One of the greatest frustrations in modern medicine occurs when a safe, tried, and proven treatment exists to prevent deadly disease, but it is not possible to administer it to the potentially vulnerable victims. Over time, the disease unnecessarily spreads exponentially. Malaria in sub-Saharan Africa where one million die from the disease each year and tuberculosis in Haiti where the highest rate in the Western Hemisphere exists, are two examples. Another such disease that can be prevented with vaccination is the Human Papillomavirus, (HPV). While some strains of HPV lead to cancer an almost 100 percent disease prevention rate is associated with those vaccinated before the age of first potential exposure.
Despite validated scientific evidence of safety for more than 15 years, HPV vaccination skepticism not only persists, but is on the increase. Surveys show that the “anti-vaccine” culture fueled by COVID 19 has carried over to other vaccinations, including HPV. For example, provider orders for HPV vaccines decreased 24% in 2020, 9% in 2021 and 12% in 2022 when compared to 2019.
Many parents belonging to the “anti-vaccine movement” justify their actions with completely unfounded and unsupported fears of autism and other illnesses from the vaccine. However, their decisions affect the health of not only their children, but others as well.
According to Paul Offit, MD, professor of pediatrics, division of infectious diseases director of the Vaccine Education Center at the Children’s Hospital of Philadelphia (CHOP), every year in the United States, thousands of men and women die of cancers that can be prevented with a simple vaccine administered during adolescence to prevent HPV. He states, “It is critical that doctors and parents keep in mind; the disease is NOT ABOUT SEX…IT IS ABOUT CANCER!”
The Centers for Disease Control (CDC) has listed the prevention of HPV as a one of its “Top 5 Health Initiatives.” The pressure will be on health care providers to take the time to educate and dispel myths in order for parents to make informed decisions for the health of their children. In fact, local pediatrician Anders Nelson, who spends significant time educating parents and children about the importance of vaccination, requires parents to sign a “Refused HPV Vaccine” form and boasts a 99% compliance rate.
2013 the CDC reported 13.9% of males and 37.6% of females’ ages 13-19 are completing vaccination for Human Papillomavirus (HPV). Despite such low vaccination rates, a 50% reduction in HPV among 14 -19-year-old females was noted. Moreover, studies demonstrate a near 100% success rate to eradicate HPV in children vaccinated between the ages of 9 and 11 years old, leading health professionals to ask a frustrating and burning question: “Why do parents hesitate to vaccinate their children from a potentially deadly virus when a safe and effective cure exists?”
Reasons cited by parents for not vaccinating are challenging to health providers. Some of the most common responses include misunderstanding of HPV and its impact, unfamiliarity with vaccine recommendations, distrust of vaccine safety, religious and moral issues with mode of disease transmission, and social pressures. It will be the purpose of this column to dispel myths and address these concerns among parents.
HPV is the most common sexually transmitted disease (STD) in the United States. It is estimated that nearly all sexually active Americans will at some point become infected with the virus. HPV is spread by direct skin to skin contact. Although the infection maybe asymptomatic, it is still possible to spread the virus. Condoms are not 100% effective to prevent HPV because infected skin may be present outside of the barrier.
Studies have demonstrated that 90 percent of sexually active males and 80 percent of sexually active females will be infected with HPV in their lifetime. Moreover, 50 percent of HPV infections are high-risk, which can lead to cancer if the body does not clear these infections.
HPV is a family of viruses that primarily produce warts, but a limited number are responsible for cancers. There are a total 120 different subtypes of the virus capable of producing warts on skin or mucus membranes. Specific strains of the virus show preference for sites of infection, and different disease progressions. For example, most types are responsible for common warts on the hands and feet, however, there are strains with a preference for producing genital/anal disease. Moreover, the HPV causing the most of significant concern are those strains responsible for certain cancers. Some HPV strains will directly interrupt a cells repair cycle, resulting in vulnerability to be transformed into a cancerous cell. HPV types 16 and 18 are high risk for cancer and account for 70% of all 490,000 cases cervical cancer with 3,900 deaths. In addition, these two types cause penile, anal and head/neck cancers.
Prevention is paramount because once infected there is no treatment for HPV infections. Only the associated lesions, including genital warts, recurrent respiratory papillomatosis (RRP), pre-cancers, and cancers are treated. Treatment options professionals utilize are biopsy, cauterization, cryotherapy, and can be mildly to severely disfiguring. Biopsy results are used to determine the HPV strain and treatment. High risk subtypes lead to increased medical observation and have the potential for more invasive treatments which can impair fertility and cause facial disfigurement.
The most popular HPV vaccine available for use is Gardasil. It has been proven to safely protect against HPV 16 and 18, which account for 70% of all cervical cancers. Gardasil additionally protects against other high and low risk virus types.
The Gardasil vaccine was initially developed in the mid 1980’s at various institutions in the US and abroad. HPV proteins were added to a previous vaccine base that was proved safe and effective. After almost 30 years of testing and scrutiny by the FDA, Gardasil was deemed safe and released to the public in 2006.
Since distribution of the Gardasil vaccine, 270 million were administered worldwide with less than .032% serious adverse events. The reported vaccine reactions are injection site discomfort, dizziness, and fainting. Furthermore, research has concluded that there is no association with neurological conditions such as Guillain-Barre’ and Autism.
Gardasil is licensed for use for males and females ages 9 through 26 years. The vaccines are administered in a series of three on a 0, 2, and 6-month schedule. Studies have shown vaccination earlier in the recommended age spectrum has more advantageous results. For example, vaccinated children between the ages of 9-11 display an almost 100% prevention of disease. Sexually activity is not a contraindication to receiving the vaccine, but the vaccine is not recommended to those currently pregnant.
Despite the safety and efficacy of the vaccines, one reason reported by parents for not vaccinating their children is the concern that vaccination will increase sexual activity in adolescents. Although disconcerting for parents, a study conducted two years before the introduction of Gardasil by the U.S. Department of Health and Human Services reported that the number of sexually active teens has increased to 30% in ages 15 to 17 and more than 63% in ages 18 to 19. Furthermore, these numbers continued to increase regardless of public programs in sexual education and abstinence.
Since released in 2006, Gardasil has made a direct impact on HPV prevalence in adolescents. Even with less than desirable vaccination rates, HPV prevalence among adolescent females age 14-19 is declining. The decline in affected teens is predicted to lead to decreased future HPV related cancers. These vaccinations are safe, effective, powerful tools at our disposal to protect our children from the detrimental effects of a preventable disease. If you would like more information on Gardasil, consult your local Family Physician, Pediatrician, or Obstetrician-gynecologists (OB/GYN). Remember the advice of CHOP pediatrician, Dr. Paul Offit regarding the HPV vaccination for adolescents, “it is critical that doctors and parents keep in mind; the disease is NOT ABOUT SEX…IT IS ABOUT CANCER!”
Sources: CDC, Journal of Pediatrics, JAMA, International Journal of Cancer, Journal of Infectious Disease; www.MerckVaccines.com (GardasilR)
Medical Reviewer & Contributor: Anders Nelson, MD., F.A.A.P. is a pediatrician with offices in Scranton, PA.
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This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!
February is National Cancer Prevention Month and March is Colorectal Cancer Awareness Month. Unfortunately, according to a study conducted by Northeast Regional Cancer Institute (NRCI), our area has a higher rate of cancer compared to the rest of the United States. Residents of NEPA must be vigilant! While there is no fool-proof method for cancer prevention, scientific research does support the fact that healthy lifestyle choices are essential.
Source: American Cancer Society
EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” via Blog
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This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!
October is National Breast Cancer Awareness Month. Due in great part to improved awareness and advances in treatment and early diagnosis, the survival rate continues to improve. The American Cancer Society relies on information from the Surveillance, Epidemiology and End Results (SEER) database to provide survival statistics for different forms of cancer.
While the overall 5-year survival rate for breast cancer is 90% and the 10-year survival rate is 84%, the survival rate for those fortunate to have early detection and treatment is even more encouraging. For example, when breast cancer is determined to be “localized” (no sign that the cancer has spread outside of the breast), the 5-year survival rate improves to 99%! AWARENESS AND EARLY DETECTION ARE CRITICAL!
Maintain Healthy Body Mass Index (BMI) – studies repeatedly show that obesity increases the risk of breast cancer. A healthy BMI for women falls between 18.5 and 24.9. To find out your BMI visit: www.calculator.net
Maintain a Healthy Diet – the Mediterranean Diet emphasizes plant-based foods such as vegetables, beans, whole grain, fruits, nuts and seeds, and plant-based oils, especially olive oil. Avoid sugared drinks, refined carbs and fatty foods and eat fish or chicken instead of red meat.
Limit Alcohol Consumption – While no alcohol consumption may be optimal, up to one drink a day for women is acceptable.
Avoid or Limit Hormone Replacement Therapy – Studies show that menopausal hormone therapy increases the risk of breast cancer. For those who must take hormones to manage menopausal symptoms, limit the time period to less than three years and avoid progesterone.
Consider Estrogen-Blocking Drugs – For women with a family history of breast cancer or those over 60, consulting your physician about the pros and cons of these drugs.
Do Not Smoke – Studies show that smoking increases the risk of breast cancer. Visit: smokefree.gov for help with smoking cessation.
Breast Feed – According to the scientific literature, women who breast feed for at least a year in total have less risk of developing breast cancer. So, breast feed as long as possible.
Participate in Research – What can you do to help? Participate in clinical trials studying new and more effective ways to detect and treat breast cancer. Visit the National Cancer Institute
Limit - Manage Stress - According to a recent long-term study, both men and women have a higher incidence of cancer in those who did not manage chronic stress well. Life is full of potential stress and it cannot be avoided. But, you can learn to handle stress better. Exercise, meditation, and counseling are some options to explore. Try Progressive Muscle Relaxation (PMR) videos.
Exercise – A recent study in the Journal of the American Medical Association from Harvard has found that regular exercise can improve the survival of patients with breast cancer.
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This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.
For all of Dr. Mackarey's articles visit our Health and Wellness Page!
In 2000, President Bill Clinton dedicated March as National Colorectal Cancer Awareness Month. The purpose of this designation is to increase public awareness of the facts about colon cancer – a cancer that is preventable, treatable and has a high survival rate. Regular screening tests, expert medical care and a healthy lifestyle, which includes a proper diet and exercise, are essential for prevention. Several studies have demonstrated that exercise can also help prevent colon cancer.
The American Cancer Society estimates that there will be approximately 150,000 new cases of colorectal cancer in 2021. Of these, 52,980 men and women will succumb to the disease. It is the second-leading cause of U.S. cancer deaths for both men and women combined. The good news is incidence and mortality rates are dropping both nationally as well as in northeast Pennsylvania. The bad news is northeast Pennsylvania still has increased incidence and mortality rates when compared to the national average.
Studies show that prevention of this disease is multifaceted and includes: engaging in daily exercise, eating a low-fat diet with little red meat, avoiding smoking, drinking in moderation and having regular colonoscopy screenings.
Early detection is the key to survival. Death from colorectal cancer can be eliminated if caught at the earliest signs of disease. Colorectal cancer progresses very slowly, usually over years. It often begins as non-cancerous polyps in the lining of the colon. In some cases, these polyps can grow and become cancerous, often without any symptoms. Some symptoms that may develop are: blood in stool, changes in bowel movement, feeling bloated, unexplained weight loss, feeling tired easily, abdominal pain or cramps, and vomiting. Contact your physician if you have any of these symptoms.
The risk of colon cancer increases with age, as 90 percent of those diagnosed are older than age 50. A family history of colon cancer increases risk. Also, those with benign polyps, inflammatory bowel disease, ulcerative colitis or Crohn’s disease are at greater risk and should be screened more frequently.
The intestine works like a sewage plant, recycling the food and liquid needed by your body. However, it also stores waste prior to disposal. The longer the wastes remain idle in your colon or rectum, the more time toxins have to be absorbed from you waste into the surrounding tissues. One method in which exercise may help prevent colon cancer is to get your body moving, including your intestines. Exercise stimulates muscular contraction called peristalsis to promote movement of waste through your colon.
Exercise to prevent colon cancer does not have to be extreme. A simple increase in daily activity for 15 minutes, two times per day or 30 minutes, once per day is adequate to improve the movement of waste through your colon. This can be simply accomplished by walking, swimming, biking or playing golf, tennis or basketball. For those interested in a more traditional exercise regimen, perform aerobic exercise for 30-45 minutes four to five days per week, with additional sports and activities for the remainder of the time. For those in poor physical condition, begin slowly. Start walking for five to 10 minutes, two to three times per day. Then, add one to two minutes each week until you attain a 30-45 minute goal.
Medical Contributor: Christopher A. Peters, M.D
Dr. Christopher Peters is a partner of Radiation Medicine Associates of Scranton (RAMAS) and serves as medical director of Northeast Radiation Oncology Centers (NROC). He is an associate professor of clinical medicine at GCSOM.
Sources: American Cancer Society/Northeast Regional Cancer Institute, and CA Cancer J Clin.
This article is not intended as a substitute for medical treatment.
If you have questions related to your medical condition, please contact your family physician.
For further inquires related to this topic email: drpmackarey@msn.com
For all of Dr. Mackarey's articles visit: https://mackareyphysicaltherapy.com/forum/
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.
