For mild dysplasia and cervical cancer, you can blame HPV

Mild cellular changes detected by Pap smears don't necessarily lead to cancer, a fact that played a role in the new pullback on cervical cancer screening, but both cell changes and cervical cancer can be traced to human papillomavirus.

As today's story noted: "Human papillomavirus, or HPV, which causes cervical cancer and infects half of all young women within a few years of sexual activity's start, also causes cell changes called dysplasia. Those abnormal cells are typically removed before they become cancerous. But such treatment may not be necessary."

Here's an overview of cervical dysplasia from the Women's Health Channel. It notes that up to 70% of mild cases resolve on their own.

The likelihood of progression depends on the amount of dysplasia. Here's what the site says about the stages.

And here are some questions and answers about human papillomaviruses, which have also been linked to cancers of the anus, penis, vulva and vagina -- and to genital warts. The information is from the National Cancer Institute. Of note: There are more than 100 types of HPV;  some are considerably more likely to cause cancer than others.

It states: "Both high-risk and low-risk types of HPV can cause the growth of abnormal cells, but only the high-risk types of HPV lead to cancer. Sexually transmitted, high-risk HPVs include types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68, and 73. These high-risk types of HPV cause growths on the cervix that are usually flat and nearly invisible, as compared with the external warts caused by low-risk types HPV–6 and HPV–11. HPV types 16 and 18 together cause about 70% of cervical cancers."

The Gardasil vaccine can protect against some, including types 16 and 18, but not all.

-- Tami Dennis

Photo: The HPV vaccine protects against four strains.

Credit: European Pressphoto Agency

Here's who should really worry about cervical cancer, doctors say

 The new cervical cancer screening recommendations might worry some women accustomed to getting screened every year. They shouldn’t, most doctors say.

 Today's story: Group recommends less frequent Pap tests 

The women who should be worried, physicians point out, are those who remain under-screened.

Half of the women who die from cervical cancer never had a Pap test, and 10% had not been screened in the five years before detection.

Overall, about 20% of U.S. women don’t get regular Pap tests, and 40% fail to get regular mammograms, said Dr. Edward Partridge, an oncologist at the University of Alabama, Birmingham. He’s the chairman of the cervical cancer screening guidelines panel for the National Comprehensive Cancer Network.

“The biggest problem is women who don’t get screened at all,” he said. “That is where your breast cancer is. That is where your cervical cancer is.”

-- Shari Roan

HHS Secretary Kathleen Sebelius wades into the mammogram fray

The reaction to this week's U.S. Preventive Services Task Force recommendation against regular mammograms for women under 50 was swift, emotional and highly public. Today, Health and Human Services Secretary Kathleen Sebelius weighed in, pointing out that, well, the task force is actually just an independent panel offering advice, not setting policy, so ... just do what you've been doing.

Seriously. "My message to women is simple. Mammograms have always been an important lifesaving tool in the fight against breast cancer, and they still are today. Keep doing what you have been doing for years — talk to your doctor about your individual history, ask questions and make the decision that is right for you."

Here's her full statement.

(Enjoy the fallout, task force folks! You're on your own!)

If you want to know more about that panel, check it out here.

By the way, it's sponsored by the Agency for Healthcare Research and Quality, an agency that — we'll say it if few others will — is known for producing excellent work based on science, not emotion. That agency is within, yep, the Department of Health and Human Services.

Here's the original story: Mammogram guidelines spark heated debate

Plus a blog post on the reaction: Don't like those new mammogram recommendations? You're not alone

And here's today's story: Mammography outcry points to trouble for healthcare reform: Some Republicans say the new recommendations are an example of "rationing" that would take place under President Obama's plan to save money by basing treatment on experts' advice.

— Tami Dennis

Photo: HHS Secretary Kathleen Sebelius said she wanted to address recent confusion head on. Address it, she did. Clear it up? Perhaps not.

Credit: Mandel Ngan / AFP / Getty Images

 

KISS ex-drummer Peter Criss had breast cancer

News that former KISS drummer Peter Criss, he of the Catman persona, suffered breast cancer has provoked new interest in the subject of male breast cancer, a rare but potentially fatal tumor.

Men have only a small amount of breast tissue concentrated in the area immediately behind the nipple, probably the main reason that they account for only about 1% of all breast cancers. Nonetheless, about 1,990 men will develop the disease this year, and 480 will die from it (compared with more than 40,000 deaths in women), according to the National Cancer Institute. Male breast cancer carries about the same risk of death as the female version, but because it is generally detected at a later stage of progression, the perception is that it is more deadly. The disease is most common in men between the ages of 50 and 60. The lifetime risk of developing it is less than 1% for the average man, but for those carrying the breast cancer gene BRCA2, the risk increases to about 6%. Family history is particularly important: One in every five men with breast cancer has a relative who's also had it.

The primary risk factors for breast cancer in men are:

-- Genetic predisposition.

-- Klinefelter's syndrome, an abnormality of the sex chromosomes.

-- Exposure to radiation as a child.

-- Exposure to estrogen, such as is used in sex-change procedures.

-- Excess weight.

-- Excessive use of alcohol.

The most common signs of the disease include skin dimpling or puckering, development of a new indentation in the nipple, other changes in the nipple, and nipple discharge. If there are signs of disease, it can be detected with a mammogram -- although that is slightly more difficult with men because of the smaller size of the breasts. "It's amazing how they can get a guy's little pecs in that thing that the poor women go through," Criss said. "I have a whole new respect for women going through mammograms.

Most treatments for male breast cancer are the same as for women, with one exception: Breast-sparing surgery is typically not feasible because men have so little breast tissue. Removing the cancer means removing all of the breast.

Criss underwent two surgeries for his tumor but did not need radiation or chemotherapy. His doctor says he is cancer-free today.

For more information, go here or here.

-- Thomas H. Maugh II

Photo (top): Peter Criss in a file photo. Credit: Associated Press / Shiho Fukada

Photo (bottom): KISS. Criss is second from right. Credit: Vince Bucci / AFP Photo

Folic acid and cancer: New data might add to suspicion or, better, to discussion

We're not trying to pick on folic acid, honest. As food additives go, the synthetic version of vitamin B9, aka folate, is one of the more noble ones, widely credited -- heralded even -- for reducing the rate of neural tube birth defects. But we are trying to point out, again, that if a little is good, a lot is not necessarily better. 

Several months ago we offered up this story in the Health section: 

Folic acid might be losing its sheen

It said: "New studies suggest that getting too much folic acid might fuel certain cancers in some people. And with the vitamin showing up in ready-to-eat cereals, bread, snack bars, multivitamins and more, some health experts fear that it's easy to far exceed the recommended daily intake of 400 micrograms. There is now an urgent need, experts say, to figure out how much folate is enough but not too much for different segments of the population."

That urgent need isn't going away. Now we have a study, published today in the Journal of the American Medical Assn., that might cause another eyebrow or two to be raised at this miracle of fortification.

Researchers in Norway analyzed data from 6,837 people with ischemic heart disease treated with folic acid, B6 and B12; folic acid and B12; just B6 or a placebo. Those treated with folic acid and B12 had higher rates of cancer, cancer deaths and deaths in general over the course of several years. Lung cancer contributed significantly to the cancer numbers.
 
Of note, Norway doesn't fortify its foods with folic acid, as does the U.S., meaning baseline blood levels were lower to start with than they would be here. Also of note, the researchers point out: Although the folic acid doses in the study were higher than what the typical American would consume through fortification alone, they were below the limits set by our Institute of Medicine.

Just as a lot of folic acid isn't necessarily a good thing, fortification isn't necessarily a bad thing. The researchers conclude:

"Our results need confirmation in other populations and underline the call for safety monitoring following the widespread consumption of folic acid from dietary supplements and fortified foods."

Here's that abstract  and more on folic acid from Medline Plus.

-- Tami Dennis

Photo: Would you like a folic-acid boost with that? You might as well.

Credit: Los Angeles Times

Don't like those new mammogram recommendations? You're not alone.

When it comes to mammograms, not only can reasonable minds disagree, they can all legitimately do so while arguing for the greater good. One would think ... The U.S. Preventive Services Task Force has recommended against regular mammograms for women under the age of 50 — and to say that this recommendation was not universally endorsed or warmly received would be an understatement.

As today's Los Angeles Times article noted:

"Other groups that issue guidelines about screening and prevention, such as the American Cancer Society, the National Cancer Institute and the American College of Obstetricians and Gynecologists, immediately attacked the federal panel's conclusion, saying that they would not change their guidelines and would continue to urge women to undergo the tests."

For details on that official dissension, here's the statement from the American Cancer Society.

It says in part: "The American Cancer Society continues to recommend annual screening using mammography and clinical breast examination for all women beginning at age 40. Our experts make this recommendation having reviewed virtually all the same data reviewed by the USPSTF, but also additional data that the USPSTF did not consider."

Here's the full response from the American College of Obstetricians and Gynecologists.

And here's a widely held perspective from Kathleen Reardon, a USC professor and, not incidentally, a breast cancer survivor. She begins today's essay on the Huffington Post:

"I'd be dead by now if it weren't for breast self-examination. And had my doctor been less convinced of his own guidelines regarding women without a known history of breast cancer, my cancer would have been detected earlier and I would have been treated sooner and less aggressively. I was 32 years old."

The task force's concerns about the risk of false positives and biopsy complications are very real, but the defenders of the new recommendations have been relatively quiet — with a few notable exceptions.

There's this from Dr. Susan Love's blog:  "The fact is the decision to change the age at which mammography screening begins in this country from age 50 to age 40 was always controversial and was never unanimously supported. That’s because mammography is not as good a tool in younger women."  

Certainly, it could be argued that this is a fair statement from a reasonable mind. But some of the responses make clear why defenders of the recommendations might be reluctant to attempt to discuss the greater good.

— Tami Dennis

Photo: Mammograms of dense breast tissue, such as on the left, can be more difficult to interpret.

Credit: National Cancer Institute

Now for a look at non-Hodgkin's lymphoma, a diagnosis that could increase

Paul Allen, co-founder of Microsoft, has reportedly begun treatment for non-Hodgkin's lymphoma, a cancer of the body's lymphatic system. This is not his first battle with cancer. Allen was diagnosed with Hodgkin's disease -- a different type of lymphoma -- in the early '80s.  More on that later ...

Here's the Reuters story on the diagnosis.

The name non-Hodgkin's lymphoma can refer to one of dozens of types of cancers, depending on the type of white blood cell associated with it. The cancers can be slow-growing or fast-growing, but they usually start with a swelling of a lymph node in the neck, armpits or groin. Here's more symptoms information from the Oncology Channel, which notes that most swellings are caused by infection, not cancer. (Again, most swellings are not caused by cancer.)

The five-year survival rate for the disease has improved dramatically over the years, but it's far from guaranteed. It hit 69% in 2005, says the Leukemia & Lymphoma Society.

As for how the disease develops, there's this from the Lymphoma Research Foundation: "NHL can start in the lymph nodes, in a specialized lymphatic organ such as the spleen, or in lymph tissue found in organs such as the stomach or intestines.  Since lymphocytes (white blood cells) can circulate to all parts of the body through the lymphatic vessels and bloodstream, abnormal lymphocytes can reach any part of the body. Thus, NHL can start in or spread to any part of the body. While some NHLs are localized to one area, most are present in other parts of the body by the time the diagnosis is confirmed."

Each year in the United States, there are 65,980 new cases of non-Hodgkin's lymphoma. Of those, 19,500 prove fatal, says the National Cancer Institute.

Most cases occur in people 60 or older. Men are generally more likely than women to develop the disease; whites are more at risk than African Americans and Asians.

For more on non-Hodgkin's lymphoma, the American Cancer Society offers this overview. To skip to the risk factors, at least as far as they can be clarified at this point, click here.

Want more information? The National Cancer Institute offers this booklet: What You Need to Know About Non-Hodgkin Lymphoma.

And the Lymphoma Research Foundation offers this: Understanding Non-Hodgkin's Lymphoma: A Guide for Patients.

Because the risk grows with age, incidence of non-Hodgkin's lymphoma is expected to grow, says LymphomaInfo.net.

Here are more stats on incidence and mortality.

As for Hodgkin's disease, here's a quick comparison with non-Hodgkin's lymphoma from the Oncology Channel.

Of note: Incidence of the former is on the wane; incidence of the latter is on the rise.

Allen, of course, now has experience with both.

— Tami Dennis

Photo: Paul Allen in 2006. Credit: Getty Images

Rodent of the Week: Drug shows effect on lung cancer tumors

Small-cell lung cancer is a disease sorely in need of better therapies. Now a study in mice has found a promising drug that may enter clinical trials in humans within a year.

One in five people with lung cancer has small-cell lung cancer. The disease has a poor long-term survival rate because the tumors spread quickly. Previous research has shown that these tumor cells grow faster because they are fueled by a growth hormone called FGF-2.

The study, published this week in the journal Cancer Research, examined a drug called PD173074 because it is known to block the receptor that FGF-2 uses to attach to tumor cells. Given to mice with the disease, the drug eliminated tumors in 50% of cases. Another test showed the compound increased the effect of chemotherapy.

"We urgently need to develop new treatments for this disease," the lead author of the study, Dr. Michael Seckl of Imperial College London, said in a news release. Although small-cell lung cancer "responds to chemotherapy initially, the tumors soon become resistant to treatment and sadly nearly all people with the disease do not survive. ... We hope to take this drug, or a similar drug that also stops FGF-2 from working, into clinical trials next year to see if it is a successful treatment for lung cancer in humans."

— Shari Roan

Photo credit: Advanced Cell Technology, Inc.

Fertility procedures do not delay cancer treatment, study finds

Women under 40 who are diagnosed with breast cancer often face the additional burden of losing their fertility due to the cancer treatment. If treatment is likely to cause future infertility, women may wish to undergo a procedure to harvest eggs to preserve future childbearing options.

A study published this week reassures women and their doctors that fertility procedures can be done in an orderly way that should not delay breast cancer treatment. The findings show the key to timely fertility procedures depends on all the parties involved -- the patient, cancer surgeon, medical oncologist and reproductive specialists -- working together and communicating effectively.

"The burden of facing premature menopause adds to the stress experienced by young cancer survivors," the lead author of the study, Dr. Lynn Westphal of Stanford University, said in a news release. "Our study shows that these procedures, when expedited and appropriately timed, do not delay cancer treatment."

The researchers identified 82 women younger than 40 who were diagnosed with breast cancer. Nineteen of the women underwent egg retrieval, while 63 did not. For the women who underwent egg retrieval, an average of 71 days elapsed between initial diagnosis to chemotherapy compared with 67 days in the women who did not have egg retrieval. The time elapsed between surgery and chemotherapy was also similar in the two groups.

The average age of the women who had underwent egg retrieval was 37, and most of them had not previously given birth. The study is published in the November issue of the Journal of the American College of Surgeons.

-- Shari Roan

Photo: Dr. David Diaz, medical director of the West Coast Fertility Centers in Fountain Valley lifts a canister containing frozen human eggs stored in liquid nitrogen. Credit: Mark Boster / Los Angeles Times.

A proposal for improving cord blood transplants

Roughly one in five hematopoietic stem cell transplants performed to treat blood disorders such as leukemia uses cord blood instead of the traditional bone marrow. Cord blood – harvested from umbilical cords shortly after birth – could be used more often if more of it were available. Nearly 14 million people worldwide have volunteered to donate their bone marrow, while the number of cord blood units available for transplant is just over 380,000.

Dutch researchers may have found a partial solution. In an article published in this week's edition of Proceedings of the National Academy of Sciences, they propose that a relatively simple change in the way donors are matched with recipients could expand the number of optimal matches by up to eighteenfold.

When patients need a bone marrow or cord blood transplant, they are matched with donors who share as many human leukocyte antigens (HLAs) as possible. The immune system checks these proteins to tell whether a cell belongs in the body or is foreign, so the closer the match, the greater the chance the transplant will take.

The researchers examined 1,121 patients who received a unit of cord blood from the New York Blood Center National Cord Blood Program. Only 62, or 6%, got blood that was HLA-matched. The remaining 1,059 patients got mismatched blood.

But by coincidence, 79, or 7%, got blood that was matched in another way – according to noninherited maternal antigens, or NIMAs. These are proteins that patients were exposed to from their mothers before they were born. As a result, the researchers speculated that patients with NIMA matches would tolerate their transplants better and have higher survival rates.

They were right.

Three years after their transplants, patients who didn’t have an HLA match but got NIMA-matched cord blood were 40% less likely to have died than patients who didn’t have either kind of match, according to the study. For the sake of comparison, patients who had an HLA match were 60% less likely to have died than patients without either kind of match.

The difference was especially pronounced in patients who were at least 10 years old. Compared with patients with no match, those with an HLA match were 70% less likely to have died and those with a NIMA match were 60% less likely to have passed away, the study found.

NIMA-matched blood had other benefits too. The transplants engrafted faster than in unmatched patients, and the incidence of graft-versus-host disease was lower. The benefits were greatest for patients who were expected to have the worst outcomes, the researchers reported.

The Dutch scientists said they intend to start using NIMA status to matching patients with cord blood and will track the results to see if these trends hold up. They urged others to do so as well.

Allowing patients to substitute one HLA-matched antigen for a NIMA-matched antigen would boost the number of possible matches by a factor of six, and allowing two substitutions would theoretically boost it as much as 18 times. The team calculated that even a sixfold increase in potential matches was the equivalent of increasing the number of cord blood units available for transplant to more than 2 million.

“Although much work lies ahead, our findings justify changing the match algorithm for CB [cord blood] transplants,” they wrote.

-- Karen Kaplan

Photo: A new matching technique could make the most of limited cord blood supplies. Credit: Los Angeles Times