Act Globally

Working in the field of global health has been a passion of mine since my wife, Melanie, and I served on a medical mission in the Dominican Republic many years ago. I saw first-hand the need to increase the quality of health care provided to women in other countries. All women require access to quality health care no matter where they live, and training and educating health workers is key to ensuring that care is available.

Mothers with babies in Vietnam by Sandy DoThe World Health Organization reports that almost all (99 percent) of the nearly 300,000 maternal deaths every year occur in developing countries. Two of the most common cancers affecting women – breast and cervical cancers – are of growing global concern. These alarming statistics are what make our partnership with Health Volunteer Overseas (HVO) so important. For nearly 30 years, HVO has empowered health care professionals in resource-scarce countries with knowledge and skills to address the health care needs of their communities.

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Guest Blog: Lady Ganga and the Fight to End Women’s Cancers

Larry Maxwell, MD, FACOG, COL(ret) U.S. Army, Director of the Globe-athon to End Women’s Cancers

Global statistics from the International Agency for Research on Cancer indicate that in 2012, gynecologic cancers accounted for 16% of the 6.6 million estimated new cases and 14% of the 3.5 million cancer related deaths among women. That means that 1 million women will be diagnosed this year with cancers below the belt and a woman will lose her battle with this disease almost every minute of every day. Cervical cancer accounted for 527,000 new cases and for 239,000 deaths. Although cervical cancer is the fourth-leading cause of cancer related death across the globe, it is the number one cause of cancer related deaths in some parts of Africa. Prevention of cervical cancer with the HPV vaccine is one of the best strategies to address the increasing problem of cervical cancer, particularly for low income countries. Unfortunately, only one third of eligible girls have received all 3 doses of the HPV vaccine in the U.S. This lack of compliance is increased among underserved groups such as African Americans. Public mistrust of the HPV vaccine has been fueled by information that is often misleading. The Vaccine Adverse Events Reporting System, a national database maintained by the CDC, has analyzed severe events and not found any causative relationships. In order to optimize public opinion and enhance compliance, it’s important to clarify additional misperceptions about the safety of the vaccine.

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Gynecologic Oncologist = Women’s Cancer Specialist

For many women, ob-gyns are their primary health care provider. It’s not uncommon for women to see their ob-gyn at least annually, and for good reason. Ob-gyns receive a comprehensive education in caring for women from adolescence through childbearing and into menopause. Our training includes care of both pregnant and non-pregnant women, surgery, pharmacology, and more.

Because we see our patients regularly, especially during their reproductive years, ob-gyns have the opportunity to build and maintain a strong patient-doctor relationship. We can observe patients when they’re healthy, establish a baseline of what’s normal, and potentially spot suspicious changes or health problems when they are most treatable.

When a patient reports out-of-the-ordinary changes and symptoms, an ob-gyn can perform diagnostic exams and tests to confirm the problem. He or she can treat changes that may lead to cancer and prevent cancer from ever developing. When invasive cancers of the female reproductive organs—cervix, ovary, uterus, vagina, or vulva—are diagnosed, ob-gyns will often consult with other ob-gyns with advanced training and experience, such as gynecologic oncologists. This can be especially helpful for cases that are thought to be more advanced.

Gynecologic oncologists are ob-gyns who have completed several additional years of training in surgery, treatment, and research on women’s cancers and received board certification in gynecologic oncology. They see patients with these cancers every day. Following diagnosis, gynecologic oncologists can perform the sometimes complicated surgical procedures (staging) necessary to improve a woman’s chances of controlling and beating cancer. They are experts in the timing and order of treatment and can also serve as the “traffic controllers” overseeing the coordination of nurses, primary care physicians, radiologists, and other health care professionals who will be involved in all aspects of the patient’s care.

Today, there are more than 1,000 board-certified gynecologic oncologists in the US. To learn more about these cancer specialists, visit the Society for Gynecologic Oncology website.

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Guest Blog: A Changing Tide—Have New Pap Test Recommendations Taken Hold?

David Chelmow, MD

David Chelmow, MD

If you’ve been following women’s health news, you know that a lot’s changed recently with Pap screening. Over the last decade, health organizations including ACOG, the American Cancer Society (ACS), and the US Preventive Services Task Force (USPSTF), have been reviewing research to determine how we can best prevent cervical cancer without excessive testing and unnecessary medical intervention.

The latest round of recommendations issued by each of these groups in 2012, building on guidance from ACOG in 2009, is generally consistent. All three organizations agree that for most women, cervical cancer screening should:

  • begin at age 21
  • stop after age 65 or following a hysterectomy in which the cervix has been removed
  • be performed every three years (Pap test only) OR every five years in women over 30 who’ve received negative results on a simultaneous Pap and human papillomavirus (HPV) test

The Centers for Disease Control and Prevention (CDC) recently published two studies looking at the use of Pap testing from 2000 to 2010. Much of what they found was good news and strongly suggests that doctors and patients are increasingly following the new recommendations. Fewer women younger than 21 were tested, and there was less Pap screening of women who had hysterectomy.

Unfortunately, there was also disappointing news. Many women continued to receive unnecessary Pap tests, including more than half of women younger than 21. Given the frequency of HPV infection in this age group, these young women are at significant risk for harms of testing without any expected benefit of cancer prevention. A much better strategy for prevention in this age group is HPV vaccination, but data from other sources suggest only a small portion of eligible women are receiving the full three-shot course of the vaccine. Additionally, 60% of women age 30 and older who had a hysterectomy continued to get Pap testing over this timeframe, according to CDC. Only a few of these women will need continued testing.

The studies also found that women age 22 to 30 who have never been screened increased from 6% to 9%—disturbing data considering most cervical cancer occurs in women who have never been screened or have not been screened in more than five years. Women age 30 to 64 who did not have health insurance were also less likely to be up to date with Pap screening in 2010 than in 2000.

For women to get the best protection against cervical cancer, they should get the HPV vaccine and be screened using the Pap and HPV tests according to ACOG recommendations. Let’s hope that the 2010—2020 summary finds that more women are getting screened according to the recommendations.

David Chelmow, MD, is professor and chair of the department of obstetrics and gynecology at Virginia Commonwealth University Medical Center in Richmond. Dr. Chelmow is a member of The American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins–Gynecology.

A Plan to Defeat HPV

In a recent blog post titled “HPV and a Vaccine: Why We Can Beat Cervical Cancer,” William Smith, executive director of the National Coalition of STD Directors, looks in depth at the conundrum of cervical cancer in the US today. On one hand, we can now classify cervical cancer as a largely preventable disease. On the other, more than 4,000 women in the US still die from cervical cancer each year. If we are to drive these numbers down, HPV vaccination must play an essential role.

The human papillomavirus (HPV) is a known cause of cervical, vulvar, vaginal, and anal cancers in women; penile and anal cancers in men; and throat, esophageal, and other head and neck cancers in both sexes. The HPV vaccine has the potential to protect young women—and men—from many, if not all, of these cancers. Recommended for girls and women ages 9–26 and boys and men ages 11–26, HPV vaccination works best if given before any exposure to HPV or the onset of sexual activity. But despite the recommendations of ACOG and other health organizations and women’s advocates, vaccination rates have remained low.

Many parents are sensitive to discussions regarding their young daughters (and sons) and sexually transmitted infections (STI). However difficult the concept, parents would be remiss in avoiding a potentially life-saving vaccine for these reasons. HPV vaccination is just another tool in a parent’s arsenal to shield their children and family from cancer. It’s no different than routinely vaccinating infants against hepatitis B—another STI that can increase the risk of liver cancer—which has been commonplace for roughly 30 years.

As a parent, some things just make good sense. And with the benefits that it provides, HPV vaccination is clearly one of those things. Protect your children; get them vaccinated.