Research presented at the 72nd Annual Scientific Meeting of the American College of Gastroenterology found that obesity, among other important risk factors, was the strongest risk factor for colorectal cancer in women.
Joseph C. Anderson, MD of Stony Brook University in New York (and the University of Connecticut) and his colleagues examined data from 1,252 women who underwent colonoscopy. They classified patients according to their age, smoking history, family history of colorectal cancer, and body mass index (BMI). Obesity was defined as a BMI of 30 or higher. For smoking, patients were divided into three groups: heavy exposure, low exposure, and no exposure. Patients who were in the heavy exposure group included women who had smoked more than 10 "pack years" and who were currently smoking or had quit in the past 10 years.
Although smoking posed a significant increased risk for colorectal neoplasia, researchers found that for women, obesity was the highest attributable risk factor for developing the disease. BMI accounted for one-fifth of all significant polyps detected during colonoscopy. Of those patients who had colorectal neoplasia, 20 percent were obese and 14 percent were smokers.
"Given the increasing number of obese patients in the U.S., identifying them as high risk may have important screening implications," said Dr. Anderson. "While obesity is positively associated with an increased risk of colorectal cancer, patients who lower their BMI could potentially reduce their risk of developing the disease in the future."
About Body Mass Index (BMI)
Body mass index, or BMI, is a measurement that determines the healthiness of a person's weight. The formula is related to the amount of fat a person carries and is calculated using the person's height and weight. A healthy BMI is between 18.5 and 24.9. People are considered underweight if their BMI is less than 18.5, overweight if their BMI is between 25 and 29.9, and obese if their BMI is 30 or higher.
About the American College of Gastroenterology
Founded in 1932, the American College of Gastroenterology (ACG) is an organization with an international membership of more than 10,000 individuals from 80 countries. The College is committed to serving the clinically oriented digestive disease specialist through its emphasis on scholarly practice, teaching and research. The mission of the College is to serve the evolving needs of physicians in the delivery of high quality, scientifically sound, humanistic, ethical, and cost-effective health care to gastroenterology patients.
The ACG is committed to providing accurate, unbiased and up-to-date health information. Visit the ACG Web site American College of Gastroenterology
to access educational resources for patients and their families spanning the broad range of digestive diseases and conditions -- both common and not-so-common. Organized by disease, state and organ system, these educational materials, developed by ACG physician experts, are offered for the information and benefit of patients and the public.
Source: Rosanne Riesenman
American College of Gastroenterology
четверг, 23 февраля 2012 г.
четверг, 16 февраля 2012 г.
Mammography: Is It Right For Me? New Book Shines Light On Mammography Controversy
The subject of changing public advice over the years, mammography and the controversy over its use continue to cause confusion in the minds of many women. A new book for lay readers entitled "Understanding the Mammography Controversy: Science, Politics, and Breast Cancer Screening" (Praeger Press), by women's health expert Dr. Madelon L. Finkel of Weill Medical College of Cornell University, provides a comprehensive guide to mammography, the mammography controversy and breast health.
The book directly addresses the still-controversial issues, such as deciding when is the "right" time to have a mammogram, what is the "right" age for mammography (the body of evidence indicates a benefit for women aged 50 to 69) and whether mammography is useful at all (it is). While not perfect, mammography is the only population-based breast cancer screening method that has been shown to actually save lives.
"It's no wonder women are confused about mammography. Sensational media stories tout the latest scientific studies, often contradicting previous findings. Above all, women need to separate the facts from the myths in order to make informed decisions about their breast health," says Dr. Finkel, professor of clinical public health and director of the Office of Global Health Education at Weill Cornell Medical College.
This book includes a timeline that details the disagreement within the scientific community and changing public advice on mammography over the years.
"The mammography debate is still not yet settled. While the latest research shows that mammography can save lives, there is still no overall consensus on what age mammogram screening should be recommended, and even whether the benefits of mammogram screening outweigh the risks in the first place," says Dr. Finkel." Each woman must consider her personal risk factors, and in consultation with her doctor, decide when and how frequently mammography should be scheduled."
The book offers readers practical information, including how to give a breast self-exam, how to communicate with one's doctor, a list of support groups and organizations for breast cancer patients, and resources for clinical trials.
"Most women will not develop breast cancer in their lifetime, and for those who do, it's no longer a death sentence. Thanks to public awareness, screening, research and new treatment options, it has become a treatable, chronic illness," says Dr. Finkel.
"Understanding the Mammography Controversy: Science, Politics, and Breast Cancer Screening" received the highest rating from BookList. The book is dedicated to the author's mother, who died of breast cancer.
Dr. Madelon Finkel
Dr. Madelon Finkel has been involved in epidemiologic research and health-care policy studies for more than two decades. Her research has been focused on such women's health issues as teenage sexual behavior and hormone replacement therapy.
Dr. Finkel received an M.P.A. and Ph.D. in epidemiology and health services research from NYU. In addition to her titles at Weill Cornell Medical College, Dr. Finkel also holds the rank of professor of research in medicine at SUNY Stony Brook, and was a visiting professor at the School of Public Health, University of Sydney (Australia) in 2004. She is a member of the American College of Epidemiology, an advisor to the American Council on Science and Health, and a charter member of the Academy of Benefit Authors of the International Foundation of Employee Benefit Plans. Dr. Finkel was awarded the highest teaching honor at Weill Cornell, the Excellence in Teaching Award, in 2000 and 2005.
The Joan and Sanford I. Weill Medical College
The Joan and Sanford I. Weill Medical College -- located in New York City -- is committed to excellence in research, teaching, patient care and the advancement of the art and science of medicine. The Medical College, which is a principal academic affiliate of NewYork-Presbyterian Hospital, offers an innovative curriculum that integrates the teaching of basic and clinical sciences, problem-based learning, office-based preceptorships, and primary care and doctoring courses. Physicians and scientists of Weill Cornell Medical College are engaged in cutting-edge research in such areas as stem cells, genetics and gene therapy, geriatrics, neuroscience, structural biology, cardiovascular biology, AIDS, obesity, cancer and psychiatry -- and continue to delve ever-deeper into the molecular basis of disease in an effort to unlock the mysteries behind the human body and the malfunctions that result in serious medical disorders. Weill Cornell Medical College is the birthplace of many medical advances -- from the development of the Pap test for cervical cancer to the synthesis of penicillin, the first successful embryo-biopsy pregnancy and birth in the U.S., and most recently, the world's first clinical trial for gene therapy for Parkinson's disease. Weill Cornell's Physician Organization includes 650 clinical faculty who provide the highest quality of care to patients.
Joan and Sanford I. Weill Medical College of Cornell University
nyp
The book directly addresses the still-controversial issues, such as deciding when is the "right" time to have a mammogram, what is the "right" age for mammography (the body of evidence indicates a benefit for women aged 50 to 69) and whether mammography is useful at all (it is). While not perfect, mammography is the only population-based breast cancer screening method that has been shown to actually save lives.
"It's no wonder women are confused about mammography. Sensational media stories tout the latest scientific studies, often contradicting previous findings. Above all, women need to separate the facts from the myths in order to make informed decisions about their breast health," says Dr. Finkel, professor of clinical public health and director of the Office of Global Health Education at Weill Cornell Medical College.
This book includes a timeline that details the disagreement within the scientific community and changing public advice on mammography over the years.
"The mammography debate is still not yet settled. While the latest research shows that mammography can save lives, there is still no overall consensus on what age mammogram screening should be recommended, and even whether the benefits of mammogram screening outweigh the risks in the first place," says Dr. Finkel." Each woman must consider her personal risk factors, and in consultation with her doctor, decide when and how frequently mammography should be scheduled."
The book offers readers practical information, including how to give a breast self-exam, how to communicate with one's doctor, a list of support groups and organizations for breast cancer patients, and resources for clinical trials.
"Most women will not develop breast cancer in their lifetime, and for those who do, it's no longer a death sentence. Thanks to public awareness, screening, research and new treatment options, it has become a treatable, chronic illness," says Dr. Finkel.
"Understanding the Mammography Controversy: Science, Politics, and Breast Cancer Screening" received the highest rating from BookList. The book is dedicated to the author's mother, who died of breast cancer.
Dr. Madelon Finkel
Dr. Madelon Finkel has been involved in epidemiologic research and health-care policy studies for more than two decades. Her research has been focused on such women's health issues as teenage sexual behavior and hormone replacement therapy.
Dr. Finkel received an M.P.A. and Ph.D. in epidemiology and health services research from NYU. In addition to her titles at Weill Cornell Medical College, Dr. Finkel also holds the rank of professor of research in medicine at SUNY Stony Brook, and was a visiting professor at the School of Public Health, University of Sydney (Australia) in 2004. She is a member of the American College of Epidemiology, an advisor to the American Council on Science and Health, and a charter member of the Academy of Benefit Authors of the International Foundation of Employee Benefit Plans. Dr. Finkel was awarded the highest teaching honor at Weill Cornell, the Excellence in Teaching Award, in 2000 and 2005.
The Joan and Sanford I. Weill Medical College
The Joan and Sanford I. Weill Medical College -- located in New York City -- is committed to excellence in research, teaching, patient care and the advancement of the art and science of medicine. The Medical College, which is a principal academic affiliate of NewYork-Presbyterian Hospital, offers an innovative curriculum that integrates the teaching of basic and clinical sciences, problem-based learning, office-based preceptorships, and primary care and doctoring courses. Physicians and scientists of Weill Cornell Medical College are engaged in cutting-edge research in such areas as stem cells, genetics and gene therapy, geriatrics, neuroscience, structural biology, cardiovascular biology, AIDS, obesity, cancer and psychiatry -- and continue to delve ever-deeper into the molecular basis of disease in an effort to unlock the mysteries behind the human body and the malfunctions that result in serious medical disorders. Weill Cornell Medical College is the birthplace of many medical advances -- from the development of the Pap test for cervical cancer to the synthesis of penicillin, the first successful embryo-biopsy pregnancy and birth in the U.S., and most recently, the world's first clinical trial for gene therapy for Parkinson's disease. Weill Cornell's Physician Organization includes 650 clinical faculty who provide the highest quality of care to patients.
Joan and Sanford I. Weill Medical College of Cornell University
nyp
четверг, 9 февраля 2012 г.
Helping Teens Overcome Fears And Stigmas Of Mental Illness
When teens start experiencing changes in moods or emotions, they tend to fear sharing their blue days with their families and adults who can help them. As a consequence, they often suffer in silence.
Case Western Reserve University KL2 Clinical Research Scholar and Instructor Melissa Pinto-Foltz from the Frances Payne Bolton School of Nursing wants to find the magical elixir that helps teens speak up, seek help and then stick with treatments that get them feeling better.
"About one in five Americans has a mental illness, with half of these individuals first experiencing symptoms of mental illness in their teen years," she said.
Pinto-Foltz's research contributes to efforts nationwide to combat a public health issue, stigma and mental health literacy, made a priority in a U. S. Surgeon General's Report and the President's New Freedom Commission on Mental Health.
She found that a good way to reach teens to help them learn about mental illness and improve negative attitudes about mental illness was through their school.
She studied 156 girls in the 9th and 10th grade in a research project set in public high schools in Louisville, Ky. About half the group participated in a special national program called In Our Own Voice, offered by the National Alliance for Mental Illness, and the other half did not see the program.
More than 200,000 people across the U.S. have seen the In Our Own Voice program, which is frequently given in schools, churches and other community settings. The one-hour program involves learning through storytelling and changing attitudes through interacting with people who are in sustained recovery from mental illness. These individuals tell their personal stories of what it was like to first discover the illness and get through their recovery from the illness.
While the program is widely used across the U.S., no evidence exists that it is effective with teens, nor has the impact of the program been examined for an extended time period.
Pinto-Foltz used the In Our Own Voice program with the teens and reported her findings from the study, "Feasibility, Acceptability, and Initial Efficacy of a Knowledge-Contact Program to Reduce Mental Illness Stigma and Improve Mental Health Literacy in Adolescents," in Social Science and Medicine.
"We tell stories every day to friends, family and co-workers," she said. "The whole idea behind this approach is that people learn about the world through stories, and interacting with people with mental illness may violate previously held stereotypes. We wanted to see if teens responded to these interactions with and stories told by people with mental illness in such a way that it decreased stigma associated with mental illness and improved their knowledge of mental illness."
She followed participants four times over 10 weeks: first to study what stigmas and knowledge they had about mental illness, then in response to the In Our Own Voice program. She conducted follow-up interviews shortly after girls saw the program and again at weeks 4 and 8 to see if there were changes in the their level of stigma associated with mental illness and whether their knowledge of mental illness increased.
Pinto-Foltz's 10-week study found that the girls liked and learned from the In Our Own Voice storytelling program, but the program was too short to change some of the girls' stigmas that they would be more accepting of individuals with mental illness.
"This was our first assessment of In Our Own Voice as it's currently given, and it's a starting point to tackle stigma and improve mental health literacy among adolescents using existing approaches," she said.
In the future, she added that we can increase our chance of combating stigma and increasing mental health knowledge by providing more opportunities for adolescents to interact with the presenters following the program.
She suggested continued interaction with the presenters through projects with the girls or visits to their health classes for further discussions about mental illness.
"The girls were eager for more interaction with the presenters," Pinto-Foltz explained. "They kept asking me when the presenters would return to tell more stories. After the program, the girls had many lingering questions about mental illness. Increasing their interaction with the presenters would allow an opportunity to clarify their questions about mental illness, increase their comfort in interacting with individuals with mental illness, and decrease stigma."
Meanwhile in the follow-up with the girls at four and eight weeks, Pinto-Foltz found that girls who participated in In Our Own Voice had improved mental health knowledge when compared to the girls who did not receive the program.
Stigma levels for both groups remained the same, calling for further examination of approaches to tackle this important and pervasive problem, Pinto-Foltz said.
This research was support by the Midwest Nursing Research Society and the Iota Chapter of Sigma Theta Tau.
Source:
Susan Griffith
Case Western Reserve University
Case Western Reserve University KL2 Clinical Research Scholar and Instructor Melissa Pinto-Foltz from the Frances Payne Bolton School of Nursing wants to find the magical elixir that helps teens speak up, seek help and then stick with treatments that get them feeling better.
"About one in five Americans has a mental illness, with half of these individuals first experiencing symptoms of mental illness in their teen years," she said.
Pinto-Foltz's research contributes to efforts nationwide to combat a public health issue, stigma and mental health literacy, made a priority in a U. S. Surgeon General's Report and the President's New Freedom Commission on Mental Health.
She found that a good way to reach teens to help them learn about mental illness and improve negative attitudes about mental illness was through their school.
She studied 156 girls in the 9th and 10th grade in a research project set in public high schools in Louisville, Ky. About half the group participated in a special national program called In Our Own Voice, offered by the National Alliance for Mental Illness, and the other half did not see the program.
More than 200,000 people across the U.S. have seen the In Our Own Voice program, which is frequently given in schools, churches and other community settings. The one-hour program involves learning through storytelling and changing attitudes through interacting with people who are in sustained recovery from mental illness. These individuals tell their personal stories of what it was like to first discover the illness and get through their recovery from the illness.
While the program is widely used across the U.S., no evidence exists that it is effective with teens, nor has the impact of the program been examined for an extended time period.
Pinto-Foltz used the In Our Own Voice program with the teens and reported her findings from the study, "Feasibility, Acceptability, and Initial Efficacy of a Knowledge-Contact Program to Reduce Mental Illness Stigma and Improve Mental Health Literacy in Adolescents," in Social Science and Medicine.
"We tell stories every day to friends, family and co-workers," she said. "The whole idea behind this approach is that people learn about the world through stories, and interacting with people with mental illness may violate previously held stereotypes. We wanted to see if teens responded to these interactions with and stories told by people with mental illness in such a way that it decreased stigma associated with mental illness and improved their knowledge of mental illness."
She followed participants four times over 10 weeks: first to study what stigmas and knowledge they had about mental illness, then in response to the In Our Own Voice program. She conducted follow-up interviews shortly after girls saw the program and again at weeks 4 and 8 to see if there were changes in the their level of stigma associated with mental illness and whether their knowledge of mental illness increased.
Pinto-Foltz's 10-week study found that the girls liked and learned from the In Our Own Voice storytelling program, but the program was too short to change some of the girls' stigmas that they would be more accepting of individuals with mental illness.
"This was our first assessment of In Our Own Voice as it's currently given, and it's a starting point to tackle stigma and improve mental health literacy among adolescents using existing approaches," she said.
In the future, she added that we can increase our chance of combating stigma and increasing mental health knowledge by providing more opportunities for adolescents to interact with the presenters following the program.
She suggested continued interaction with the presenters through projects with the girls or visits to their health classes for further discussions about mental illness.
"The girls were eager for more interaction with the presenters," Pinto-Foltz explained. "They kept asking me when the presenters would return to tell more stories. After the program, the girls had many lingering questions about mental illness. Increasing their interaction with the presenters would allow an opportunity to clarify their questions about mental illness, increase their comfort in interacting with individuals with mental illness, and decrease stigma."
Meanwhile in the follow-up with the girls at four and eight weeks, Pinto-Foltz found that girls who participated in In Our Own Voice had improved mental health knowledge when compared to the girls who did not receive the program.
Stigma levels for both groups remained the same, calling for further examination of approaches to tackle this important and pervasive problem, Pinto-Foltz said.
This research was support by the Midwest Nursing Research Society and the Iota Chapter of Sigma Theta Tau.
Source:
Susan Griffith
Case Western Reserve University
четверг, 2 февраля 2012 г.
Outcomes For Robotic-Assisted Hysterectomy Similar To Conventional Laparoscopy, Study Finds
Two methods of performing a minimally invasive hysterectomy -- either by a surgeon alone or with assistance of robotic equipment -- produced similar, positive outcomes in women with endometrial cancer, according to a study in the journal Obstetrics & Gynecology, Reuters reports. The study's authors said both methods proved superior to the traditional open procedure, which involves a relatively large abdominal incision.
More than 40,000 women are diagnosed with endometrial cancer in the U.S. every year. Treatment usually involves a hysterectomy -- the surgical removal of the uterus -- and often the removal of lymph nodes to determine the stage of the cancer.
The conventional minimally invasive procedure is performed through laparoscopy, using a small incision and a video camera, but it requires intensive training on the part of the surgeon. The robot, though adding a few thousand dollars to the procedure's price, provides better vision, improves range of motion and uses more intuitive movements.
The study found that both minimally invasive techniques resulted in longer operations but shorter hospital stays, compared with the open procedure. The robotic surgery caused about half as much blood loss as the standard laparoscopy. There were no differences in complications among the three techniques.
"Robotics increases the chance that a hysterectomy can be done by laparoscopy," Tommaso Falcone of the Cleveland Clinic said. "However, if the surgeon is skilled enough to do the hysterectomy without the robot by laparoscopy, then the outcomes will be similar," he said (Peeples, Reuters, 11/29).
Reprinted with kind permission from nationalpartnership. You can view the entire Daily Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women's Health Policy Report is a free service of the National Partnership for Women & Families.
© 2010 National Partnership for Women & Families. All rights reserved.
четверг, 26 января 2012 г.
Federal Judge Rejects Motions To Dismiss Trial Against Convicted Murderer Kopp
U.S. District Judge Richard Arcara on Thursday rejected all defense motions to dismiss the upcoming federal trial against convicted murderer James Kopp and ruled that Kopp cannot discuss his antiabortion views during the trial, the AP/Jackson News-Tribune reports (Thompson, AP/Jackson News-Tribune, 12/7). Kopp in 2003 was convicted under state second-degree murder charges and sentenced to 25 years to life in prison for murdering Buffalo, N.Y., abortion provider Barnett Slepian in 1998. In the upcoming trial, he faces charges of violating the federal Freedom of Access to Clinic Entrances Act. The federal charges could carry a sentence of life in prison without parole. Kopp's former attorney, John Humann, had filed a motion to suppress Kopp's confession to the murder despite Kopp's objection. Kopp subsequently made a request to represent himself, which Arcara granted in May. Prosecutors had asked Arcara to prohibit buttons or T-shirts displaying abortion-related slogans in the courtroom. They also attempted to prevent Kopp from explaining his reasons for opposing abortion, describing the experiences of former abortion patients and how fetuses develop or showing the jury pictures of aborted fetuses (Kaiser Daily Women's Health Policy Report, 7/19). Arcara ruled that Kopp cannot discuss his antiabortion views or offer abortion-related photographs or testimony because they are irrelevant (AP/Jackson News-Tribune, 12/7). Arcara has tentatively scheduled the federal trial for Jan. 3, 2007 (Kaiser Daily Women's Health Policy Report, 7/19).
"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
четверг, 19 января 2012 г.
Partner Assistance Allows ADPH To Continue Serving Women At High Risk Of Breast And Cervical Cancer
Thanks to the generosity of the Joy to Life Foundation and the Susan G. Komen for the Cure,
North Central Alabama Affiliate, the Alabama Department of Public Health can continue to fund
the screening of high-risk women for breast and cervical cancer through June 30.
In the past seven months the Alabama Breast and Cervical Cancer Early Detection Program
has served 10,000 women, the number of women ordinarily served during an entire year. All
program appropriations have been depleted because of this unprecedented demand for
services. To avoid completely suspending the program, the two nonprofit organizations have
stepped forward to provide funding for screening high-risk women.
"We are very appreciative of the donation of private funds by the Joy to Life Foundation and the
Susan G. Komen for the Cure, North Alabama Affiliate," said Dr. Donald Williamson, state
health officer. "We would have been forced to suspend services were it not for their donations
that will carry the program through the next five months. Last year alone more than 150
medically underserved women were diagnosed with breast and cervical cancer through this
program, and more than 1,700 women have been diagnosed since this program began in 1996."
Early detection of these cancers saves lives. Breast cancer screening services include clinical
breast examinations and mammograms. Cervical cancer screening services include pelvic
exams and Pap smears. If an abnormality is detected, diagnostic testing for both cancers may
include an ultrasound, biopsy or colposcopy.
To be eligible for screening, the individual must be female, have an income at or below 200
percent of the federal poverty level, and have no insurance or be underinsured. In addition, the
patient must be age 40-64 and have an abnormal clinical breast exam, or age 50-64 and never
had a mammogram in her lifetime, or have not had a Pap smear in the past five years
Funding for screening services is provided by the Centers for Disease Control and Prevention,
State of Alabama, and the National Breast Cancer Foundation. Aside from provision of new
funds, Joy to Life and Komen have been providing funding for mammograms to women under
50 years of age for several years.
Program services are provided by more than 400 contracted physicians, surgeons, radiologists
and facilities across the state committed to providing services to underserved women. These
providers agree to accept a reduced rate for their services, they also agree to submit required
data regarding services they provide for submission to the CDC.
In addition to the Joy to Life Foundation and Susan G. Komen for the Cure, North Alabama
Affiliate, other partners include the American Cancer Society, Deep South Network, REACH US/
REACH 2010 Coalition, the University of Alabama at Birmingham's Comprehensive Cancer
Center, the University of South Alabama Mitchell Cancer Institute, Southeast Alabama Regional
Medical Center, Avon Foundation's Butterfly Project, and many others.
Source:
Alabama Department of Public Health
North Central Alabama Affiliate, the Alabama Department of Public Health can continue to fund
the screening of high-risk women for breast and cervical cancer through June 30.
In the past seven months the Alabama Breast and Cervical Cancer Early Detection Program
has served 10,000 women, the number of women ordinarily served during an entire year. All
program appropriations have been depleted because of this unprecedented demand for
services. To avoid completely suspending the program, the two nonprofit organizations have
stepped forward to provide funding for screening high-risk women.
"We are very appreciative of the donation of private funds by the Joy to Life Foundation and the
Susan G. Komen for the Cure, North Alabama Affiliate," said Dr. Donald Williamson, state
health officer. "We would have been forced to suspend services were it not for their donations
that will carry the program through the next five months. Last year alone more than 150
medically underserved women were diagnosed with breast and cervical cancer through this
program, and more than 1,700 women have been diagnosed since this program began in 1996."
Early detection of these cancers saves lives. Breast cancer screening services include clinical
breast examinations and mammograms. Cervical cancer screening services include pelvic
exams and Pap smears. If an abnormality is detected, diagnostic testing for both cancers may
include an ultrasound, biopsy or colposcopy.
To be eligible for screening, the individual must be female, have an income at or below 200
percent of the federal poverty level, and have no insurance or be underinsured. In addition, the
patient must be age 40-64 and have an abnormal clinical breast exam, or age 50-64 and never
had a mammogram in her lifetime, or have not had a Pap smear in the past five years
Funding for screening services is provided by the Centers for Disease Control and Prevention,
State of Alabama, and the National Breast Cancer Foundation. Aside from provision of new
funds, Joy to Life and Komen have been providing funding for mammograms to women under
50 years of age for several years.
Program services are provided by more than 400 contracted physicians, surgeons, radiologists
and facilities across the state committed to providing services to underserved women. These
providers agree to accept a reduced rate for their services, they also agree to submit required
data regarding services they provide for submission to the CDC.
In addition to the Joy to Life Foundation and Susan G. Komen for the Cure, North Alabama
Affiliate, other partners include the American Cancer Society, Deep South Network, REACH US/
REACH 2010 Coalition, the University of Alabama at Birmingham's Comprehensive Cancer
Center, the University of South Alabama Mitchell Cancer Institute, Southeast Alabama Regional
Medical Center, Avon Foundation's Butterfly Project, and many others.
Source:
Alabama Department of Public Health
четверг, 12 января 2012 г.
Human Papilloma Virus Vaccine Effective In Women Aged 24-45 Not Previously Exposed
An article published Online First and in an upcoming edition of The Lancet reports that women aged between 24 and 45 can be protected by the human papilloma virus (HPV) vaccine, if they have not been already infected by the virus. The report is the work of Dr Nubia Mu?±oz, from the National Institute of Cancer, Bogot??, Colombia, and collaborators.
Over the last thirty years, sexual behavior has changed. The age of the first marriage is rising, divorce rates are augmenting. As a result, premarital intercourse and having a new sexual partner around middle-age are common behaviors. The HPV virus is transmitted through sexual intercourse and can lead to cervical cancer or other cervical disease. It could be beneficial for older women to receive vaccination against the HPV virus. The women who participated in the randomized trial did not have a history of cervical disease or cancer or genital warts, caused by HPV types 6, 11, 16 and 18. The first group of women received the quadrivalent HPV vaccine and the second group received placebo (at day 1 and months 2 and 6).
There were a total of 1911 women in the first group and 1908 in the second group. The first endpoint for assessment was infection for six months or more, and cervical and external genital disease due to HPV 6, 11, 16, 18. The second was the same but genital disease was due to HPV 16 and 18 only. The average of follow-up time was of 2.2 years. No further data was analyzed at the end of the four year trial. Among the women, specific populations were analyzed.
The per-protocol population of ideal participants included 1615 women who were given the vaccine and 1607 receiving placebo. From day 1 and up to month seven, they all tested negative for the appropriate vaccine HPV type. Within one year, they all had to receive three vaccine doses. They were required to have one or more follow-up visits after month seven. Research showed that there were four cases of infection or disease in the vaccine group compared to forty one in the placebo group. Researchers observed the vaccine proved to have 91 percent effectiveness against all four virus strains (the percent reduction in incidence rate in the vaccine group compared to the placebo group). In the evaluation of the HPV 16 and 18 only, four cases occurred in the vaccine group compared with 23 in the placebo group (vaccine efficiency of 83 percent). When women who had not been completely vaccinated and had already existing HPV infection were included in the analysis, vaccine efficacy against all four HPV types was lower (31 percent). Effectiveness was of 24 percent when it was specifically against types HPV 16 and 18.
The authors write: "Lower effectiveness (about 30%) detected in the mixed population (susceptible women and those who have already acquired HPV infection or HPV-associated disease) suggests that the public health effect of vaccinating women aged 25-45 years will be smaller than that recorded after vaccinating susceptible adolescents. This notion will be assessed in future cost-benefit analyses."
Although there were two target outcomes of the trial, the researchers observed that in general, the women reaching the endpoint had infections, rather than cervical or genital disease. As a result, the high vaccine efficacy in the intention-to-treat population was mostly as a result of efficacy against infection.
The authors explain: "Maximum effect from prophylactic HPV vaccination programmes will be achieved in women who are susceptible to infection and disease related to vaccine HPV types (those not previously exposed). Notably, most adult women enrolled in the current study remained susceptible to vaccine HPV types at entry. Almost all women enrolled were susceptible to three or four vaccine HPV types, and about a third were positive to HPV 6, 11, 16, or 18 at baseline by serological or DNA testing; therefore about two-thirds were susceptible to all four vaccine HPV types. Most women who were HPV positive were positive to only one HPV type, meaning that the quadrivalent HPV vaccine could still potentially benefit these women via protection against vaccine HPV types with which they are not infected with."
They write in conclusion: "The quadrivalent HPV vaccine is efficacious in women aged 24??????"45 years not infected with the relevant HPV types at enrolment."
"Safety, immunogenicity, and efficacy of quadrivalent human papillomavirus (types 6, 11, 16, 18) recombinant vaccine in women aged 24-45 years: a randomised, double-blind trial"
Nubia Mu?±oz, Ricardo Manalastas Jr, Punee Pitisuttithum, Damrong Tresukosol, Joseph Monsonego, Kevin Ault, Christine Clavel, Joaquin Luna, Evan Myers, Sara Hood, Oliver Bautista, Janine Bryan, Frank J Taddeo, Mark T Esser, Scott Vuocolo, Richard M Haupt, Eliav Barr, Alfred Saah
DOI: 10.1016/S0140-6736(09)60691-7
thelancet
Stephanie Brunner (B.A.)
Over the last thirty years, sexual behavior has changed. The age of the first marriage is rising, divorce rates are augmenting. As a result, premarital intercourse and having a new sexual partner around middle-age are common behaviors. The HPV virus is transmitted through sexual intercourse and can lead to cervical cancer or other cervical disease. It could be beneficial for older women to receive vaccination against the HPV virus. The women who participated in the randomized trial did not have a history of cervical disease or cancer or genital warts, caused by HPV types 6, 11, 16 and 18. The first group of women received the quadrivalent HPV vaccine and the second group received placebo (at day 1 and months 2 and 6).
There were a total of 1911 women in the first group and 1908 in the second group. The first endpoint for assessment was infection for six months or more, and cervical and external genital disease due to HPV 6, 11, 16, 18. The second was the same but genital disease was due to HPV 16 and 18 only. The average of follow-up time was of 2.2 years. No further data was analyzed at the end of the four year trial. Among the women, specific populations were analyzed.
The per-protocol population of ideal participants included 1615 women who were given the vaccine and 1607 receiving placebo. From day 1 and up to month seven, they all tested negative for the appropriate vaccine HPV type. Within one year, they all had to receive three vaccine doses. They were required to have one or more follow-up visits after month seven. Research showed that there were four cases of infection or disease in the vaccine group compared to forty one in the placebo group. Researchers observed the vaccine proved to have 91 percent effectiveness against all four virus strains (the percent reduction in incidence rate in the vaccine group compared to the placebo group). In the evaluation of the HPV 16 and 18 only, four cases occurred in the vaccine group compared with 23 in the placebo group (vaccine efficiency of 83 percent). When women who had not been completely vaccinated and had already existing HPV infection were included in the analysis, vaccine efficacy against all four HPV types was lower (31 percent). Effectiveness was of 24 percent when it was specifically against types HPV 16 and 18.
The authors write: "Lower effectiveness (about 30%) detected in the mixed population (susceptible women and those who have already acquired HPV infection or HPV-associated disease) suggests that the public health effect of vaccinating women aged 25-45 years will be smaller than that recorded after vaccinating susceptible adolescents. This notion will be assessed in future cost-benefit analyses."
Although there were two target outcomes of the trial, the researchers observed that in general, the women reaching the endpoint had infections, rather than cervical or genital disease. As a result, the high vaccine efficacy in the intention-to-treat population was mostly as a result of efficacy against infection.
The authors explain: "Maximum effect from prophylactic HPV vaccination programmes will be achieved in women who are susceptible to infection and disease related to vaccine HPV types (those not previously exposed). Notably, most adult women enrolled in the current study remained susceptible to vaccine HPV types at entry. Almost all women enrolled were susceptible to three or four vaccine HPV types, and about a third were positive to HPV 6, 11, 16, or 18 at baseline by serological or DNA testing; therefore about two-thirds were susceptible to all four vaccine HPV types. Most women who were HPV positive were positive to only one HPV type, meaning that the quadrivalent HPV vaccine could still potentially benefit these women via protection against vaccine HPV types with which they are not infected with."
They write in conclusion: "The quadrivalent HPV vaccine is efficacious in women aged 24??????"45 years not infected with the relevant HPV types at enrolment."
"Safety, immunogenicity, and efficacy of quadrivalent human papillomavirus (types 6, 11, 16, 18) recombinant vaccine in women aged 24-45 years: a randomised, double-blind trial"
Nubia Mu?±oz, Ricardo Manalastas Jr, Punee Pitisuttithum, Damrong Tresukosol, Joseph Monsonego, Kevin Ault, Christine Clavel, Joaquin Luna, Evan Myers, Sara Hood, Oliver Bautista, Janine Bryan, Frank J Taddeo, Mark T Esser, Scott Vuocolo, Richard M Haupt, Eliav Barr, Alfred Saah
DOI: 10.1016/S0140-6736(09)60691-7
thelancet
Stephanie Brunner (B.A.)
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