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I’m a critical care nurse with many years of experience in multiple areas of nursing. In the hospital I mostly practice in the emergency room but I’m passionate about women’s health, and holistic healthcare, specifically mindfulness and meditation. My blog is based on as much evidence based practice as I can muster, and my educated interpretation of what I’ve seen in the medical setting. I will do my best to be as accurate as possible, and to identify occasions when I’m merely speaking to my own experience and not to articles I have read. When at all possible I will link to current research to support my blog posts. You are encouraged to comment and join in the conversation, especially to share your own experiences, but please keep the conversation respectful and compassionate.
The risk of HPV associated malignancies of the anogenital and oropharyngeal region persist for decades after the initial diagnosis of Cervical Intra-epithelial Neoplasia grade 3 (CIN3). Incidence Rate Ratios (IRR) - or the incidence in CIN3 patients compared to matched controls - were 88.08 for vaginal cancer, 26.65 for vaginal intraepithelial neoplasia grade 3 (VAIN3) 4.97 for vulvar cancer and 13.66 for vulvar intraepithelial neoplasia grade 3 (VIN3). For oropharyngeal, anal and intraepithelial neoplasia grade 3 (AIN3), the IRRs were 5.51, 3.85 and 6.68 respectively. These data, recently reported from the Netherlands, provide strong evidence for this.
High-risk human papilloma virus is prevalent in almost 100 percent in cervical cancer; prevalence in anogenital cancers are only slightly lower and range from 20 – 90 percent.
When prophylactic HPV vaccination is given to cover up to 50% or more of a female cohort, there is 68% reduction in type 16 and 18 HPV infection. By inference, HPV-related cancers and pre-malignancies might well be completely preventable by HPV vaccination. Since men are a significant source of transmission, HPV vaccination of boys and men starting around 11 - 13 years should be a requirement.
HPV vaccination for boys and girls should reduce the long-lasting risk of HPV-related cancers and pre-cancers for both women and men.
This recent demonstration of persistence of cancer risk after CIN3 dignosis now suggests another important area for study. Intensified screening in this high risk group appears intuitive and studies to show efficacy of this intervention are clearly indicated. Vaccination with HPV vaccines is another maneuver that could prove useful in reducing the risk of disease in this population
The role of prophylactic HPV vaccination in adult women remains controversial. It is still not clear "how clinically and cost effective prophylactic hrHPV vaccination would be in women treated for CIN3. In Holland, guidelines advise that hrHPV vaccination be considered in women with CIN3, until more conclusive evidence on vaccine effect after treatment of CIN3 is available. Clearly, current findings emphasize the importance of continued surveillance in women with a previous diagnosis of CIN3.
Based on available data, we would recommend HPV vaccination of boys and girls prior to the age of initiation of sexual activity. We also feel that vaccination and continued intensive surveillance in women after a prior diagnosis CIN3 is waranted.