HPV testing for cervical cancer screening

Although cervical cancer is the 2^nd highest cancer in women in the world, its number has decreased markedly with advancement of cervical cytology (pap smear).   In the last a few years, HPV (Human Papilloma viruses) testing has been promoted to reduce the number even more with less frequent of doctor visit.

The current recommendation is to start pap smear at age 21 years old.  From age 21 to age 30 years old , pap smear should be done every 3 years.   You still need to come for pelvic exam yearly.   From age 30 to 65 years old, your doctor may recommend pap smear every 3 years or contesting (pap smear and HPV testing) every 5 years.   Younger people tends to be more sexually active, thus, having more HPV.  Fortunately, most of HPV infections go away on their own.  This is the reason on not testing women younger than age 30 years old. 

There are some fears that changing the frequency of pap smear from yearly to every 3 -5 years may miss some cancers.  Unfortunately, we do miss cancer.  But the risks of doing pap smear annually seems to be greater than every 3-5 years: excess procedures, cost, etc.

The pap smear guideline continues to change.  Thus, discuss it with your health care providers.

Risks for anal cancer

Cervical cancer share the same cause as most anal cancer: namely HPV viruses.   Thus, it is reasonable to be concerns.   Our study done at the West Clinic has just been published in August 2013 at the Obstetrics & Gynecology journal.   

We studied 327 patients with a biopsy-confirmed diagnosis of genital intraepithelial neoplasia (vulvar, vaginal, or cervical) underwent both anal cytology and anoscopy. We identified 64 (46.7%) women with anal intraepithelial neoplasia (which may lead to anal cancer), yielding a prevalence of 19.6%. Immunosuppression, vulvar dysplasia, multiple sexual partners (more than four), smoking history, and history of anal sex were positively associated with anal intraepithelial neoplasia (P<.05). 

We develop a simple predictive model based on the presence or absence of two of three risk factors (VIN, immunosuppression, and history of anal sex).  If you have two out of these 3 risk factors, please discuss with your health care providers about screening test for anal cancer.   

Reference:  Elnaggar AC, Santoso JT.  Risk Factors for anal intraepithelial neoplasia in Women with genital dysplasia.  Obstet  Gynecol .  2013, 122: 218-223

 

Should I take aspirin to reduce risks of cancer and heart diseases?

I often heard and read about the health benefits of aspirin.  A study summarizing nine randomized placebo-controlled trials with at least 1000 participants each evaluated the role of aspirinr on cardiovascular disease (CVD), nonvascular outcomes, or death.

The study, which involved over 100, 000 participants, showed that aspirin reduced total CVD events by 10%, driven primarily by reduction in nonfatal MI (heart attack). There was no significant reduction in CVD death or cancer death.  There was increased risk of nontrivial bleeding events

The study concluded that for most of us who are healthy and do not have heart diseases, aspirin prophylaxis may not help reducing death from CVD or cancer and may increase bleeding complications.   As most of things in medicine which hardly black or white, you should discuss risks and benefits with your doctors.

Reference:

Seshasai SR, Wijesuriya S, Sivakumaran R, Nethercott S, Erqou S, Sattar N, Ray KK.  Effect of aspirin on vascular and nonvascular outcomes: meta-analysis of randomized controlled trials. Arch Intern Med. 2012;172(3):209.

 

What is my risk of re-operation if I elect to preserve my ovaries during hysterectomy?

About 500,000 hysterectomies are performed annually in the US.   Many of these surgeries are done for benign (non cancer) reason such as bleeding, fibroid, etc.    Many of these patients, especially if they are young, are often offered to remove their uterus but preserve their ovaries.   They often ask what is the risk of needing surgery in the future because of some problems with their ovaries.

 

Casiano and her team published a study to answer such question. Using Rochester Epidemiology Project resources,  they compared the risk of oophorectomy (removal of ovaries), among 4,931 women, who underwent ovary-sparing hysterectomy for benign indications (case group)  with 4,931 age-matched women who did not undergo hysterectomy (referent group).  With 30 years follow up, 9.2% of women of elected to preserve their ovaries required another surgery to remove the ovaries.   This only 1.9 percentage points higher than the incidence of oophorectomy in referent women with intact reproductive organs.

The conclusion of the study is try to preserve your ovaries during hysterectomy if you are pre-menopausal and being operated for non-cancer diagnosis.  However, as always, your case may be unique and do discuss it with your surgeon.

Reference:

Casiano ER, Trabuco EC, Bharucha AE, Weaver AL, Schleck CD, Melton LJ 3rd, Gebhart JB. Risk of oophorectomy after hysterectomy. Obstet Gynecol. 2013 May;121(5):1069-74