Will You "Cervive" in 2015?

Is 2015 the year you finally truly prioritize YOUR health? The majority of Americans include weight loss and possibly exercise in their New Year's Resolutions each year...and do really well on their strict diets for a few days or maybe even a few weeks. While I absolutely applaud attention to weight and activity levels, I want to encourage you to think beyond diet and exercise for your 2015 health resolutions. (And I will spend time in future blogs this month talking more about what diets work best, but today I want to shift the focus...)

January happens to be Cervical Cancer Awareness month, so women- how about starting your 2015 Resolution list with scheduling your "annual" exam, especially if your last "annual" was way more than a year ago? The GOOD news is that screening recommendations have changed quite a bit, so women no longer need to have Pap tests every year. Current guidelines tell us for young women to have their FIRST Pap test at age 21, then (assuming tests do not show a problem) every 3 years between 21-29, and then after age 30, testing can actually occur simply every 5 years (by using both the Pap test and a specific HPV test combined).

In the United States, cervical cancer is still diagnosed in over  12,000 women per year, and tragically, still causes over 4000 deaths per year. We can do better! The vast majority of women with cervical cancer have little to NO symptoms- this is a silent killer. While prevention (with the HPV vaccine) is optimal, early detection absolutely saves lives- so do NOT put off getting your Pap test.

While most of us have run 5K's or worn PINK for breast cancer awareness, few people know or talk about their diagnosis of cervical cancer. Tamika Felder, a now 13 year survivor of cervical cancer, is leading the charge to increase personal and community support for cervical cancer. For my fellow AUSTINITES- if you or someone you love has been diagnosed with cervical cancer (whether that diagnosis was recent or many years ago), please let them know about CERVIVOR SCHOOL- a four day learning, connecting and revitalizing retreat NEXT WEEK, starting Thursday evening, 1/15/15 through Sunday afternoon.

BOTTOM LINE: Women, if you are due for a Pap test, please move that to the top of your 2015 Resolution list! 

Gardasil- What's Up Down Under?

The HPV (Human Papilloma Virus) vaccine, Gardasil, was FDA approved in the United States for use in young women in June, 2006, then extended for males in October, 2009. In October of 2011, the Advisory Committee on Immunization Practices (ACIP- the group that creates our national guidelines that you see posted on your doctor's office walls) extended their official recommendations to include ROUTINE VACCINATION of both boys and girls at age 11-12 years, with "catch up" immunizations for those youth  ages 13-21 who had missed getting this vaccine series.

Why are we vaccinating?
We vaccinate primarily for CANCER PREVENTION. Each year in the United States, we have over 33,300 cases of HPV-related cancers (data from CDC, 2012). About 2/3 of these occur in women, primarily with cervical cancers, but also other genital, anal and oral cancers. In men, the majority of HPV related cancers are oral, but they, too, can have genital and anal cancer, though it is less common than in females.
Gardasil also protects against the two strains of HPV that cause 90% of genital warts, and with over one million cases of this malady each year in the US, you can see what an impact prevention can make here!

How well are we doing?
Not as well as we could do...because national immunization surveys have shown that in teenagers 13-17 years old, only 53% of young women had started the series, and only 1/3 of that group had completed the series. A bit more encouraging is an improvement in the very low percentage of teenage males getting the vaccine, which was at 8% in 2011 (the first year it was considered a "routine" universal vaccine) and more than doubled to over 20% in 2012.

How effective is this vaccine? Here is the GREAT news- the HPV vaccine is unbelievably effective when given to young adults not previously exposed to HPV (with no prior sexual intimacy). The CDC's data demonstrates efficacy nearing 100% protection for women in preventing cervical, vulvar & vaginal cancers and genital warts, and 90% efficacy in men for genital wart prevention and 75% efficacy preventing early anal cancers.

What happened down under? 
From 2007-2009, Australia provided the HPV vaccine free of charge to all young women ages 12-26, and had extremely high vaccination rates as they utilized the school system to give out these shots. Follow up studies in 2011 and 2012 showed dramatic results, with 92% decline in genital warts in young women (< 21years old),  72% decline in women ages 21-30, and interestingly...an 81% delicate in young (< 21) heterosexual men and 51% decline in men ages 21-30. This is interesting because the young men saw improvement not because they had been immunized, but simply from the widespread immunization of all the women. Pre-cancerous cervical abnormalities also markedly declined in this short time period, and since cervical cancer typically is very slow growing, we expect to see dramatic falls in cervical cancer rates in the next few years and certainly, in the next decade.

BOTTOM LINE: HPV vaccination SHOULD BE a routine immunization for our sons and daughters- talk to your family physician about it at your next visit*

(In this day and age, I feel compelled to add two things: one, I in no way financially benefit from the makers of the Gardasil vaccine; two, yes, we chose to vaccinate our daughters.)

How Safe is Gardasil?

Parents are appropriately concerned about vaccines, but I get frustrated with the enormous amounts of negative popular press that immunizations are receiving these days. Vaccines are not only saving lives, but they are improving the quality of our lives dramatically with every decade. Today I'd like to discuss the statistics with Gardasil, a vaccine that protects against four strains of the human papilloma virus which cause genital warts and cervical cancer.

Gardasil was FDA approved and recommended in June of 2006. Since that time, over 32 million doses of the vaccine have been administered. There have been over 17,000 "adverse events" reported, including roughly 1000 "serious" events. The mild to moderate events (over 90%) include transient local swelling or pain, mild and moderate fevers, and nausea or fainting.

So what about the serious events, including 56 deaths? The serious events included primarily Guillian-Barre syndrome (a severe neurologic disorder) and blood clots. The numbers of GBS are no higher than expected in the age group receiving the vaccine, and the girls with blood clots typically had other risk factors for clotting, such as taking the birth control pill. Though deaths in young people are tragic REGARDLESS of the cause, there has been no identifiable pattern in these deaths to suggest that the vaccine caused them. If you look at any age population of 10 million people (32 million doses divided by the 3 shots in a series), sadly, you will see certain lethal cancers, neurological diseases, and other rare ailments.

It is important to understand that in order to figure out side effects from vaccines, any and ALL events that happen within a month (or up to a year) after receiving an immunization can and should be reported- even if it looks like they are completely coincidental. For example, if you get a flu shot today, and are diagnosed with advanced leukemia tomorrow, it gets reported as an "adverse event" of the flu shot- even though it obviously was going on before your shot. Why do this? Because we want to be SURE that there is NOT a relationship between any serious diseases and vaccines, and the only way to know is to collect all the data.

BOTTOM LINE: For Gardasil, look at these numbers and remember there are 1 million new cases of genital warts per year, 12,000 cases of cervical cancer and 4000 deaths from cervical cancer. You do the math. We are choosing to immunize our daughters.

An AGGIE Wearing ORANGE? Join Tamika and the Fight Against Cervical Cancer

This week I am talking about HPV (Human Papilloma Virus) and the diseases it causes. The most serious consequence of HPV infection is CANCER, and there are roughly 12,000 American women diagnosed with cervical cancer (caused by HPV) each year.
A couple weeks ago, while I was a guest on a Doctor Radio show that focused on cervical cancer, I met an amazing woman: Tamika Felder.
Tamika was diagnosed with cervical cancer at the very young age of 25, just as she was beginning to enjoy a successful career as a television producer in our nation's capitol. Her treatment included not only chemo and radiation, but also a complete hysterectomy. While friends were planning weddings and baby showers, Tamika was fighting for her life and giving up the dream of having children.
Lucky for the rest of us, Tamika's amazing spirit and talents emerged through her therapy, as she created a nonprofit organization to increase awareness about HPV and cervical cancer. In addition to public speaking, Tamika & Friends offer an online support group for women diagnosed with cervical cancer. Her mission is to spare those women newly diagnosed the shame and isolation that she endured over a decade ago. Click on her website: TamikaandFriends.org and read all the amazing survivor stories! Women from all backgrounds have bonded together to help other women face this challenge.
So why ORANGE? Every cancer seems to have its own color now, and Tamika wanted a color that reflected hope and positive energy, like a sunburst. Why not wear some orange this week, and pass on Tamika's message?
BOTTOM LINE: Cervical cancer is a very serious disease, and PREVENTION plus EARLY DETECTION are key! Remind your girlfriends to SCHEDULE their PAP TEST and get vaccinated against HPV!

HPV Vaccine (Gardasil)- Don't Forget the BOYS!

I'll bet you could quote the commercial for the HPV vaccine, Gardasil, about choosing to be "one less"- one less woman to get cervical cancer. This is one time where I am pleased that the media is playing a role in pharmaceutical awareness! We absolutely want EVERYONE to know about cervical cancer and the exciting news that we now know not only how this cancer is caused and spread, but most importantly, we know how it can be PREVENTED.

Did you know, though, that this vaccine also protects against genital warts? Two strains of HPV (6& 11) cause 90% of genital warts. Every year there are over a MILLION cases of genital warts in the United States alone. They are COMMON. These warts are transmitted by direct skin-to-skin contact, and though this usually occurs during sex, actual intercourse is certainly not required to pass them on. They are very contagious, with estimates up to 65% transmission. Warts typically recur despite treatment, and frankly, the treatment is unpleasant at best- we burn the warts chemically or with liquid nitrogen. If you've ever had a wart frozen/burned off your knee, you know what that feels like, and the genital area has more nerve endings. Enough said!

While males don't have a cervix to get cancer, they do have other parts that get HPV-related cancers (anal & penile, as well as some head and neck cancers,) although certainly these cancers are less common. Obviously, males can also get genital warts. In my clinical experience, little harms self-image like a young person developing these genital lesions, especially because we cannot simply cure them and make them go away forever.

Gardasil was approved for use in males over a year ago. A study recently published in the New England Journal of Medicine demonstrated that the vaccine had good efficacy in prevention of genital warts in males. More on this study tomorrow...

BOTTOM LINE: PREVENTION is KEY for HPV disease- talk with your doctor (or your child's doctor) about HPV vaccinations for your SONS & DAUGHTERS.

PS. I am NOT on anyone's payroll for this vaccine- but I absolutely do recommend it.

Does PAP = "Pelvic" ?

You may be aware that in 2010, the recommendations for Pap smears (to detect cervical cancer) have changed. Many women grew up being told that they should have a Pap smear once they started menstruating, or perhaps before they head off to college. It turns out, what MATTERS is simply whether or not you have had sex.

Cervical cancer is caused by a virus- the human papilloma virus, or HPV for short. We know that the vast majority of people who have sex will at some point in their life be infected with HPV. Certainly, the more partners you have, the higher the risk of contracting it. If two people are together, and neither has ever had their clothes off and been intimate with anyone else, there should be no risk of HPV. Otherwise, even if only one partner has had previous intimate contact with another person, there is risk, and most of the time this is a silent disease.

The GOOD news is that most people who are infected never develop adverse consequences. The BAD news is that over a million Americans see their doctors for genital warts each year, and that 12,000 women per year develop cervical cancer (not to mention the other cancers also caused by HPV.) More GOOD news, though- we have vaccines that can help. Gardasil protects against the strains that cause 90% of genital warts (types 6 & 11) and those that cause 70% of cervical cancers (types 16 & 18). Cevarix protects against the cancer causing strains as well.

So, back to the Pap smear. Yes, we recommend them, and the timing has changed (first Pap now recommended at age 21.) However- this is ONLY the recommendation for PAP SMEARS that screen for cervical cancer. If you wait several years to get ANY pelvic exam, and you have had new sexual partners, you risk developing complications from numerous other sexually transmitted diseases such as chlamydia, gonorrhea, trichomonas, syphilis, HIV and herpes.

BOTTOM LINE: MOST SEXUALLY TRANSMITTED DISEASES can be SILENT, so do not wait till it's time for your Pap smear to get a pelvic exam and/or get tested (which may only be a urine and blood sample)!