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Vulvar cancer is an underrecognized gynecologic malignant disease. The incidence of vulvar cancer is 2.3 per 100 000 people in Canada, and is increasing with the rising prevalence of human papillomavirus (HPV). More than 90% of vulvar cancers are squamous cell carcinomas (SCC), mostly diagnosed after age 65 years. Vulvar SCC mimics nonspecific inflammation, which often delays diagnosis. Risk factors include advanced age, HPV infection, lichen sclerosis, smoking, immunodeficiency, and pelvic radiation
The AAP recommends vaccines to protect children against 18 diseases. The updated CDC schedule removed routine recommendations for hepatitis A and B, COVID-19, respiratory syncytial virus, rotavirus, influenza, and meningococcal disease, instead only recommending them for certain groups at high risk of infection or based on shared clinical decision-making. The AAP continues to suggest vaccines for these diseases.
There are also differences regarding administration. For example, the new CDC schedule recommends that children aged 4 to 6 years receive both a measles, mumps, and rubella vaccine and a monovalent varicella vaccine, but the AAP also supports a combination vaccine that covers all 4 viruses. And although the CDC recommends 1 dose of the human papillomavirus virus vaccine at ages 11 to 12 years, the AAP recommends 2 doses starting at ages 9 to 12 years.
Recommendations from the AAP are based on a review of vaccine safety data and the epidemiology of US diseases, the organization said. It added that insurance coverage and liability protection are expected to continue for all vaccines on the CDC schedule—even those no longer considered routine—according to federal officials.
Cervical cancer screening is one of the most significant public health accomplishments of the 20th century. Over the last 50 years, incidence and mortality rates from cervical cancer in the US have decreased by more than 50%1 because of widespread use of the Papanicolaou test and later adoption of high-risk human papillomavirus (hrHPV) testing.
Regular screening is critical in detecting disease because women with precancerous cervical intraepithelial neoplasia or early-stage cervical cancer are often asymptomatic. When detected early, 5-year cervical cancer survival is higher than 90%.1 Yet more than half of all cervical cancer diagnoses are made beyond an early stage; 37% when cancer has spread regionally to local lymph nodes and 15% when there are distant cancer metastases. Five-year survival is just 20% for women diagnosed with metastatic disease.1
Cervical cytology (Papanicolaou test) and hrHPV tests are highly effective in detecting early, more treatable disease; however, these modalities are only beneficial for women who undergo recommended screening. Unfortunately, about half of all women diagnosed with cervical cancer have never been screened or are not up-to-date on screening,2 and these women are more likely to present with regional or distant metastatic disease. Overall, approximately 1 in 4 women in the US are not up-to-date on cervical cancer screening.3 Women living in poverty or having fewer years of formal education have even lower screening rates. The direct link between screening and survival illustrates a clear and urgent need to improve cervical cancer screening rates in the US; new self-collection options approved by the US Food and Drug Administration (FDA) provide an opportunity to do so.
In this Double Take video from the New England Journal of Medicine, Dr. Julie Barzilay discusses the connection between certain strains of human papillomavirus (HPV) and cancer, as well as the evidence to support the safety and efficacy of the HPV vaccine in reducing the risk of cervical neoplasia. Strategies for discussing the HPV vaccine with patients and families are also reviewed.
This JAMA Patient Page discusses screening for cervical cancer, including who should be screened, recommendations for handling positive results, and the prevention of cervical cancer.
