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Most women can go as long as five years between cervical cancer screenings as long as they make sure to get both a Pap smear and an HPV test when they do get examined, a government panel said Wednesday.

The interval between cervical cancer screenings can safely be extended for women between the ages of 30 and 65, according to the new recommendations from the U.S. Preventive Services Task Force.
 
Women ages 21 to 30 should still get a Pap smear every three years, the interval currently recommended. But those younger than 21 and older than 65 can skip the screen altogether, the experts concluded.

The panel is urging a extended intervals in screenings in an attempt to cut back on the number of women who end up being treated for lesions that might resolve on their own.

The downside could be a very small potential increase in the number of women who might die of cervical cancer, experts said.

“It’s a trade-off,” said Dr. Michael LeFevre, co-vice chair of the task force and a professor of family and community medicine at the University of Missouri at Columbia.

While screening more often might turn up more cancers and pre-cancerous lesions, it would also lead to far more unpleasant and painful therapies for women who might ultimately not have needed them, LeFevre said.

When a lesion is found, generally a colposcopy is ordered, said Dr. Alan Waxman, a professor of obstetrics and gynecology at the University of New Mexico.

And the often painful test can amount to a lot of unnecessary suffering given that many lesions frequently disappear on their own. For women who’ve never experienced a colposcopy, Waxman offered this description: “It’s like a Pap test on steroids.”

Beyond this, lesions may end up being excised in an uncomfortable procedure that can impact future fertility, the task force found. Studies have shown that some treatments for precancerous lesions can result in adverse pregnancy outcomes, including pre-term delivery, an infant that is underweight at birth, or even stillbirth or death shortly after delivery.

Until experts can find a way to cut back on colposcopies and excisions for precancerous lesions, it makes sense to screen less often because this will give some lesions time to resolve on their own, Waxman said.

He predicted that the new recommendations will take time to be accepted into practice.

“I anticipate there will be some apprehension among ob-gyns about it,” Waxman said. “It’s something new. And there’s always a concern if you screen less often you’re going to miss disease.”

Dr. Thomas Randall is one of those who isn’t yet convinced that the proposed changes are the best solution.  

One thing missing from the new recommendations are studies that look at how women feel about treatment issues, said Randall, director of gynecologic oncology at Pennsylvania Hospital.

“I applaud the panel’s effort to minimize the emotional and physical burden of treatment on patients,” Randall said.  “But I think we need to think very carefully about what patients’ preferences actually are.”

Beyond this, Randall said, it might make more sense to look at ways to decrease the number of colposcopies and excisions rather than cutting back on screening.

“Limiting screening seems a little paternalistic,” he explained. “Maybe we should be looking more at treatment patterns than at screening patterns in order to decrease the burden of treatment.”

The new recommendations were published in the Annals of Internal Medicine.

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The nation's largest pediatrician group today released its new schedule of recommended childhood vaccinations. It made three major changes to its previous recommendations, after a federal advisory panel of experts reviewed recent evidence from vaccine studies.

The biggest change is the new recommendation that boys should be vaccinated against human papillomavirus (HPV). Since 2006, the HPV vaccine has been recommended for girls, primarily to help prevent cervical cancer, and in 2009, the experts advised that boys "could" be given the shots, too.

The stronger wording in the new recommendations, that boys "should" be given the shots, came about because new data showed giving boys the vaccine can help lessen the odds of HPV-associated cancers in men and in women, said Dr. H. Cody Meissner, chief of pediatric infectious disease at the Floating Hospital for Children at Tufts Medical Center in Boston.

Meissner was part of the group of experts updating this year's recommendations from the American Academy of Pediatrics; the panel also included experts from the Centers for Disease and Prevention, which had previously recommended the HPV vaccine for boys.

The new vaccination schedules are published today (Feb. 1) in the journal Pediatrics.

Routine HPV vaccinations for boys

The new guidelines call for boys to get the first of the three doses of HPV vaccine at age 11 or 12, the same age the shot is recommended for girls.

HPV vaccinations are also advised for young men ages 13 to 21 if they've not yet had all three shots. It may be given to boys as young as 9 and to men between 22 and 26. 

Young people are encouraged to get all three shots, given over a 6-month period, before they become sexually active.

"Every parent likes to think their child is not sexually active in their early teen years," Meissner said. "But if you wait until they're sexually active, you miss the benefit of the vaccine."

The vaccine has been known to protect against genital warts in males and females, and recent evidence has shown it can prevent anal cancer in men and women. The HPV vaccine has also been shown to be protective against penile cancers, as well as head and neck cancers.

Updates to meningococcal and flu vaccines

The meningococcal and flu vaccines are the focus of the other two changes to the guidelines.

A booster dose of the meningococcal vaccine is now recommended for children at age 16. The previous schedule recommended children be routinely immunized against meningococcal disease, which prevents most types of meningitis, when they are 11 or 12.

Infectious disease experts had thought that one dose of meningococcal vaccine would protect a young person through the college years, Meissner said. "But data became available that the vaccine doesn't last that long, and the risk goes up late in the teen years," he said.

Teens are now advised to get a booster dose to make sure that protection is maintained through the high-risk window, which occurs between 16 and 21 years, when many are living in close quarters, such as in college dormitories.

Some slight tweaks were also made to flu shot recommendations. This was the second year the AAP is recommending that children 6 months and older need to get the annual flu shot, Meissner said.

The new schedule clarifies the guidance for giving the flu shot to kids with egg allergies. Studies have shown the amount of egg protein in the flu vaccine is not enough to produce an allergic reaction in those with mild allergies, who can eat cooked eggs, Meissner said. Still, the flu shot may not be appropriate for people with a severe egg allergy, he said.

Advice for parents

A lot of parents are nervous about the number of shots recommended for children and teenagers these days, and they want to know how long each vaccine has been around, and how serious the risk is if their child does not get it, said Dr. Peter Greenspan, medical director of MassGeneral Hospital for Children in Boston.

He said he has noticed that parents are getting increasingly discerning about immunizations. "I find that parents really want to know the whys about the vaccines, which is entirely appropriate and important information for doctors to share," Greenspan said.

When new changes are made to the vaccination schedule, he said, "it's just a matter of explanation and discussion with your pediatrician."

Pass it on: Experts now recommend that pre-teen boys get vaccinated against HPV, that 16-year-olds be vaccinated against meningitis and that almost all children receive a flu shot annually.

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About 7 percent of adults and teens in the United States are orally infected with the human papillomavirus, or HPV, a new study says. This represents about 14.9 million people.

More men are affected than women: About 10 percent of men ages 14 to 69 have an oral HPV infection, compared with 3.6 percent of women, the study showed.

Oral HPV infections cause some oropharyngeal cancers, or cancers of the tongue, the tonsils or back of the mouth. People who are infected with the strain HPV 16 are 14 times more likely to develop these cancers compared with those not infected with the virus.

The new findings were "reassuring," according to study researcher Dr. Maura Gillison, chair of cancer research at The Ohio State University , because they show that while oral infection with the virus is common, cancer cases as a result of these infections are rare. In other words, most infected people don't get cancer. The American Cancer Society estimates there will be about 40,000 new cases of cancer of the oral cavity and pharynx in 2012.

The findings also show oral HPV infections are, for the most part, sexually transmitted. People who reported engaging in oral sex were twice as likely to have an oral HPV infection as those who did not engage in oral sex. People who had had sex of any kind, including vaginal sex or oral sex, were eight times more likely to have an oral HPV infection than those who had not had sex. Among those who'd had 20 or more sexual partners, one in five had an oral HPV infection.

"Taken together, these data indicate that transmission by casual, nonsexual contact is likely to be unusual," the researchers wrote in their study.

However, there are clues HPV may also spread by kissing. Oral HPV infections were more common among sexually experienced people who had not engaged in oral sex than among sexually inexperienced individuals, a finding that is "consistent with transmission by other sexually associated contact (eg, deep kissing)," the researchers wrote in their study.

"This study of oral HPV infection is the critical first step toward developing potential oropharyngeal cancer prevention strategies," Gillison said. "This is clearly important, because HPV-positive oropharyngeal cancer is poised to overtake cervical cancer as the leading type of HPV-caused cancers in the U.S."

More studies are needed to know whether the HPV vaccine effectively prevents oral HPV infections, the researchers said. Currently, the vaccine is recommended to prevent cervical cancer, anal cancer and genital warts.

How common is oral HPV?

Between 1998 and 2004, incidence of new cases of oropharyngeal cancer in the United States more than tripled (from 0.8 cancers per 100,000 people to 2.6 cancers per 100,000 people).

Despite the rise, little was known about the prevalence of oral HPV infection, and the characteristics of those who have it.

In the new study, Gillison and colleagues analyzed data from more than 5,500 men and women in the United States. Participants answered questions about their sexual behavior and substance use. They were also asked to gargle mouthwash for 30 seconds, and cells that were exfoliated into the rinse were analyzed for evidence of HPV infection.

The researchers found HPV in the cells of 6.9 percent of the participants, and HPV 16 in 1 percent.

The infection was most common among those ages 60 to 64 years, (at 11.4 percent), and those ages 30 to 34 (at 7.3 percent).

Physicians should encourage their patients who engage in oral sex to use barrier protection, Dr. Hans P. Schlecht, of the Drexel University College of Medicine, Philadelphia, wrote in an editorial accompanying the study.

Smokers and alcohol users also had a high prevalence of HPV. About 20 percent of those who said they smoke 20 or more cigarettes per day had oral HPV infection.

More research

It's not clear why oral HPV infection was more common among men than women. It could be that HPV is more likely to be transmitted through oral sex on women versus men, the researchers said. Differences in hormone levels between the sexes could also affect the duration of an infection.

Smoking may suppress the immune system, leading to longer infections with the virus, the researchers said.

The researchers noted their findings are based on study participant's reports of their sexual behavior and smoking, which may not be completely accurate.

Researchers need to follow people over time to better understand the effects of age, gender, sexual behavior and smoking on the incidence and duration of oral HPV infections, the researchers said.

The study will be presented this week at the Multidisciplinary Head and Neck Cancer Symposium in Phoenix. The study and editorial are published online today (Jan. 26) in the Journal of the American Medical Association.

Pass it on: Oral HPV infections affect about 7 percent of adults in teen in the United States, and are more common in men than women.

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A huge spike in the number of head and neck cancers linked to HPV over nearly two decades is raising alarms about the risk of the sexually contracted infections in a whole new population: men.

Between 1988 and 2004, head, neck and throat cancers that tested positive for the human papilloma virus rose an astounding 225 percent, according to a new study in the Journal of Clinical Oncology.

Within the next decade, the study authors argue, the incidence of such cancers — which are almost always contracted as a result of oral sex — will surpass that of cervical cancer, and the majority of those cases are going to be in men.

That’s a point often missed in public talk about HPV infection — and the vaccine that can prevent it.

In the recent controversy over comments made by presidential candidate Michele Bachmann about the HPV vaccine, the focus was squarely on young women and cervical cancer. But HPV, mainly a strain called HPV-16, also causes oropharyngeal and anal cancer, a fact not often publicized because medical organizations, the government, and academics would rather not step into any debates about sex practices.

Until recently, head and neck cancers were primarily diagnosed in older people, with an average age of 60, said Dr. Gregory Masters, an expert with the American Society of Clinical Oncology. Those cancers were usually caused by smoking or drinking too much booze, exposures that take 20 years or more to trigger disease. And, they typically didn't test positive for HPV markers. In fact, the incident of HPV-negative head and neck cancers declined by more than 50 percent during the 16-year study period, mostly because of declines in smoking and other tobacco use.

Now, however, oncologists like Masters, who is affiliated with the Helen F. Graham Cancer Center in Newark, Del., are seeing the average age of head and neck cancer diagnoses drop as younger people develop HPV-caused cancers resulting from sexual exposure.

The study authors collected their data from the three states that participate in a government cancer incidence database for oropharyngeal cancer: Hawaii, Iowa and Louisiana. They determined the HPV status of 271 tumors and found that the prevalence of HPV-related cancers increased from 16.3 percent during 1984-1988 to 71.7 percent from 2000 to 2004. 

An accompanying commentary noted that “we can expect some 10,000 to 15,000 patients with (the cancers) per year in the United States, with the great majority having HPV-positive (cancers)."

Consultants to drug companies that make HPV vaccines are represented among the study’s authors; clearly the companies have an incentive to suggest that males be vaccinated. But in many cases, health experts believe that economics and health are aligned on this issue and that boys and young men ought to be receiving the HPV vaccine right now. For instance, Dr. James Turner, a past president of the American College Health Association and a liaison to the Advisory Committee on Immunization practices has long advocated vaccinating all boys against HPV.

Yet neither the Centers for Disease Control and Prevention nor medical organizations such as ASCO have recommended it, although the vaccines are approved for use in males. The reason, suggested Masters, is squeamishness.

“When we get more comfortable as a society with the whole discussion of sexually-related cancer, then you will, I think, see us saying it makes a lot of sense for all boys and girls to get vaccinated … I am not, as a representative of ASCO, saying we recommend it, but I think (such recommendations) are forthcoming.”

Meanwhile, suggested a commentary accompanying the study, “patients should be encouraged to minimize behaviors that put them at risk.”

That, of course, would mean reducing oral and anal sex, two activities now firmly entrenched in the American mainstream. According to the National Survey of Family Growth issued last March by the National Center for Health Statistics, about 90 percent of both men and women have engaged in oral sex with an opposite-sex partner, and 36 percent of women and 44 percent of men have had anal sex.

Statistics like that, and the new study’s findings on head and neck cancer rates may combine to make a broader vaccine recommendation more urgent.  

Follow Brian Alexander on Twitter.

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