Prevent HPV

The CDC currently recommends HPV vaccine at 11-12 years of age.  HPV Vaccine Information

Here’s why: NY Times: Close to Half of Americans with HPV

An excerpt:

More than 42 percent of Americans between the ages of 18 and 59 are infected with genital human papillomavirus, according to the first survey to look at the prevalence of the virus in the adult population.

The report, published on Thursday by the National Center for Health Statistics, found that high-risk strains of the virus — a cause of cervical and vaginal cancers, and cancer of the penis, as well as cancers of the anus and throat in both sexes — infect 25.1 percent of men and 20.4 percent of women.

The virus is transmitted by skin to skin contact; people who are infected may pass the virus to sexual partners…

“If we can get 11- and 12-year-olds to get the vaccine, we’ll make some progress,” Dr. McQuillan said. “You need to give it before kids become sexually active, before they get infected. By the time they’re in their mid-twenties, people are infected and it’s too late. This is a vaccine against cancer — that’s the message.”

Related blog post: Latest Vaccine Recommendations

CCFA Conference Notes 2016 (part 3) -Malignancy and IBD

This blog entry has abbreviated/summarized this terrific presentation; most of the material has been covered in this blog in prior entries but still this was a useful review. Though not intentional, some important material is likely to have been omitted; in addition, transcription errors are possible as well.

3rd Lecture: Prevention and management of malignancy in IBD –Dr. Thomas Ullman

Malignancy risk (colorectal cancer [CRC]) is present with prolonged ulcerative colitis, though more recent studies have shown lower risk than in the past –not much higher than the general population.

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  • CRC surveillance–colonoscopy monitoring after 8-10 years. Typically colonoscopy every other year for most patients, every year in higher risk patients (eg. PSC).

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  • Unclear if chemoprevention is effective (5-ASA, thiopurines, others).
  • Chromoendoscopy “has not been consensus on its use in our field (yet).” It is time consuming and expensive and unclear if it will improve outcome.

Does medical therapy for IBD predispose to developing cancer?

  • Thiopurines increase the risk of malignancy. (Pasternak et al) though the risk returns to near baseline when stopped according to study below.

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  • No overall increased risk with anti-TNF agents with RCTs (may not follow patients long enough) but also not seen in Danish registry either (JAMA study)
With Anti-TNFs

No increased risk of malignancy in this study with Anti-TNFs

  • Lymphoma risks: age, immunodeficiency, EBV
  • EBV negative are at risk for HLH with thiopurines
  • HTSCL ~200, >90% men and >90% <35 years. NOT EBV-related. Has not been identified in anti-TNF monotherapy.

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  • Skin cancer –main concern is in non-melanoma skin cancer (possibly melanoma too). Skin cancer increase has not been noted with methotrexate. Prevention: Skin care, and annual dermatology visits.
  • Cervical cancer—likely increased risk in IBD, probably due to thiopurine exposure and reduced immune surveillance. Prevention: HPV vaccination, Pap testing.
  • Urinary Tract cancers –especially in those >65 years with thiopurine exposure