, and is affiliated with North Shore University Hospital. He was president of the LIJMC medical staff from 1982-9183. In addition to his work as an attending gynecologist, he has been actively involved in medical and residency teaching. On why they supported the vaccine: Dr. Lewin wrote: "The evidence clearly shows that the quadrivalent HPV vaccine prevents cervical intraepithelial neoplasia caused by 70% of known HPV subtypes as well as preventing genital warts - both of which are highly contagious (even without sexual penetration), cause significant distress, substantial cost, and cannot reliably be permanently eliminated. There are published reports of oral cancer caused by the HPV virus. Oral cancers and their treatment are devastating, and the ability to avoid HPV-related oral cancers strongly increases my support [...]

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