Studies Confirm Long-term Protection Against Precancerous Cervical Lesions With Vaccines Against Human Papilloma Viruses (HPV)

Follow-up studies of two vaccines against HPV causing cervical cancer have shown long-term protection against precancerous lesions, according to results reported at the 2007 Annual Meeting of the American Association for Cancer Research (14-18 April, 2007; Los Angeles, USA).


Results from long-term follow-up of women vaccinated with a candidate vaccine against HPV types 16 and 18 (Cervarix, being developed by GlaxoSmithKline) showed 100% efficacy in preventing precancerous lesions due to these virus types for up to 5.5 years. The initial study was a double-blind, controlled trial of 1113 women (aged 15-25 years) who were randomised to receive three doses of the vaccine or placebo at 0, 1 and 6 months.


The extended follow-up included 776 women who were followed for up to 67 months. The vaccine induced a strong immune response in virtually 100% of women, which was sustained out to 5.5 years for both HPV types 16 and 18. At the end of the follow-up period, the average level of antibodies against both virus types was at least 11 times higher than those associated with natural infection.


Results showed 68% efficacy against precancerous lesions (CIN2+) and 38% efficacy against abnormal Pap smears, regardless of the type of cancer-causing virus detected. Further results showed that the vaccine provided significant protection against genetically similar viruses, with 88% efficacy against HPV 45 and 54% against HPV 31.


Stanley Gall, professor of obstetrics, gynaecology and women's health at the University of Louisville, Kentucky, USA, reported: "These new data demonstrate the longest duration of protection seen in any cervical cancer vaccine trial reported to date. They are exciting for the prevention of cervical cancer in women around the world."


Results from long-term follow-up of women given a quadrivalent HPV vaccine (Gardasil) also demonstrated sustained protection against precancerous lesions. A total of 21,000 women (16-25 years) in four cohorts have now been randomised to vaccine or placebo at day 1, and months 2 and 6. Efficacy in women receiving all three doses was 99-100%.


The vaccine proved highly effective against cervical intraepithelial neoplasia grades 2 and 3, precancerous lesions that are frequently caused by HPV 16. Only a single woman in the vaccine group presented with an early HPV type 16 lesion, compared to 42 in the placebo group with HPV 16 or 18 related cervical intraepithelial neoplasias of grades 2 or 3, or adenocarcinoma.


Darron Brown, professor of medicine, microbiology and immunology at Indiana University School of Medicine, reported: "After three years, we see that the vaccine remains highly effective against HPV 16 and 18 related precancerous cervical and other genital lesions caused by these HPV types. The high degree of efficacy and safety of this vaccine is remarkable." He noted that results from a study of cross-protection were 'very encouraging' but would not be available for a few more weeks.



: Susan Mayor PhD

Freelance medical journalist


View drug information on Cervarix [Human Papillomavirus Bivalent; Gardasil.

Toronto Star Profiles Work Of Women's HIV/AIDS Advocacy Group In Namibia

The Toronto Star on Wednesday profiled the work of the International Community of Women Living With HIV/AIDS in Namibia, which aims to improve support, information and services available for HIV-positive women in the country. The group also works to increase HIV-positive women's influence and input on policy development in Namibia. According to the Star, stigma associated with HIV/AIDS and the "social realities of being a woman in a poverty-stricken and unequal society" underscore the fact that the "plight of an HIV-positive woman goes beyond already troubling issues of medication access and proper health care."

Jennifer Gatsi-Mallet, ICW Namibia's program coordinator, said that through the program, women and girls living with HIV/AIDS are allowed to "advocate for their own issues, be it rights issues, economic empowerment issues or sexual reproductive health issues." Gatsi-Mallet added, "Through support groups that they organize, meetings that they attend with ministry officials and training workshops that they attend, it's all in an effort to ultimately make them feel empowered, where at many times in their life they may feel powerless."

In 2005, ICW Namibia, under Gatsi-Mallet's leadership, began organizing training workshops in reaction to the growing problems experienced by HIV-positive women in previously isolated villages and communities, as well as the realization that women across the country had little or no access to health care facilities or reproductive and sexual health knowledge. At such a workshop in January, several HIV-positive women said they had been forcibly sterilized because of their HIV status. Although a few women knew the consequences of the procedure, they consented because they needed other services. Such cases have prompted ICW -- along with the Legal Assistance Centre in Namibia and ICW branches in London and Washington, D.C. -- to investigate the matter and support the affected women (Sidhu, Toronto Star, 8/20).


Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation.

© 2008 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Federal Judge To Rule On Request For Temporary Injunction Against Enforcing Missouri Abortion-Related Law

Planned Parenthood of Kansas and Mid-Missouri would have to end abortion services at clinics in Columbia and Kansas City if a new Missouri law (SB 370) is allowed to take effect Thursday, PPKM CEO Peter Brownlie testified at a federal court hearing Thursday, the Kansas City Star reports (Morris, Kansas City Star, 8/23).

The law will designate facilities performing second- or third-trimester abortions or more than five first-trimester abortions each month as "ambulatory surgical centers." Clinics designated as ambulatory surgical centers are subject to increased regulation from the state Department of Health and Senior Services. The law will require that hallways be at least six feet wide and doors at least 44 inches wide. The clinics must also have separate male and female changing rooms for staff and a recovery room with space for a minimum of four beds with three feet of clearance around each bed. The health department said the law requires that three clinics in the state be licensed as ambulatory surgical centers.

PPKM on Monday filed a lawsuit that asks a federal court to block enforcement of the law. The suit alleges that the new regulations are unnecessary and are not meant to improve safety, but to interfere with a woman's constitutional right to abortion. PPKM in the suit also is asking that its Columbia and Kansas City clinics be exempt from the law because they were open before the law was passed (Kaiser Daily Women's Health Policy Report, 8/21). Brownlie on Thursday said the high costs of upgrading the clinics to comply with the law would force them to stop providing abortion services (Kansas City Star, 8/23). U.S. District Judge Ortrie Smith said he would rule on the request for a temporary injunction by Monday (Stafford, AP/Forbes, 8/23).

Smith noted quotes from elected officials and press releases about the law, adding, "Let's be real. The purpose of the legislation was to make abortions more difficult for women to obtain." State Assistant Attorney General Michael Pritchett replied, "This legislation was written to improve the standards for women who are seeking abortions." According to the Star, lawyers representing the state said the new regulations would not place a burden on women seeking abortion because abortions services are available in neighboring states (Kansas City Star, 8/23).

Missouri Health Director Hires Private Lawyers To Prosecute Case
Missouri Health Director Jane Drummond on Wednesday in a letter to state Attorney General Jay Nixon (D) said she would be using a private law firm rather than the attorney general's office to defend PPKM's challenge to the law, the St. Louis Post-Dispatch reports. Drummond has hired two lawyers from the Kansas City-based conservative religious group Alliance Defense Fund to defend the case. The lawyers, Dale Schowengerdt and Kevin Theriot, are not charging the state for their work (St. Louis Post-Dispatch, 8/23).














Drummond in the letter to Nixon said that she is using separate counsel because Nixon has "been an outspoken supporter of abortion on demand and a political ally of Planned Parenthood." She also wrote, "I did not believe I could trust you to defend me and my department vigorously" (Lieb, AP/Springfield News-Leader, 8/23). The Missouri Republican Party on Tuesday said that Nixon, who is running against Gov. Matt Blunt (R) in the 2008 gubernatorial race, had a conflict of interest in the case, citing the attorney general's decision in the 1990s to allow state funds to be used to hire a private lawyer to defend a Missouri law against a challenge by Planned Parenthood. Scott Holste, a spokesperson for Nixon, said the case is "about law, not politics."

Schowengerdt said he and Theriot "have every intention to work with the attorney general and defend this law together" (St. Louis Post-Dispatch, 8/23). Pritchett on Thursday said Nixon believes his office should lead the prosecution of the case. The attorneys for Drummond appeared at the hearing Thursday and presented testimony from Elizabeth Shadigian, an ob-gyn at the University of Michigan, about the risks of medical abortion drugs, the Star reports. According to the Star, PPKM's Kansas City clinic only provides drugs for medical abortions, while the Columbia clinic also provides first-trimester surgical abortions (Kansas City Star, 8/23).

"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Women Live Longer But In A Worse Condition

Catalan researchers have studied the socioeconomic and health inequalities experienced by people over the age of 64. The results of the study show that women live longer, but experience more limitations to daily activity (53%) and a lower quality of life than men of the same age (30%).


Although women have a longer life expectancy, they experience a much greater prevalence of disability in old age than men do. This is the main conclusion of the study published in the latest issue of the Journal of Women's Health.


"We focused on a socioeconomic position factor such as educational level and health factors such as limitations to daily activity. By studying this relationship we were able to see the social inequalities in dependency", Albert Espelt, lead author of the study and a researcher at the Public Health Agency of Barcelona, tells SINC.


The study is based on the health surveys that have been carried out in Barcelona by the Public Health Agency since 1982. "These are representative of the non-institutionalised population living in Barcelona", explains the expert. In total, the team interviewed 4,244 people aged above 64 (893 in 1992, 2,140 in 2000 and 1,211 in 2006).


"We saw differences in limitations according to socioeconomic position, which remained steady over the course of time", the expert points out.


The prevalence of disability in people aged over 64 increased among women in Catalonia between 1992 and 2006, but not among men, due to the increase in female life expectancy. The prevalence of disability in 2006 was 30% among men and 53% in women. In other words, it increases among the most elderly women.


"The double burden of work that women experience throughout their lives (domestic work and work outside the home) is a key factor in explaining this difference in different studies", says Espelt. Domestic work is less rewarding than working outside the home, and leads to a greater prevalence of non-fatal diseases such as musculoskeletal problems and depression.


Fewer inequalities with the Law of Dependency?


The Law to Promote Personal Autonomy and Care for Dependent People governs the basic conditions for ensuring equality in personal autonomy and care for dependent people.


"In this sense, the law approved in 2006 has represented a step forward in recognising a new universal right for citizens. Now it is to be hoped that this law will help to reduce the social inequalities that we found in our study", points out the researcher.


"It is still too soon to demonstrate the impact of the 2006 law", says Espelt. The Public Health Agency of Barcelona is already designing a new health survey for 2011, which will include the same questions as the previous one.


Source: Plataforma SINC

More Knowledge Not Always Helpful For Women Dealing With Heart Disease

Women with congestive heart failure who repress their emotions, especially anger, are more likely than emotionally expressive women to experience symptoms of depression associated with knowledge about their disease, according to new research.


Coping styles of women in the study influenced how depressed or anxious they felt. The less they talked about or expressed their emotions, the more likely they were to have symptoms of depression and anxiety.


When Ohio State University researchers examined the influence of knowledge about their illness on the patients' mental well-being, they found that some women with heart failure felt worse emotionally when they had more information about the disease. For those women -- who tend to deny their emotions -- less information is better. For them, certain types of knowledge can actually lower their emotional quality of life, according to the research.


The findings of this pilot study suggest that clinicians should consider patients' individual coping styles when educating them about their illness, the researchers say. For example, women who cope by denying their emotions might become particularly distressed by information that provokes fear such as learning about the increased risk of hospitalization as a consequence of not taking medication or exercising enough.


"We're not saying knowledge is not a good thing," said Charles Emery, professor of psychology at Ohio State and co-author of the study. "For patients who are greater in denial, knowledge seemed to be a negative factor. Whereas for people who either had difficulty expressing emotion or putting a label on their emotion, knowledge is still beneficial. "


Emery co-authored the study with Jamie Jackson, a former Ohio State graduate student who is now a postdoctoral fellow at Northwestern University. The study is published in a recent issue of the journal Heart & Lung.


The study involved 35 women diagnosed with at least stage C congestive heart failure as categorized by the American College of Cardiology, meaning they had structural heart damage, experienced symptoms that might include shortness of breath and swelling in the legs and abdomen, and were managing the disease with medication. Heart failure is a condition in which the heart muscle is weakened, resulting in reduced blood flow throughout the body.


The researchers asked the participants to complete a number of questionnaires to measure their coping styles, illness knowledge, emotional quality of life and physical quality of life.


Women's coping styles were categorized in three ways: anger-in, or a tendency to withhold angry emotions; alexithymia, or difficulty identifying and describing feelings; and emotional expressivity, which could be either low or high.















Overall, the women reported elevated symptoms of depression and anxiety compared to national data on these symptoms in healthy adults.


Depressive symptoms which can include loneliness, sadness, fear, sleep problems and an unshakable sense of the "blues" as well as anxiety symptoms were associated with repression of anger, difficulty describing feelings and low emotional expressivity. Those with a higher level of emotional expression were less likely to report depressive symptoms.


"The basic idea is very simple: that in general, it is better to express your emotions than to hold them in," said Emery, also an investigator in Ohio State's Institute for Behavioral Medicine Research. "The correlations in this paper are exactly what one would expect."


And when the researchers then factored in how much the women knew about their illness, a clear link emerged between higher knowledge and more depressive symptoms in women who repressed their anger.


"These are women who would not want to deal with their negative emotions. I think the reason we're seeing this pattern is that if you're scared about your health condition, and you're confronted with more and more information, that makes it more real to you," Jackson said. "If you're somebody who doesn't want to acknowledge the emotion around the situation, it may result in reacting with greater negative emotion.


"In this particular study, depressive symptoms are where we see the effect."


On the other hand, women who had trouble describing their emotions felt more anxious if they had less knowledge about their illness than did women with similar coping traits who had greater knowledge.


The study showed no indication that coping style and illness knowledge influenced the patients' physical quality of life.


Emery noted that the education patients receive about an illness is critical to keeping them informed about the best ways to maintain their health. So ensuring that patients receive the information in a way that preserves their emotional health is likely to encourage greater compliance with doctors' orders, he said.


"The longer-term purpose of this line of research is to better predict which patient is going to benefit from which kind of intervention," he said. "Even with a high-denial patient, we would still embrace using knowledge. But we might identify non-aversive ways of presenting them with the knowledge."


The researchers suggest in the paper that clinicians may want to consider using mindfulness strategies for patients who tend to repress anger or have trouble describing their feelings. This technique helps people monitor their emotional response and observe their thoughts without judgment, said Jackson, who has been trained to provide mindfulness-based interventions in a clinical setting.


"Mindfulness encourages people to be comfortable with living in the moment with whatever emotional experience they're having," she said. "If we can help patients do that, they might be more receptive to information about their condition, and might have a better quality of life in general."


Source: Ohio State University