The latest issue of the Annals of Internal Medicine contains 2 noteworthy papers on cervical cancer screening. The first, a systematic review of studies commissioned by the USPSTF, looked at 3 methods for evaluating abnormalities in women over 30 years:
high-grade cervical cell dysplasia (Dr. E. Uthman, Wikimedia Commons)
1. Conventional cytology (as in a Pap smear; the cervix is scraped and cells splayed onto a microscope slide for examination);
2. Liquid-based cytology (for LBC, the NHS explains: the sample is taken as for a Pap test, but the tip of the collection spatula is inserted into fluid rather than applied to slides. The fluid is sent to the path lab for analysis);
3. Testing for high-risk HPV (human papillomavirus). Currently 3 tests have been approved by the FDA in women with atypical cervical cells or for cervical cancer risk assessment in women over the age of 30: Digene Hybrid Capture 2 (manufactured by Quiagen), Cobas 4800 HPV (Roche) and Cervista HR HPV (Hologic); another Roche Diagnostics assay, Amplicor HPV, awaits approval.
These HPV assays use distinct methods to assess DNA of various HPV strains.
There’s a lot of jargon here, and I have to admit some of this was new to me despite my nearly-due diligence as a patient at the gynecologist’s office and my familiarity as an oncologist with the staging, clinical manifestations and treatment of cervical cancer. Who knew so many decisions were made during a routine pelvic exam about which manner of screening? Read more »
*This blog post was originally published at Medical Lessons*
Campaigns against public spitting in the 19th century were largely driven by concerns about the spread of tuberculosis. However, at the beginning of the 21st century, spitting seems to be making a comeback. Over the past few years, several companies have begun offering personal genomic tests online to the public. There have been famous images of “spit parties”, where celebrities are seen filling tubes with saliva to ship for DNA testing. Getting information on one’s genes has been promoted as fun, as part of social networking, and as a basis for improving health and preventing disease.
When it comes to spitting to improve one’s health, we say: think before you spit. Our knowledge of the potential benefits and harms of these tests is incomplete at best. Despite exciting research advances in genomics of common diseases, there is still much to learn about what this information means and how to use it to prevent disease. A little bit of incomplete or inaccurate information may even be harmful.
There are at least 2 key questions to consider when deciding whether personal genomic tests are worth your spit. Read more »
*This blog post was originally published at Genomics and Health Impact Blog*
Without having one myself, I am pretty familiar with bone marrow transplant as a potential curative and lifesaving approach. After all, it was invented in my hometown of Seattle and I’ve met Dr. Donall Thomas who won a Nobel prize for developing the approach. I have met people who have been given a new lease on life because of transplant, I’ve known people who have died when transplant did not work for them or complications overwhelmed them, and I know many doctors who are transplant experts.
I know how finding a perfect match can be hard — especially when the patient in need is part of an ethnic minority. And I have heard the horror stories of matched donors saying no to patients who would die if they didn’t receive a transplant from them.
Now comes a story from Massachusetts that’s almost as bad — not a story of sentencing people to death by not donating, but a story of defrauding our healthcare system and, in the process, undermining a legitimate nationwide effort to have more people registered as potential donors. Read more »
*This blog post was originally published at Andrew's Blog*