Should boys get the HPV vaccine?

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Men rarely get cancer from HPV, but they do pass the virus to their female partners, and they do get genital warts from HPV as well. In Europe and the U.K., Gardasil is licensed for use in both boys and girls, although so far only Austria's public health program actually recommends vaccinations for both.

The reason it's not generally recommended for boys in the U.S. is because it hasn't been approved for use in boys. General thinking may be, too, that it's more cost-effective, from a public-health standpoint, to vaccinate girls only. And insurance companies won't cover vaccines that aren't recommended. Gardasil retails at around $375 for the three-dose  course

What about women over 26?

Older women and boys are in a similar situation, says Dr. Handsfield. "Women who get beyond their 20s are statistically at lower risk for HPV infection," he says, "so from a public-policy standpoint, it's not a priority." Also, since the research studies that led to Gardasil's approval were limited to the under-26 crowd, it's not FDA-approved for older women.

"But sure, the vaccine almost certainly would work in older women," Dr. Handsfield says. "This'll evolve."

As an older woman, you can pay out of pocket and get the vaccine, but it may not help (you may already have those strains of the virus). If you're older than 26 and considering the vaccine, it makes sense to evaluate your sexual history. "Say there's a 28-year-old woman, she's about to be out there dating again, and she's only had three or four partners; she probably is still susceptible," says Dr. Hansdfield. "She clearly needs the vaccine. "

  

If I get vaccinated, do I still need to get regular Pap smears?

Yes! Experts agree that the vaccine does not replace the need for regular Pap smears, since it protects only against the strains of the virus that cause 70% of all cervical cancers. You'll still need to protect yourself from the rest with yearly screenings.

Can cervical cancer be prevented?

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The Pap test is the best way to find cervical cell changes that can lead to cervical cancer. Regular Pap tests almost always show these cell changes before they turn into cancer. It is important to follow up with your doctor after any abnormal Pap test result to treat abnormal cell changes. This may help prevent cervical cancer.

If you are age 26 or younger, you can get the HPV shot. The vaccines Cervarix and Gardasil protect against two types of HPV that cause cervical cancer. Gardasil also protects against two types of HPV that cause genital warts. Three shots are given over 6 months. The series of shots is recommended for girls age 11 or 12 and can be given to females ages 9 to 26.

The virus that causes cervical cancer is spread through sexual contact. The best way to avoid getting a sexually transmitted disease is to not have sex. If you do have sex, practice safer sex, such as using condoms and limiting the number of sex partners you have.

Almost everyone carries the human papillomavirus (HPV), and it's usually pretty harmless. But a few strains are the main cause of cervical cancer. Gardasil, the HPV vaccine approved by the FDA in 2006, guards against two of these strains, plus two other strains that are responsible for most genital warts.

Since most adults have already been exposed to HPV, the vaccine is recommended for girls who haven't become sexually active yet. (The federal Centers for Disease Control and Prevention recommends vaccination at age 11 or 12, but Gardasil is approved for girls as young as 9.)

So far, so good. But the introduction of this new vaccine has stirred up a small fuss.

The controversy

Perhaps the main fear of the vaccine's opponents is that it might encourage adolescent promiscuity.

H. Hunter Handsfield, MD, a clinical professor of medicine at the University of Washington and a nationally recognized STD expert, believes most parents are all for it, however. "It can prevent cancer?" he says, parroting the most common parental concern. "Well, duh, give my kid the shot.

Servical cancer

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Is this topic for you?

This topic talks about the testing, diagnosis, and treatment of cervical cancer. For general information about abnormal Pap test results, see the topic Abnormal Pap Test.

What is cervical cancer?

Cervical cancer occurs when abnormal cells on the cervix grow out of control. The cervix is the lower part of the uterus that opens into the vagina. Cervical cancer can often be cured when it’s found early. It is usually found at a very early stage through a Pap test.

What causes cervical cancer?

Most cervical cancer is caused by a virus called human papillomavirus, or HPV. You can get HPV by having sexual contact with someone who has it. There are many types of the HPV virus. Not all types of HPV cause cervical cancer. Some of them cause genital warts, but other types may not cause any symptoms.

You can have HPV for years and not know it. It stays in your body and can lead to cervical cancer years after you were infected. This is why it is important for you to have regular Pap tests. A Pap test can find changes in cervical cells before they turn into cancer. If you treat these cell changes, you may prevent cervical cancer.

What are the symptoms?

Abnormal cervical cell changes rarely cause symptoms. But you may have symptoms if those cell changes grow into cervical cancer. Symptoms of cervical cancer may include:

• Bleeding from the vagina that is not normal, or a change in your menstrual cycle that you can't explain.
• Bleeding when something comes in contact with your cervix, such as during sex or when you put in a diaphragm.
• Pain during sex.
• Vaginal discharge that is tinged with blood.

How is cervical cancer diagnosed?

As part of your regular pelvic exam, you should have a Pap test. During a Pap test the doctor scrapes a small sample of cells from the surface of the cervix to look for cell changes. If a Pap test shows abnormal cell changes, your doctor may do other tests to look for precancerous or cancer cells on your cervix.

Your doctor may also do a Pap test and take a sample of tissue (biopsy) if you have symptoms of cervical cancer, such as bleeding after sex.

How is it treated?

Cervical cancer that is caught early can usually be cured. If the cancer is caught very early, you still may be able to have children after treatment.

The treatment for most stages of cervical cancer removes the cancer and makes you unable to have children. These treatments include:

• A hysterectomy and removal of pelvic lymph nodes with or without removal of both ovaries and fallopian tubes.
• Radiation therapy.
• Chemotherapy.

Depending on how much the cancer has grown, you may have one or more treatments. And you may have a combination of treatments.

It’s common to feel scared, sad, or angry after finding out that you have cervical cancer. Talking to others who have had the disease may help you feel better. Ask your doctor about support groups in your area. You can also find people online who will share their experiences with you.

How to Weigh Your Breast Cancer Risk Factors

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Not all breast cancer risks factors have the same influence.

• "A family history will still drive [risk] much more powerfully than other reproductive risk factors—like having no children, having few children, or having children late," says Angela R. Bradbury, MD, director of the Margaret Dyson Family Risk Assessment Program at Fox Chase Cancer Center in Philadelphia.

• Having a first-degree relative such as a mother, sister, or daughter with a breast cancer history boosts your risk much more than if a cousin or more distant relative has had it—particularly if the diagnosis came before the age of 50 or your family’s background is Ashkenazi Jewish.

• Then there are the so-called breast cancer genes, BRCA-1 and BRCA-2. Mutations in these genes raise your risk even higher than the family connection alone. If you have relatives with breast cancer, you might be a candidate for BRCA testing or for other modifications to your screening for the disease. Make an appointment to talk through your options with your doctor or a genetic counselor.

What Causes Breast Cancer?

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No one knows very much about why breast cancer happens, except that it likely starts in our genes. "Cancer in general is a disease of aging, and breast cancer is probably caused by an error in gene replication—the older we get, the more error prone we get," says Ramona F. Swaby, MD, a medical oncologist specializing in breast cancer at Fox Chase Cancer Center in Philadelphia. Indeed, a woman’s chance of getting breast cancer doesn’t rise to the terrifying one in eight until she’s reached 85 years of age. If you’re a woman under 40, for instance, your risk is much lower: one in 233.

Approximatly 5% to 10% of the roughly 200,000 American women diagnosed with breast cancer each year have an inherited gene mutation that puts them at higher risk for developing the disease. Most of these genes remain unidentified, but scientists know that mutations to the BRCA-1 and BRCA-2 (Breast Cancer 1 and 2) genes, which normally help prevent cancer by regulating cell growth, are linked to an increased risk for breast and ovarian cancer.

If you’re wondering whether you carry the BRCA-1 or BRCA-2 mutations, you may have considered getting a genetic test to find out. That’s a tough decision, because it’s not always clear what to do with your test results. Some women who know they are at higher risk without taking the test simply commit to more frequent mammograms; others feel the need to know as much as possible and may consider prophylactic surgery if they test positive.