Gardasil 9: Helping to prevent cervical cancer

In late 2014, the U.S. Food and Drug Administration approved Gardasil 9, a vaccine that protects against nine types of the human papillomavirus (HPV). Gardasil 9 covers a broader range of the HPV virus as compared to Gardasil, which protects against only four types of HPV. For those who’ve already received the Gardasil vaccine, questions arose about revaccination and the potential effectiveness of Gardasil 9 in addressing a more complex group of HPV. And a broader debate continued as to why both vaccines continue to be underused.

“HPV is an extremely common sexually transmitted disease which, if left untreated, can lead to cervical cancer,” said Orlando Suris, M.D., an obstetrician-gynecologist with the Institute for Women’s Health, San Antonio. “Fortunately, the Gardasil and Gardasil 9 vaccines have proven to be very effective in reducing the risk of contracting HPV.”

The seven types of HPV which are implicated in 90 percent of cervical cancers are covered with Gardasil 9, in addition to two types associated with genital warts.

HPV is typically detected through a Pap test, which is conducted at an annual well woman gynecologist appointment. Pap tests screen for cervical cancer and other vaginal abnormalities. Since the introduction of these tests in the 1950s, cervical cancer incidence and mortality have decreased sharply. “Still,” Dr. Suris cautioned, “It’s necessary to continue to receive a Pap test in order to detect HPV.”

The Gardasil and Gardasil 9 vaccines prevent cancer from forming by immunizing the patient to HPV. HPV is the root cause of the majority of cervical cancers, which are traditionally extremely slow to form. “Patients whose Pap test results indicate the presence of HPV don’t necessarily have cervical cancer,” Dr. Suris said. “Further testing is necessary to determine a treatment plan.” A treatment plan for HPV or cervical cancers is most effective if HPV is detected early enough.

Vaccination against HPV is recommended for girls ages 9 – 26 and boys ages 9 – 15, ideally before they become sexually active. The vaccine is administered in three doses over a six-month period.

Since their introduction to the market, the vaccinations have been underused. Many physicians believe that the stigma surrounding the vaccination of a child for an STD while they are very young is the cause of this underutilization. To address this issue, the Centers for Disease Control launched a campaign called “You are the key to cancer prevention” in 2014. The campaign aims to educate physicians and parents about the benefits of recommending their children be vaccinated. After all, they pointed out, it’s about cancer, not sex.

When it comes to revaccinations, however, the topic is less complicated.

“If you’ve already received the Gardasil vaccine, there’s no need to be revaccinated with Gardasil 9,” Dr. Suris said. “If you’re 21 or older, just continue to schedule your annual well woman exams, and have your gynecologist order your Pap tests on the schedule specific to you.”

Orlando Suris, M.D., is an obstetrician-gynecologist with the Institute for Women’s Health, San Antonio. To schedule an appointment with Dr. Suris, please call 210.494.2000.

This Article Originally Appeared on https://www.ifwh.org/en/gardasil-9-helping-to-prevent-cervical-cancer/

The Complications for Pregnant Women

Through stories from friends and informational packets from doctors, women are aware of many risks associated pregnancy. Flu-like symptoms, vomiting, preeclampsia, maternal bleeding, and preterm labor are often discussed. Our bodies are incredible, complicated things, however, and sometimes serious issues fly under the radar during all the chaos of caring for a brand new baby.

Unfortunately, the vast majority of women who develop diabetes during pregnancy are not screened for diabetes again within one year after giving birth. There are many cases where gestational diabetes resolves after pregnancy. On the other hand, there are some cases where women will develop type 2 diabetes. The American College of Obstetricians and Gynecologists recommend that women with gestational diabetes have their blood sugar levels checked at least six to 12 weeks after giving birth.

It’s not uncommon for women who have a history of gestational diabetes have a higher risk of developing diabetes. The risk level is at its highest within 10 years of having gestational diabetes. Researchers have used commercial insurance claims to study more than 440,000 women who gave birth at least once between 2000 and 2012. Not to mention, there were 32,252 women who had gestational diabetes in that same time frame.

Gestational diabetes often has no symptoms and can only be diagnosed at a routine screening. Hyperglycemia, which is known as high blood glucose (blood sugar), can cause thirst, dry mouth, frequent urination, fatigue, recurrent infections, and blurred visions. Unfortunately, many may write off these symptoms as normal when, in actuality, they are serious warning signs. In cases of untreated gestational diabetes, there is a high possibility that the placenta may break away from the wall of the uterus (placenta abruption), causing vaginal bleeding and abdominal pain.

The hormones such as estrogen, progesterone, and human placental lactogen (HPL) that are produced during pregnancy can make the body insulin-resistant. This allows extra glucose and nutrients to be passed to the fetus. There are a few women who are either unable to produce enough insulin during pregnancy, or the body’s cells are more resistant to insulin, which can result in gestational diabetes.

Having a BMI above 30, a previous baby that was large for its gestational age, gestational diabetes in a previous pregnancy, a family history of diabetes, or being of South-Asian, Afro-Caribbean, or Middle Eastern descent can increase the risk of developing gestational diabetes.

The condition often arises in the third trimester and disappears once the baby is born. Controlling gestational diabetes requires for women to diet and exercise. It occasionally requires medication and if left untreated, it can increase the chances of birth complications.

Surprisingly, within one year after giving birth, only 25 percent of women had received blood sugar screening. How could so many women with diabetes be left out of receiving treatment for such a long time? Who’s responsible for causing this kind of situation? These kinds of questions raise concern for the pregnant women community. While many women are willing to accept the pregnancy risks they are aware of, potential mothers deserve to know the full picture of what long-term changes their bodies might undergo as a result of said pregnancy.

Thankfully, there are some signs of improvement in this area. Recommended screening at six to 12 week postpartum increased from two percent of women in 2001 to seven percent in 2011. . In addition, oral glucose tolerance tests were performed in 36 percent of women in Western states within 12 weeks of giving birth. Imagine that statistic compared to 19 percent of women in the Northeast and 18 percent in the South. Interestingly, Asian women were more likely than white women to receive blood sugar screening while they were pregnant

Women who visited either an endocrinologist or a nutritionist-diabetes educator after giving birth were more than likely to be screened for diabetes. Currently, it appears that women need to reach out to doctors for follow-up tests. Whether or not scheduling follow-up appointment is responsibility of the new mother or her medical health professional is debatable and varies from clinic to clinic. However, the point remains that women who have gestational diabetes and are not screened postpartum may continue to develop elevated blood sugar. Worst case scenario, the women can become pregnant again and have overt diabetes. Entering a pregnancy with overt diabetes poses greater risks to the fetus and the pregnancy.

In addition to screening after giving birth, usually at the six to 12-week postpartum follow-up appointment, women with gestational diabetes should receive ongoing blood sugar screening every one to three years.

When you have a new baby, it is difficult to keep up with the medical care routine, especially when the obstetrics team changes between pregnancies. Sometimes it isn’t possible to stay with the same OBGYN and many women don’t push their obstetrics teams communicate. This lack of communication between women’s different obstetric teams can cause problems and more stress towards the woman giving birth. Sometimes, it may not be clear as to which doctor is supposed to do the screening or when he/she should plan to do it.

If women catch diabetes or abnormal blood sugar early, there are ways one can try to prevent overt diabetes from occurring. It’s important for women to catch this irregular behavior early in order for their dietary change and exercise to have profound effects.

If you live in San Antonio, Texas, make sure to take the risk of diabetes seriously. A study by the University Health System found that 11.8% of the Bexar County population (137,009 people) are diagnosed with diabetes. They believe approximately 440,468 Texans are undiagnosed. Women in San Antonio need to take the risk of gestational diabetes seriously. The Institute of Women’s Health provides OB/GYN services to women across San Antonio.