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7 Facts You Need to Know About HPV and Gardasil
Tweet Share on Facebook November 17, 2008 Comment (11)As women—and soon men—gain access to the new Merck vaccine Gardasil, which targets the sexually transmitted human papillomavirus, the Centers for Disease Control and Prevention has stepped up efforts to identify the 25,000 or more cancers primarily associated with HPV that increase the burden of cancer in the United States each year. As reported in the November 15 supplement to the journal Cancer, the latest figures include 10,846 patients with invasive cancer of the cervix, followed by 7,360 with cancers of the mouth, particularly the tonsils and the back of the tongue. In addition, there are 3,018 cancers of the anus, 2,266 of the vulva, and 828 of the penis.
To the CDC, these are baseline numbers to track the life-threatening consequences of HPV infection. To sexually active young people, this report should be a wake-up call. The hows and whys of catching contagious warts and cancer through sex should be part of every parent's birds-and-bees talk, every school's sex-ed curriculum, and—most of all—all young people's thinking about their own sexual vulnerability. Here are seven need-to-know facts:
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HPV Vaccine for Men: It's About Time
Tweet Share on Facebook November 14, 2008 Comment (30)Finally, two years after it was approved for use in young women, a vaccine against the sexually transmitted human papillomavirus (HPV) has now been shown to be safe and effective in protecting young men as well. Merck's vaccine Gardasil cut infections caused by the four most dangerous strains of this virus by 45 percent and reduced the occurrence of HPV-induced warts by 90 percent, according to a new study involving more than 4,000 male volunteers age 16 to 26. The next step is for the Food and Drug Administration to give its blessing.
The delay in studying the vaccine in men has puzzled me. Men are, after all, carriers of this virus known to infect the female cervix, leading to a virtual epidemic of abnormal Pap smears in sexually active young women. Although in most women the virus is cleared by their immune system, when it's not it continues to percolate for years and each year accounts for the almost 11,000 cancers of the cervix—a cancer that robs women of their fertility if not their life. Ignoring the role of men in promulgating this illness is at odds with how we approach most other forms of STDs, where doctors treat both partners. Leaving men out also subverts the core tenet of vaccination: creating so-called herd immunity.
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5 Reasons Women Should Still Take Vitamin D
Tweet Share on Facebook November 12, 2008 Comment (45)Don't throw away your vitamin D tablets based on the latest news on the supplement's failure to prevent breast cancer in postmenopausal women. The Women's Health Initiative study published this week shows that after seven years of calcium and vitamin D supplementation, there was no reduction in breast cancer risk. In retrospect, this is what one would have expected: The vitamin D dose of 400 IU seemed more than enough when the study began in the early 1990s, but science has moved on. In fact, that level is barely sufficient for what is a major deficiency common to most Americans and Europeans. In addition, many of the participants in the placebo group, or control arm of the study, diligently continued taking their calcium and vitamin D supplements, limiting the effectiveness of a randomized trial. So what does this mean to women—and men for that matter?
Michael Holick, a vitamin D expert in the Department of Endocrinology, Nutrition, and Diabetes at Boston University Medical Center, just last year in the New England Journal of Medicine reviewed the abundant and highly convincing laboratory and clinical research that supports the pivotal role of adequate vitamin D levels both in bone health and in cutting the risk of chronic disease, including many cancers. Here's a summary of five key points to keep in mind:
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CRP Heart Test May Lead to Overuse of Statins Like Crestor
Tweet Share on Facebook November 11, 2008 Comment (12)At the center of the JUPITER trial results released this week is a modest elevation in the hot molecule C-reactive protein—a nonspecific marker for low-grade inflammation. Increases in CRP are now being widely hailed as justification for starting people who have no evidence of cardiovascular disease, and may not even have other risk factors for stroke or heart attack, on intensive therapy with the statin Crestor.
In response to my comments on the study yesterday, a dentist, David Jones of Texas, posted a comment noting that gingivitis causes elevated CRP. He wondered whether JUPITER patients had been screened for that common gum disease. The JUPITER report does not mention any evaluation of oral health. But Dr. Jones's concern is absolutely correct: CRP is a nonspecific finding and can be bumped up by gingivitis. Before committing patients to a lifetime of statins, doctors had better know they are treating the right condition.
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Interpreting JUPITER: Statins for Everyone?
Tweet Share on Facebook November 10, 2008 Comment (8)JUPITER, a heart attack and stroke prevention study led by Paul Ridker of Harvard, made a splash at the American Heart Association meetings in New Orleans on Sunday, leaving many experts convinced that it will change overnight how we practice preventive medicine. For men over 50 and women over 60, the results suggested, a blood test for C-reactive protein or CRP that signals low-grade inflammation in the body could dramatically reduce the risk of first time heart attacks, strokes, and other artery problems in apparently healthy people if an abnormal CRP level triggers continuous intensive statin therapy. In this study, the statin of choice was Crestor.
It sounds easy, if not breathtaking. But I'm inclined to line up with those who say, "slow down." Before doctors translate what are undoubtedly important scientific findings into an enthusiasm for placing 6 million people on a strong drug forever, JUPITER needs to provide further analysis of what on closer look is a highly varied group of patients carrying a wide range of health risks.
