Pap smear PSA

[manderz]

Hi Ginger et al:

Could you please clarify what effect the HPV vaccine has on all this. Should , as an example, Missy get the vaccine as she is in her 40's. I had squamous cell cervical cancer that spread to both lungs, which of course required surgeries and chemo. It was diagnosed stage 2A. The Drs did say they thought it was the HPV virus, and admittedly I had a number of different sex partners which as you know the virus is passed along.

So do you think the vaccine protects more now and thus is one of the reasons for the extended time between paps. I would hope this is the case.



Annette

Yes, the benefits of Gardasil are definitely being very seriously backed by the proposal here (with the basis of it the result of Ian Frazer's effort, it is strongly supported within Australia). ~85-90% of SCC and ~75-80% of adenocarcinomas are directly linked to HPV infection, an extremely strong correlation (causation, really). However large those numbers are, that still leaves 10-15% of SCC patients without HPV, and 20-25% of AC patients without HPV. Cancer arises from the accumulation of numerous genetic errors, which can be caused by any number of elements. It is definitely the case that if you eliminate HPV infections from the greater population, you will see a decrease of cervical cancer. The issue with backing Gardasil so heavily is the fact that it only provides protection (if you seroconvert it properly) against HPV strains 6, 11, 16, and 18 (16 being the prime culprit of SCC and 18 the prime culprit of AC). That leaves nearly 150 strains NOT protected against, of which ~40 can infect the genital tract, and of which 11 are known to be associated with cervical cancer. They account for ~30% of Cx Ca, with 16/18 linked to the 70% majority.

For a normal 40 year old woman, there's no reason NOT to get Gardasil. You cannot guarantee the fidelity of a partner, and it does protect you from the 2 strains most likely to cause warts and the 2 strains most likely to cause cancer. If used in addition to Paps, cervical cancer rates would bottom out. Sadly, we appear to be ok with 'low-ish' rates and are happy to put all of our eggs in the Gardasil basket.

I do know researchers here are working on adding some of the other HPV strains to a new vax - 35 and 41, I think. Again, beneficial. Again, 20% of cervical cancers arise independently of HPV infection.

I was under the impression that Gardasil was only being given to women 26 or under. Per their website, as listed below.

http://www.gardasil.com/are-you-18-to-26/considering-gardasil/

Cross-country information. The TGA here has approved Gardasil use in women 9-45, and MEN only up to 26 (here is the Gardasil info sheet: https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2010-CMI-05715-3). Perhaps in the States it is 26 for everyone.

Ah, must just be US then. I had been unaware that it was offered to men, but when I got it, it was only being offered to age 26, and I had a friend who was a smidge older who was unable to get it.

This is correct -- Gardasil approved in the US for 26 and under. I was 28 when it came out... I was upset.

Yeah, I just squeaked in. I had several friends who were just months older than me who were unable to get it. Also, the doctors in the US don't allow women to use IUDs for as long as other countries. I'm being naughty and keeping mine for longer.

 

[TooPatient]

Going in for mine tomorrow. I've been having these yearly for the past 12 years (since 17) but never gave much thought to them as I figured the dr just did some standard thing. Now I'm wondering if there is something I don't know about so figured I'd ask here. (Learning lots of great health tidbits here!)


Do they do all of the tests standard or is there something I should know to ask about?

Is there something that is good to check but not done standard?

Any other interesting tips or facts or whatever?

 

[justginger]

Screening is easier, with fewer potential pitfalls, if you go bang-on mid cycle, right at ovulation. Going in the first 1-7 days post-menstration can result in a smear with endometrial cells present, which can sometimes be a pitfall for CIN.

It will likely cost more, but I like having a conventional Pap and a liquid-based one done simultaneously. Older, experienced screeners are used to the cytological architecture seen in the traditional prep, with large cell groups and feathering. However, the liquid-based test allows for further adjunct testing (cell blocks, stains, molecular typing) and statistically has a significantly higher detection rate of adenocarcinomas. If you only get ONE kind of Pap, request a liquid-based one (their brand names are ThinPrep and SurePath).

Other than that, it is a pretty standard screen, no special requests or testing, unless you are HPV-positive and then you need to be subtyped to determine if it is a high risk strain (this can be done from a liquid Pap, but not a conventional smear).

 

[smitcompton]

Hi,

Another point of clarification please. Are you all saying that the vaccine will only be given to 26 and under age women, or that insurance companies won't pay for those above that age?.

I found this situation to be true with the shingles vaccine. If you were above age 60 insurance would cover it. If not, you could pay out of pocket. I got 2 different prices when I called. $225 at one place and 155.00 at another. But you could get it.

So, is this an insurance obstacle or a true cutoff?


Annette

I already passed along the info to a friend who has 2 boys college age. Her 17 yr old daughter got the vaccine , but not her sons. She didn't know it was offered to men as well.