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1. HPV Vaccine: A Little Pain Now, Cancer Protection Later
What Is HPV?
The term human papillomavirus actually refers to a group of 100 DNA viruses that
may cause warts (or papillomas), which are benign tumors. Common warts that are
usually seen on hands and feet are caused by HPV. About 40 types of HPV can infect
the skin in the genital area.
How Do I Get HPV?
HPV is spread from one person to another from skin-to-skin contact during sexual
activity. Since HPV is mainly a "silent infection" — meaning it usually does not cause
symptoms — it is usually impossible to know when a person became infected or who
gave it to them.
How Common Is HPV?
Genital HPV is the most common sexually transmitted infection in the United States,
with approximately 6.2 million people becoming newly infected each year.
It is estimated that nearly one out of every four females between the ages of 14 and 59
in the United States are infected with HPV, and that on average, a woman has an 80
percent chance of becoming infected during her lifetime. Recent studies suggest HPV
is just as common in college-age men.
If I Am Infected With HPV, What Could Happen?
Most people with genital HPV infections are unaware that they were exposed or
infected and the virus goes away on its own after one to two years.
There are about 15 types of HPV that cause illness and are classified as either
low-risk or high-risk HPV types. Infections with these types of HPV can persist for
many years and even decades. The low-risk types of HPV can cause genital warts
while the high-risk types can persist for many years and may develop into cancer of
the cervix, vulva, vagina or anus.
Cervical cancer is the second most common cancer in women. Approximately 10,000
women are diagnosed with cervical cancer each year in the United States, resulting in
nearly 4,000 deaths per year.
How Do I Get Tested for HPV?
HPV infections in women are usually diagnosed by seeing abnormal cervical cells
under a microscope after a Pap test. These abnormal cells are ones that have been
infected by HPV and are now either cancer cells or cells that might become cancer.
Your physician can also do an HPV test on the cervical cells to detect the type of viral
DNA present. This test can determine whether the infection is due to a high-risk type
of HPV.
There is currently no HPV test on the market for men.
How Can I Avoid Getting Infected With HPV?
Because HPV is so common and most people don't know that they are infected, the
only sure way to prevent infection is not to have sex.
Being in a mutually faithful monogamous relationship with someone who has had no
other or few prior sex partners can reduce the risk of HPV. Condoms will lower the
chance of catching or spreading HPV, but does not prevent HPV entirely since some
areas of the skin are uncovered.
A recently released vaccine will prevent infection with the types of HPV that cause
the most disease. The vaccine can prevent the two types of HPV that cause 90 percent
of genital warts and the two types that cause 70 percent of the cervical cancers.
The Gardasil vaccine, manufactured by Merck, is approved by the Food and Drug
Administration for use in females between the ages of 9 and 26 years old, and the U.S.
Centers for Disease Control and Prevention has recommended it for all girls between
11 and 12 years old.
Three shots are given over six months at a cost of approximately $360. A federal
program called Vaccines for Children will provide free vaccine for girls younger than
19 years old who are uninsured, are on Medicaid or do not have health insurance that
covers the shots.
Why Is the HPV Vaccine Recommended at Such a Young Age?
The vaccine is most effective if given before females becoming sexually active. There
is less benefit if you are already infected with one of the four types of HPV in the
vaccine.
The CDC bases its recommendations on surveys of teenagers about when they
become sexually active. The young age does not mean this is when most girls begin to
have sex, but rather when a significant portion report becoming sexually active.
Parents should talk with their children and determine when it is appropriate for their
child to consider getting vaccinated.
If I Get Vaccinated, Can I Stop Having Pap Tests?
No. There are some types of HPV that are not covered by the vaccine. A Pap test will
detect abnormal cells if you are infected with one of these types. Also, we are unsure
how long the vaccine will prevent HPV infections so there may be a need to get a
booster dose in about five years.
The Future of HPV Protection
An additional HPV vaccine is likely to be approved early this year. This vaccine is
also intended to prevent the initial infection with HPV so it is also recommended for
young women.
There are current trials that are studying the use of HPV in men and older women. A
more potent HPV vaccine, which produces a vigorous immune response, is being
tested as a treatment for genital warts. Finally in the near future, DNA technology
could replace the Pap test with a rapid, simple, accurate and affordable test to screen
for all high-risk HPV strains.
While no one enjoys getting shots, the mild pain experienced by young women from
the HPV vaccine injection is well worth the future benefits in protecting against
cervical cancer.
he Flu Kills More Than 36,000 People Each Year -- Here's How to Protect
Yourself
Flu has been one of the most devastating infections in human history. In 1918 and
1919, the flu killed 50 million people worldwide in just a few months.
Fortunately, flu seasons this dangerous are rare. According to the Centers for Disease
Control and Prevention, 5 to 20 percent of Americans get the flu each year. That is 15
to 60 million people in the United States alone.
Approximately 200,000 are hospitalized because of flu complications, and 36,000 die.
Many of these deaths could be prevented if people got their flu vaccine in the fall each
year.
There are hundreds of possible strains of flu virus, and getting the flu once does not
protect you from getting it again.
Each year scientists determine which strains of flu are the most likely for the next flu
season. Then they make a vaccine to protect against those strains.
Even if you get infected with a different strain, the flu vaccine will help your body
fight off the infection more quickly, and you will not get as sick.
What Is Flu?
The flu is caused by the influenza virus, a potentially life-threatening respiratory tract
infection that can be prevented by getting vaccinated and avoiding exposure.
Preventing the spread of influenza is everyone's responsibility.
Flu symptoms include sudden onset of high fever, dry cough, sore throat, stuffy nose
and severe muscle pains in the legs and low back. People with the flu usually do not
experience a runny nose, vomiting or diarrhea.
Most people with flu will feel terrible for five to seven days and then recover
completely. However, the very young, elderly or those with chronic illnesses are at
greater risk of developing complications that may lead to hospitalization or even death.
These patients develop life-threatening complications such as pneumonia, respiratory
failure or heart failure.
What Do I Do If I Get the Flu?
The most important thing any flu victim can do is to stay at home. This will help
prevent spread of flu to others.
A quick call to your doctor is also important because there are medicines that will
shorten the course and decrease the severity of flu symptoms, but they must be started
within 48 hours of the first symptoms.
Rest, drink plenty of fluids and take acetaminophen, ibuprofen or aspirin to help with
the fever and muscle aches. But never give aspirin to children with the flu because
serious and deadly complications can develop.
Tylenol is a very safe medication for treating fever and pain, but high doses or even
normal doses taken with alcohol can cause liver failure. Check over-the-counter
medication labels to be sure that you do not take more than 4000 mg of
acetaminophen in 24 hours. Ibuprofen should be taken with plenty of liquids and
some food to prevent stomach upset.
How Can I Prevent Flu?
Vaccination is safe and effective. There are two kinds of vaccine: an injection and a
new nasal vaccine.
The injection is made with killed flu virus and is safe for people 6 months old and
older. The nasal vaccine is administered directly into the nose and is for healthy
people between the ages of 5 and 49 years.
You cannot get flu from the injected vaccine. There is a small risk that people with
weakened immune systems could become sick from the nasal vaccine, which is made
with a weakened form of the flu virus.
Some people still get flu after vaccination, but they are much less likely to become
seriously ill than those who have not been vaccinated.
There may not be adequate supplies of flu vaccine to vaccinate everyone against flu
every year. In that case, vaccine manufacturers and public health authorities will work
together to assure those at greatest risk receive vaccines first.
Priorities for flu vaccination include individuals at high risk for complications and
their caregivers. This includes children 6 months to 5 years old, pregnant women,
those over 50 years old, people who live in nursing homes and those with chronic
illnesses.
Complications associated with flu vaccine are very rare and include pain and swelling
at the injection site, fever and aches (more common in children), and allergic
reactions to components of the vaccine.
Medicines used to treat flu can also be used to prevent flu, but these work best when
used in addition to the vaccine. Otherwise, they must be taken for the whole flu
season, which spans fall and winter.
Some people cannot take vaccine and may need to take these medications to prevent
flu. Check with your doctor if you have questions about flu prevention.
Keeping sick people at home, washing hands frequently, covering nose and mouth
with tissue when coughing or sneezing will prevent flu, as well as ward off other
germs that cause colds, vomiting or diarrhea.
Today most people have heard the statement "secondhand smoke kills." But in
society's increasing awareness of the health dangers of tobacco, of the lies
manufactured by the tobacco industry, and of an emerging body of law supporting
smokefree policies, it is not enough to simply state "secondhand smoke kills" without
knowing how secondhand smoke is a health danger, whom it affects, where exposure
is the most serious, and what can be done to stop it.
Throughout the years, the science of secondhand smoke has driven the secondhand
smoke policy engine from separate smoking and nonsmoking sections to separately
ventilated smoking rooms to 100% smokefree environments. We now know that
53,800 people die every year from secondhand smoke exposure. This number is based
on the midpoint numbers for heart disease deaths (48,500), lung cancer deaths (3,000),
and SIDS deaths (2,300) as calculated in the 1997 California EPA Report on
Secondhand Smoke. And children are at significant risk to many acute and chronic
diseases as a result of secondhand smoke exposure.
In 2007, a study using magnetic resonance imaging (MRI) technology was able to
detect damage in the lungs of nonsmokers exposed to secondhand smoke. For more
information on this study, read the study's abstract. (Courtesy of RSNA and Chengbo,
Wang, PhD.)
CNN also produced a video news story about the study, which can be viewed online
here.
To view a larger image of the MRI
scans, click on the image itself.
Courtesy of RSNA and Chengbo, Wang,
PhD.
Since the 1986 Surgeon General's Report titled The Health Consequences of
Involuntary Smoking stated that secondhand smoke can cause disease in nonsmokers,
hundreds of studies have concluded not only this, but that exposure to secondhand
smoke can result in death. Over the past 20 years, scientific research has become even
more clear, resulting now in the ability to pinpoint the effects of secondhand smoke
not just on particular organs, but on various ethnicities, types of workers, and
socioeconomic classifications.
The 2006 Surgeon General's Report on The Health
Consequences of Involuntary Exposure to Tobacco Smoke
confirmed the known health effects of secondhand smoke
exposure, including immediate adverse effects on the
cardiovascular system, and coronary heart disease and lung
cancer. The report concluded that there is no safe level of exposure to secondhand
smoke and that establishing smokefree environments is the only proven way to
prevent exposure. The report also finds that many millions of Americans are still
exposed to secondhand smoke despite substantial progress in tobacco control. Here is
the great video shown at the Surgeon General press conference in June 2006.
As the body of scientific evidence becomes larger and more precise, it is now possible
to prove that smokefree policies not only work to protect nonsmokers from the death
and disease caused by exposure to secondhand smoke, but also have an immediate
effect on the public's health . On a larger scale, a study has confirmed that restaurants
and bars located in smokefree cities have 82% less indoor air pollution than
restaurants and bars in cities that do not have smokefree protection. Because of the
mountain of evidence from these peer-reviewed, scientific studies, the Centers for
Disease Control recently issued a warning for anyone at risk for heart disease to avoid
smoke-filled indoor environments completely.
Secondhand smoke kills. Knowing the science behind it, as well as how smokefree
policies protect the public from secondhand smoke, will help cement this in the minds
of the public.
Chronic Cough and Sputum Linked to Secondhand Smoke
According to a new study, secondhand smoking is associated with chronic cough and
sputum production. Researchers from the University of California, Irvine, studied the
association of secondhand smoking and respiratory symptoms in 139 patients from a
Veterans' Administration Medical Center who underwent left ventricular ejection
fraction measurements for clinical reasons. The presence of chronic cough, sputum
production, and secondhand smoking, and association between the three were
evaluated. Compared with controls, secondhand smokers showed a significant
association with chronic sputum production and also showed a trend toward an
increased prevalence of cough. Clinical implications suggest that secondhand
smoking has a deleterious effect on lung function.
If you are a smoker not only is your risk of developing age-related macular
degeneration (AMD) greater, but also the risk of existing AMD progressing faster is
also higher if you smoke. This is according to an article published in Archives of
Ophthalmology (JAMA/Archives).
AMD is a leading cause of vision loss among older people, the authors explain.
Previous studies had already demonstrated that smoking is one of the few modifiable
risk factors for AMD. Smoking leads to higher AMD risk through several pathways smoking reduces antioxidant levels, it lowers blood flow around the eye, and it may
also affect the coloration (pigments) in the retina.
Ronald Klein, M.D., M.P.H., University of Wisconsin School of Medicine and Public
Health, Madison, and team looked at 4,926 residents of Beaver Dam, Wisconsin, USA,
during the period 1987-1988. They were aged 43-84. They were initially examined in
1988-1990 and then again every five year for the next 15 years. Photographs of the
retina measured AMD status.
21% of the males and 18% of the females smoked when the study began. The
researchers report that smokers ran a 47% higher risk of developing early AMD,
compared to the non-smokers. Early AMD is the least severe form of AMD. It was
also found that the average age smokers developed AMD was 69.2 years, compared to
72.3 years for former smokers and 74.4 years for those who had never smoked. The
authors added "There were few associations of specific characteristics of smoking
(e.g., intensity, pack-years smoked, duration and age at initiation and quitting) with
AMD outcomes."
They concluded "In summary, while controlling for other factors, smoking appears to
be related to the incidence and progression of AMD in our population. This has
important health care implications, because early AMD is associated with an increase
in the risk of developing late AMD and smoking behavior is modifiable."
A Place For Smokers To Find Out: What Has Smoking Done To My Lungs?
How Can I Quit?
A unique, multidisciplinary clinic designed for current and former smokers to help
them assess the condition of their lungs and to get them started down the road to
quitting will open this Friday at the Seattle Cancer Care Alliance. The clinic also is for
current and former smokers diagnosed with a precancerous lung nodule that needs
further assessment and treatment.
Early detection of lung disease and cancer, and ultimately quitting smoking, is key to
preventing and reducing the incidence of lung cancer while giving smokers a healthier
life, according to Jason Chien, M.D., M.S., a pulmonary and critical-care specialist at
the SCCA who directs the new clinic. He is also a clinical researcher at Fred
Hutchinson Cancer Research Center.
"Based upon what we know about early versus late stage lung cancer, we believe that
early detection of lung cancer should extend life. If you are looking for biomarkers
that can detect early stage lung disease, who do you study? People who smoke,"
Chien said. "The only way to end the majority of lung cancer cases that we see today
is for everyone to stop smoking. Realistically, that's unlikely to happen, and even if it
does, lung cancer will still be a major health problem in the foreseeable future
because former smokers remain at risk for lung cancer. So the alternative is to reach
people at high risk much earlier to try to identify the cancer earlier or identify people
at highest risk for the cancer."
The weekly clinic on Fridays will serve two patient populations: "worried well"
current or former smokers who are concerned about their health, their risk of lung
cancer and who want to quit, as well as patients whose primary- care doctors have
discovered a lung nodule during a routine chest X-ray.
What makes this service unique for both groups is that every patient will meet with a
physician for a thorough pulmonary assessment and smokers who want to quit will be
referred to the SCCA Smoke Free Life Program, directed by Abigail Halperin, M.D.,
director of the Tobacco Studies Program at the University of Washington, and
co-medical director of Free & Clear, the nation's largest smoking-cessation program.
Quitting smoking stops the risk of developing lung cancer from rising any more than
it already has. However, former smokers always have a risk of lung cancer; this risk is
fixed at the time they quit and actually increases as they approach the age of 70,
Chien said.
The evaluation of otherwise healthy smokers will include a lung function test and if
determined clinically appropriate, a CT scan of the lungs. Since it is not yet
established that CT screening will extend the life of lung cancer patients, the SCCA
program will not automatically recommend a radiology exam unless it is truly needed.
The use of CT scans for lung-cancer-screening is not standard practice; avoiding
unnecessary scans prevents radiation exposure and lowers costs. The evaluation exam
is not covered by insurance.
It's more likely that smoking-related respiratory diseases such as emphysema will be
found during an exam than cancer, Chien said. Additional care for any diagnosed
illness such as emphysema, COPD, chronic bronchitis, or asthma likely will be
covered by insurance.
Patients who are referred to the clinic to have lung nodules assessed will be evaluated
by a multidisciplinary team consisting of a pulmonologist, thoracic surgeon, chest-CT
expert and nuclear-medicine specialist. If a malignancy is diagnosed, the team will
also facilitate the next course of action for the patient, such as meeting with an
oncologist or a surgeon. Such follow-up treatment is likely covered by insurance.
"We envision this service as a comprehensive center for primary-care physicians to
refer their patients so that they can have their nodules thoroughly evaluated and
diagnosed," Chien said.
New research released has found that babies exposed to secondhand smoke are almost
twice as likely to develop allergies to inhaled allergens such as animal hair as infants
who are not exposed to tobacco smoke. Children whose parents smoke are almost
50% more likely to be allergic to certain foods. [1]
Smoking during pregnancy may have longer lasting effects on your child than you
might think -- particularly on a child's long-term behavior.
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Michigan State University researchers Dr. Joel Nigg and Dr. Naomi Breslau
addressed these effects in a study published in this month's Journal of the American
Academy of Child and Adolescent Psychiatry.
Nigg and Breslau followed just over 700 children from age 6 through age 17,
randomly selected from two groups: those with normal birth weight and those with
low birth weight (less than 5 lbs 8 oz).
Their main goal was to tease out the influences of low birth weight and maternal
smoking -- singly and combined -- on the development of attention deficit
hyperactivity disorder (ADHD), as well as two other specific behavioral disorders in
children: Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD).
Most people are familiar with ADHD, a syndrome that is first recognized in early
childhood and is characterized by the core symptoms of hyperactivity, impulsivity and
inattention.
Less well-known is ODD. Children with this condition frequently show loss of temper,
are argumentative with adults, and refuse to obey rules, deliberate annoyance of
others, as well as spitefulness and vindictiveness.
CD, another lesser known disorder, is thought to be a progression of ODD in most
cases, includes more severe behaviors. These include aggression toward animals and
people, destruction of property, excessive lying, theft, and serious violation of rules.
Using a variety of accepted methods to diagnose behavioral disorders, these
researchers found that a mother's smoking during pregnancy influences the
development of ODD and, later, CD.
The effect of smoking was independent of birth weight, as well as other maternal
factors such as the mother's education, urban vs. suburban residence, and alcohol or
drug abuse by the mother.
Taken together, these findings mean that a clearer line than ever can be drawn
implicating smoking as a primary cause of these behavioral disorders.
Droplet transmission
When you cough or sneeze, you expel droplets into the air around you. When you're
sick with a cold or the flu — or any number of other illnesses — these droplets
contain the germ that caused your illness. Spread of infectious disease in this manner
is called droplet spread or droplet transmission.
Droplets travel only about three feet because they're usually too large to stay
suspended in the air for a long time. However, if a droplet from an infected person
comes in contact with your eyes, nose or mouth, you may soon experience symptoms
of the illness. Crowded, indoor environments may promote the chances of droplet
transmission — which may explain the increase in respiratory infections in the winter
months.
Particle transmission
Some disease-causing germs travel through the air in particles considerably smaller
than droplets. These tiny particles remain suspended in the air for extended periods of
time and can travel in air currents. If you breathe in an airborne virus, bacterium or
other germ, you may become infected and show signs and symptoms of the disease.
Tuberculosis and SARS are two infectious diseases usually spread through the air, in
both particle and droplet forms.
Infectious diseases spread through vectors and vehicles
Bites and stings
Some germs rely on insects — such as mosquitoes, fleas, lice or ticks — to move
from host to host. These carriers are known as vectors. Mosquitoes can carry the
malaria parasite or West Nile virus, and deer ticks may carry the bacterium that
causes Lyme disease.
The vector-borne spread of germs happens when an insect that carries the germ on its
body or in its intestinal tract lands on you or bites you. The germs travel into your
body and can make you sick. Sometimes the germs that cause infectious disease need
the insect for specific biological reasons. They use the insect's body to multiply,
which is necessary before the germs can infect a new host.