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Debbie Saslow (8 posts)  RSS

The HPV vaccine could do even more

January 23, 2014

EDITOR'S NOTE: The President's Cancer Panel has released a report that says increasing HPV vaccination is one of the most important opportunities in cancer prevention. The report calls for re-energized efforts to promote vaccination and reach the HPV vaccines' potential to save lives by preventing avoidable cancers in men and women. It explores underuse of HPV vaccines, identifies key barriers to increasing vaccine uptake, and provides actionable recommendations for overcoming these obstacles. To coincide with the release, here is our recent blog on the subject.

 

By Debbie Saslow, PhD

The HPV vaccines (Gardasil and Cervarix) have been recommended for girls in the US for nearly 10 years. They protect against human papillomavirus (HPV), the virus that causes most cases of cervical cancer, and Gardasil also protects against nearly all cases of genital warts. Uptake of HPV vaccination has been slow in this country, though; less than 35% of girls have gotten all 3 recommended doses.

Despite low vaccination rates, we have already seen HPV infections (related to the types of HPV targeted by the vaccines) drop by 56% in the United States. In countries that have higher vaccine rates, there are even larger drops. Indeed, data published last year suggest that higher vaccination rates could reap great benefits.

The potential to eliminate genital warts

 

A study from Australia, where more than 70% of adolescent girls are vaccinated, suggests that in countries where vaccine coverage is high, genital warts may be eliminated in the coming decades.

The government-funded Australian HPV vaccine program has provided free vaccine in schools to 12- and 13-year-old girls since 2007. From 2007-2010, free vaccine was also offered to girls and women ages 14-26.

The number of cases of genital warts among young people has dropped dramatically since the program began. More...

Can breastfeeding lower breast cancer risk?

May 07, 2013

By Debbie Saslow, PhD


There are a limited number of things that women can do to lower their risk of breast cancer, including getting regular physical activity, limiting alcohol, and maintaining a healthy weight. Breastfeeding has often been included in the protective behaviors against breast cancer, but the research has been inconsistent.

Looking at the research on breastfeeding and breast cancer risk, it is clear that this has been a difficult area to study. If breastfeeding does lower risk, the level of protection is small and depends on women breastfeeding for a long time.  In countries such as the U.S., most women who breastfeed their babies stop after several months, or they breastfeed less frequently as they start to supplement with formula and baby food. Women who have many children and breastfeed each baby for a long time seem to be at somewhat lower risk of breast cancer than women who have smaller families and breastfeed for a shorter time. Studies that have found that breastfeeding does lower breast cancer risk have also found that protection builds up over time (that is, duration of breastfeeding) and number of children that are breastfed.

The major study (Collaborative Group on Hormonal Factors in Breast Cancer; Lancet, 2002 Jul 20; 360 (9328): 187-95) that supports breastfeeding as protective against breast cancer was published in 2002. The researchers analyzed 47 studies in 30 countries; these studies had information about 50,000 women with invasive breast cancers and 97,000 women without breast cancer.  The study authors found that the rate of breast cancer diagnoses was slightly lower among women who had breastfed and among women who had breastfed for longer periods of time. More...

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Breast Cancer | Debbie Saslow

Cervical Cancer is an International Issue

January 30, 2013

By Debbie Saslow, PhD

A lot has happened in the area of cervical cancer this past year. The American Cancer Society, the U.S. Preventive Services Task Force and the American College of Obstetricians and Gynecologists all released virtually identical screening guidelines, leading to less confusion and higher acceptance from health care professionals and the public.

Thanks to screening, cervical cancer is not very common in the U.S., with about 12,340 new cases of invasive cervical cancer expected to be diagnosed in 2013. Unfortunately the same is not true around the world, where more than half a million women are diagnosed with cervical cancer each year.  It is actually the 2nd largest cancer killer among women in most low- and middle-income countries.

Sadly, this disease threatens to undermine the important gains worldwide that have been made in sexual and reproductive health, maternal and child health, HIV/AIDs and other infectious diseases. For women in many countries in Africa, Asia, and Latin America, cervical cancer is often detected late, when there is little hope for successful treatment. And it can be devastating to the whole family, both emotionally and financially.

The good news is that a lot has been happening in global cervical cancer.  Indeed, many underserved societies have been actively advocating for improved cervical cancer control policies. In response, governments are increasingly making the HPV vaccine available through their health systems and are supporting new cervical cancer screening methods appropriate for their needs and resources. More...

Can Removing Fallopian Tubes Prevent Cancer ?

August 28, 2012

By Debbie Saslow, PhD

 

I've seen a few articles recently about removing the fallopian tubes to prevent ovarian cancer, a procedure called "prophylactic bilateral salpingectomy". And not just in women who are at high risk for ovarian cancer, which is already recommended by gynecological medical societies in the United States, but for all women who are not planning to have any more children and who are about to undergo abdominal surgery for any reason.


I can see the appeal given that many, if not most, ovarian cancers actually originate in the fallopian tubes. In fact, it is more common to find microscopic fallopian tube cancer than microscopic ovarian cancer in women with a BRCA1 or BRCA2 mutation when they have their ovaries and fallopian tubes removed. (These mutations put them at higher risk for ovarian and breast cancer.) And unfortunately we don't yet have an accurate test to screen women for ovarian cancer, so these cancers are usually found at a late stage when they are often fatal. 


It is common for women to get their "tubes tied" (i.e. tubal ligation) as a form of permanent birth control, and we know this reduces the risk of ovarian cancer. But removing the fallopian tubes is a more invasive procedure, and the potential benefits and potential harms are largely unknown. Is it worth it? Does it really reduce the risk of ovarian cancer and, if so, by how much? More...

Is a Pap test necessary every year?

March 14, 2012

By Debbie Saslow, PhD


When it comes to screening for cancer, a common belief held by doctors as well as patients is "more is better." It seems only logical that more frequent screening with the newest technologies translates to more cancers detected at the earliest possible time and, ultimately, more lives saved.


Cervical cancer is an example of why this is not necessarily so. Dating back to the late 1940s, the Pap test has been detecting not only early cervical cancers, but changes in the cervix ("pre-cancers") that when treated or removed lead to actual prevention of cancer in addition to early detection. For decades, the majority of women in this country have scheduled their doctor appointments around their "annual Pap."  As a result of widespread Pap testing, mortality rates dropped by 70% and the Pap test became the biggest success story for cancer screening in history.


In the late 1980s, it was discovered that cervical cancer is caused by HPV, the human papilloma virus. Studies of the natural history of HPV and cervical cancer showed that it takes, on average, 10-20 years from the time a woman is first infected with HPV until the time a cervical cancer might appear.


In 1987, the American Cancer Society, and several other national organizations, recommended that most women could safely be screened for cervical cancer with the Pap test every 3 years rather than every year. Twenty-five years later, studies show that the majority of health care providers still recommend annual screenings and that the majority of women expect annual screenings. More...

Ovarian Cancer: Do Screening Tests Work?

September 01, 2011

By Debbie Saslow, PhD


For years, patients, doctors, and researchers have been trying to find a way to catch ovarian cancer early, when it's most treatable. For women, the chance of getting ovarian cancer is about 1 in 70.  In most cases, the cancer is found at an advanced stage and survival is, sadly, quite low.


Most women get tested regularly for breast cancer and cervical cancer, and hopefully colorectal (colon) cancer. Why aren't they checked for ovarian cancer, too?  Unfortunately we don't have tests like mammograms or Pap tests for the ovaries. Doctors often do a pelvic exam, which includes checking the ovaries, but this exam rarely finds ovarian tumors unless they have grown very large.


Some other tests, like the CA-125 blood test and transvaginal ultrasound, have been studied to see if they can be used to test for ovarian cancer, but none have proven to be accurate enough to consistently find cancer. More...

The HPV vaccine: 3 shots of prevention

July 26, 2011

By Debbie Saslow, PhD


Many people ask me about whether or not their daughters should get the human papillomavirus (HPV) vaccine, which can help prevent cervical cancer. As with all new vaccines, there has been some controversy. Some parents have been reluctant to get their daughters vaccinated before they are sexually active, yet this is precisely when the vaccine will be most effective. Others were concerned about safety; the HPV vaccines are extremely safe, based on tens of millions of doses distributed worldwide. There was also an initial push, generated by the manufacturer, to require HPV vaccination for middle school enrollment. To date only Virginia and Washington, D.C., have such a requirement.

To answer the question of whether to vaccinate, it helps to have some background:

In the United States, an estimated 12,200 cases of invasive cervical cancer were expected to be diagnosed in 2010, with an estimated 4,210 deaths. But there have been fewer deaths over the past several decades due to cancer screening tests. That's great news. But we can reduce the number of people even getting cervical cancer by doing what  we know works. More...

Lymph node surgery for breast cancer patients—Can I get by with less?

April 12, 2011

By Debbie Saslow, PhD

 

A recent study has shown that for some women diagnosed with breast cancer, extensive lymph node surgery isn't needed. This is great news because removal of lymph nodes in the armpit area can have debilitating and life-long side effects.


Here is a little background: In the United States, about 210,000 new cases of invasive breast cancer will be diagnosed this year. Of the invasive cancers, about 30% of cases, or 63,000 cancers, will be diagnosed at the "regional stage," which means the cancer has spread to nearby lymph nodes. The findings of this study are important for women in this group.

More...

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