Patient Education

Educational interventions to increase Tdap vaccination rates among pregnant women

The highly contagious respiratory infection pertussis remains a public health problem for the United States.1 Infants have the highest morbidity and mortality rates from pertussis because of a lack of immunity at birth and an immature immune system. In 2015, a total of 20,762 cases of pertussis were reported in the U.S., with infants accounting for 1,960 cases (9.5% of the total cases).2 Continue reading »

Genetic testing for hereditary cancer syndromes in women

What is a hereditary cancer syndrome?

Cancer can be sporadic, familial, or hereditary. A sporadic cancer happens at random, maybe because of a mistake that occurred when cells in the body were dividing or because a person was exposed to toxins (poisons) in their environment—for example, cigarette smoke—over a long period of time. A familial cancer occurs in members of the same family and is likely caused by a combination of genetic and toxic environmental factors. A hereditary cancer syndrome is caused by a specific mutation (change) in a certain gene that can be passed down from parent to child. Continue reading »

Lung cancer screening*

Tests are used to screen for different types of cancer.

Some screening tests are used because they have been shown to be helpful both in finding cancers early and in decreasing the chance of dying from these cancers. Other tests are used because they have been shown to find cancer in certain people; however, it has not been proven in clinical trials that use of these tests will decrease the risk of dying from cancer.

Scientists study screening tests to find those with the fewest risks and most benefits. Cancer screening trials also are meant to show whether early detection (finding cancer before it causes symptoms) decreases a person’s chance of dying from the disease. For some types of cancer, finding and treating the disease at an early stage may result in a better chance of recovery. Clinical trials that study cancer screening methods are taking place in many parts of the country. Information about ongoing clinical trials is available from the National Cancer Institute website.

Three screening tests have been studied to see if they decrease the risk of dying from lung cancer.

Low-dose spiral CT scan (LDCT scan): A procedure that uses low-dose radiation to make a series of very detailed pictures of areas inside the body. It uses an x-ray machine that scans the body in a spiral path. The pictures are made by a computer linked to the x-ray machine. This procedure is also called a low-dose helical CT scan.

Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.

Sputum cytology: Sputum cytology is a procedure in which a sample of sputum (mucus that is coughed up from the lungs) is viewed under a microscope to check for cancer cells.

Screening with low-dose spiral CT scans has been shown to decrease the risk of dying from lung cancer in heavy smokers.

The National Lung Screening Trial studied people aged 55 years to 74 years who had smoked at least 1 pack of cigarettes per day for 30 years or more. Heavy smokers who had quit smoking within the past 15 years were also studied. The trial used chest x-rays or LDCT scans to check for signs of lung cancer.

The scientists found that LDCT scans were better than chest x-rays at finding early-stage lung cancer.  Screening with LDCT also decreased the risk of dying from lung cancer in current and former heavy smokers. A Guide is available for patients and healthcare providers to learn more about the benefits and harms of LDCT screening for lung cancer.

Screening with chest x-rays and/or sputum cytology does not decrease the risk of dying from lung cancer.

Chest x-ray and sputum cytology are two screening  tests that have been used to check for signs of lung cancer. Screening with chest x-ray, sputum cytology,  or both of these tests does not decrease the risk of dying from lung cancer.

  • National Cancer Institute. Updated April 27, 2015. Readers are invited to photocopy Patient education pages in the journal and distribute them to their patients.

 

 

 

Depression among women of childbearing age*

More than just feeling sad or down or having the blues, many women like yourself, in your late teens to early 50s, can develop a mental illness called depression. Yes, depression is an illness, not a sign of weakness, and it is treatable. If you think you might have depression, see your healthcare provider (HCP) to find out, and to get the treatment you need.

What is depression?

Many women, including pregnant women and women who have recently given birth, experience depression. Just like other illnesses, depression has symptoms, including:

  • A low or sad mood
  • Loss of interest in fun activities
  • Changes in eating, sleep, and energy
  • Problems in thinking, concentrating, and making decisions
  • Feelings of worthlessness, shame, or guilt
  • Thoughts that life is not worth living

When many of these symptoms occur together and last for more than 1-2 weeks at a time, this is depression. According to a national survey, about 11% of non-pregnant women of childbearing age experienced major depression in the previous year.1

What is postpartum depression?

Postpartum depression is depression that occurs after having a baby. Symptoms of postpartum depression are similar to those of depression, but they also include:

  • Trouble sleeping when your baby sleeps (more than the lack of sleep new moms usually get)
  • Feeling numb or disconnected from your baby
  • Having scary or negative thoughts about the baby, like thinking someone will take your baby away or hurt your baby
  • Worrying that you will hurt the baby
  • Feeling guilty about not being a good mom, or ashamed that you cannot care for your baby

According to the same national survey, 8%-19% of women who gave birth within the past year reported having frequent postpartum depression symptoms.

I just had a baby. Why am I having such a hard time now?

Being a mom is hard! For some women, the journey to becoming a mom is hard too. You may have heard of postpartum depression, but many women don’t know that depression can occur during pregnancy (it’s called perinatal depression) or with other events, such as losing a baby or having trouble getting pregnant. According to the same national survey mentioned above, about 8% of women who were pregnant during the past year experienced depression during their pregnancy.1

Did you know that the following experiences may put some women, including you, at higher risk for depression than others?

  • Having a hard time getting pregnant: Depression affects many women who experience infertility.
  • Having twins or triplets: Mothers of multiples, compared with women who give birth to just one baby, have a greater risk of developing depression.
  • Losing a baby: Women who experience miscarriage (losing a baby early in pregnancy), stillbirth (losing a baby late in pregnancy), or death of a newborn are more likely to experience depression.
  • Having a baby as a teen: Teen moms are more likely than older moms to have postpartum depression.
  • Having premature labor and delivery: These mothers have a significantly higher risk for depression.
  • Having a baby who is different: A mother’s risk for depression increases if the baby has a birth defect or disability.
  • Pregnancy and birth complications: Some studies have shown an increased risk for depression among women who experienced complications and hospitalization during pregnancy or an emergency C-section.
  • Having a baby who is sick or in the hospital: Women with sick or hospitalized babies may be at increased risk for depression, as well as stress and anxiety.
  • Having a healthy pregnancy and childbirth: Women having a difficult pregnancy or childbirth are not the only ones who experience depression. Depression can also occur among women with a healthy pregnancy and healthy birth.

That sounds like me. But how do I know if what I’m experiencing is depression? What should I do?

Depression is common. If you are worried about the way you have been feeling, you need to tell your HCP about your concerns. Answering these questions may help you determine whether what you are experiencing is depression. During the past 2 weeks, how often have you felt…

Little interest or pleasure in doing things?
Not at all
Several days
More than half the days
Nearly every day
Down, depressed, or hopeless?
Not at all
Several days
More than half the days
Nearly every day

If you answered “more than half the days” or “nearly every day” to either question, you may be depressed and should seek help from an HCP. Your HCP can help figure out whether you have depression or not, and she or he can help find the best treatment for you.

If I don’t do anything about my depression, will it eventually go away on its own?

The depression may eventually go away without help. It could also get worse instead of better. There are effective treatments for depression that may include medication or talking with a trained therapist. The best way to deal with depression is to see an HCP or a counselor. The earlier you seek help, the better you may do.

References
1. Ko JY, Farr SL, Dietz PM, Robbins CL. Depression and treatment among U.S. pregnant and nonpregnant women of reproductive age, 2005-2009. J Womens Health (Larchmt). 2012;21(8):830-836.

2. Davé S, Petersen I, Sherr L, Nazareth I. Incidence of maternal and paternal depression in primary care: a cohort study using a primary care database. Arch Pediatr Adolesc Med. 2010;164(11):1038-1044.

Content source: Centers for Disease Control and Prevention, Division of Reproductive Health, National Center for Chronic Disease Prevention, and Health Promotion. http://www.cdc.gov/reproductivehealth/Depression/

*Readers are invited to photocopy Patient education pages in the journal and distribute them to their patients.

Human papillomavirus (HPV)*

As parents, you do everything you can to protect your children’s health for now and for the future. Today, there is strong weapon to prevent several types of cancer in our kids: the HPV vaccine.

HPV and cancer

HPV is short for human papillomavirus, a common virus. In the United States each year, there are about 17,000 women and 9,000 men affected by HPV-related cancers. Many of these cancers could be prevented with vaccination. In both women and men, HPV can cause anal cancer and mouth/ throat (oropharyngeal) cancer. It can also cause cancers of the cervix, vulva, and vagina in women; and cancer of the penis in men.

For women, screening is available to detect most cases of cervical cancer with a Pap smear. Unfortunately, there is no routine screening for other HPV-related cancers for women or men, and these cancers can cause pain, suffering, or even death. That is why a vaccine that prevents most of these types of cancers is so important.

More about HPV

HPV is a virus passed from one person to another during skin-to-skin sexual contact, including vaginal, oral, and anal sex. HPV is most common in people in their late teens and early 20s. Almost all sexually active people will get HPV at some time in their lives, though most will never even know it. Most of the time, the body naturally fights off HPV, before HPV causes any health problems. But in some cases, the body does not fight off HPV, and HPV can cause health problems, like cancer and genital warts. Genital warts are not a life-threatening disease, but they can cause emotional stress, and their treatment can be very uncomfortable. About 1 in 100 sexually active adults in the United States has genital warts at any given time.

HPV vaccination is recommended for pre-teen girls and boys at age 11 or 12 years

HPV vaccine is also recommended for girls aged 13 through 26 years and for boys aged 13 through 21 years who have not yet been vaccinated. So if your son or daughter hasn’t started or finished the HPV vaccine series—it’s not too late! Talk to his or her healthcare provider (HCP) about getting the series for your child now. Two vaccines—Cervarix and Gardasil—are available to prevent the HPV types that cause most cervical cancers and anal cancers. One of the HPV vaccines, Gardasil, also prevents vulvar and vaginal cancers in women and genital warts in both women and men. Only Gardasil has been tested and licensed for use in males. Both vaccines are given in a series of 3 shots over 6 months. The best way to remember to get your child all three shots is to make an appointment for the second and third shot before you leave the HCP’s office after the first shot.

Is the HPV vaccine safe?

Yes. Both HPV vaccines were studied in tens of thousands of people around the world. More than 57 million doses have been distributed to date, and there have been no serious safety concerns. Vaccine safety continues to be monitored by the CDC and the FDA. These studies continue to show that HPV vaccines are safe.

The most common side effects reported are mild. They include pain where the shot was given (usually the arm), fever, dizziness, and nausea.

You may have heard that some kids faint when they get vaccinated. Fainting is common with preteens and teens for many health-related procedures, not just the HPV shot. Be sure that your child eats something before going to get the vaccine. It’s a good idea to have your child sit or lie  down while getting any vaccine, and for 15 minutes afterwards, to prevent fainting and any injuries that could happen from fainting.

The HPV vaccine can safely be given at the same time as the other recommended vaccines, including the Tdap, meningococcal, and influenza vaccines. Learn more about all of the recommended pre-teen vaccines at www.cdc.gov/vaccines/teens.

Help paying for vaccines

The Vaccines for Children (VFC) program provides vaccines for children aged 18 years or younger who  are under-insured, not insured, Medicaid-eligible, or American Indian/Alaska Native. Learn more about the VFC program at www.cdc.gov/Features/VFCprogram/.

Whether you have insurance, or your child is VFC-eligible, some HCPs’ offices may also charge a fee to give the vaccines.

For more information about the vaccinesrecommended for pre-teens and teens:800-CDC-INFO (800-232-4636) http://www.cdc.gov/vaccines/teens

 

Infertility evaluation and treatment

How common is infertility?

After 1 year of having unprotected sex, 15% of couples are unable to conceive—that is, to get pregnant. After 2 years, 10% of couples still have not had a successful pregnancy.

What are the causes of female infertility?

For about a third of couples who have difficulty conceiving, the woman is found to have the problem. In order for a woman to conceive, she needs to ovulate (produce and release eggs from your ovaries), have patent Fallopian tubes (that is, tubes free of blockages), and have a healthy uterus that can support a pregnancy. Fertility can be affected by problems with the menstrual cycle, by a disease or a condition, by lifestyle factors, and/or by age-related factors.

What are the causes of male infertility?

For more than a third of couples who have difficulty conceiving, the man is found to have the problem. To impregnate a woman, a man must have sperm that can reach and combine with a woman’s egg. Sperm are made and stored in the testicles. During sex, sperm mix with seminal fluid, or semen, and are ejaculated by the penis into the woman’s reproductive tract. Infertility in a man is often related to low sperm production, which may be due to a varicocele, an enlarged vein in the testicle. Other causes of male infertility are hormone imbalances, medication or steroid use, and blockages in the reproductive organs.

How is female infertility evaluated?

In addition to a health history and physical exam, your healthcare provider will likely order blood tests to check for conditions such as a thyroid disorder or a high level of the hormone prolactin. Other blood tests may check:

A progesterone level late in the second half of your menstrual cycle to tell if ovulation has occurred and if your ovaries are producing a normal amount of this hormone.

Follicle-stimulating hormone and estradiol levels in the first few days of the menstrual cycle to evaluate ovarian function.

Anti-Müllerian hormone (AMH) level to evaluate ovarian reserve (your remaining egg supply).

Because some of these tests must be done at specific times in the menstrual cycle and repeated for accuracy, this part of your evaluation may take several weeks.

Other tests may be done to examine your Fallopian tubes and determine if a blockage is preventing movement of the egg from the ovaries or preventing the egg and sperm from reaching each other. These tests include a hysterosalpingogram, transvaginal ultrasound (TVUS), and laparoscopy. TVUS can also be used to assess your ovaries, including the number of remaining follicles you have, and it can be used to assess the uterus.

How is male infertility evaluated?

A health history and physical exam are also part of the man’s evaluation. The most common lab test for male infertility is a semen analysis to assess the quantity and quality of the sperm. A man may need to provide a semen sample on more than one occasion because sperm production can vary over time, depending on his activities and stress level.

How is female infertility treated?

Treatment options depend on the cause. If you have a problem with ovulation, you may try a medication that will help your ovaries produce and release eggs. If you have a blockage in a Fallopian tube, you may need to undergo a minor surgical procedure to remove it. If neither medication nor surgery is an option or if the treatment does not work, you may be able to use an assisted reproductive technology (ART) such as in vitro fertilization.

How is male infertility treated?

Medication can treat problems such as hormone imbalances. Surgery can help repair blockages in the tubes that transport sperm from the testicles to the penis. Surgery can be used to repair a varicocele. If medication or surgery does not restore fertility, ART may be considered.

Resources: National Institutes of Health. Eunice Kennedy Shriver National Institute of Child Health and Human Development. When should I consult a healthcare provider? How is infertility diagnosed?

* Readers are invited to photocopy or download a PDF Patient Education pages in the journal and distribute them to their patients.

Inside Knowledge: Get the Facts About Gynecologic Cancer

The Inside Knowledge campaign raises awareness of the five main types of gynecologic cancer: cervical, ovarian, uterine, vaginal, and vulvar. Inside Knowledge encourages women to pay attention to their bodies, so they can recognize any warning signs and seek medical care.

New television and radio public service announcements in English and Spanish feature actress Cote de Pablo, talking about her own cervical cancer scare, and sharing advice for other women. And check out the new posters telling Cote’s story, as well as our Behind-the-Scenes videos from filming!

Inside Knowledge also has new TV and radio PSAs that highlight gynecologic cancer symptoms. The PSAs encourage women to learn the symptoms, and pay attention to what their bodies are telling them.

Inside Knowledge has resources for women, and for health care providers and organizations to share with their patients and communities.

Read more and access the resources here at the CDC’s website

Ten questions patients are being encouraged to ask (are you proactively answering them?)

The communication gap between healthcare providers (HCPs) and patients has been met with its fair share of commentary, research, and critique. One thing we can likely all agree on:

For patients to safely use their medications—and reap the most benefit—they need a clear understanding of how and when to take them and what to be on the lookout for in terms of potential risks and side effects. Studies have shown that all too commonly, patients lack key information or are not aware of risks associated with the medications they take. Clear communication at the start of a new drug regimen can help maximize the helpful effects and minimize possible adverse effects of medications.

With the ultimate goal of reducing adverse drug reactions and improving medication adherence, the National Council on Patient Information and Education (NCPIE), in collaboration with the FDA, launched the Talk Before You Take (TBYT) public education initiative to increase medication safety communications between HCPs and patients. TBYT encourages patients to proactively ask, and HCPs to proactively address, 10 questions about all new medications prescribed:

1. What’s the name of the medicine, and what is it for?

2. How and when do I take it, and for how long?

3. What side effects should I expect, and what should I do about them?

4. Should I take this medicine on an empty stomach or with food?

5. Should I avoid any activities, foods, drinks, alcoholic beverages, or other medicines while taking this prescription?

6. If it’s a once-a-day dose, is it best to take it in the morning or in the evening?

7. Will this medicine work safely with any other medicines I’m taking, including over-the-counter medicines?

8. When should I expect the medicine to begin to work, and how will I know if it’s working?

9. How should I store it?

10. Is there any additional written information I should read about the medicine?

Do you and your teams proactively address these questions with patients when a new medicine is prescribed?  Initiatives to improve medication safety, such as

Talk Before You Take, are most effective when HCPs are aware and involved. NPWH serves on NCPIE’s advisory board and supports its activities to educate and mobilize consumers around safe use of medications. To facilitate clear conversations about medication use, the campaign provides information for HCP offices and handouts for patients, all available at TalkBeforeYouTake.org.

W. Ray Bullman is Executive Vice President of the National Council on Patient Information and Education.

Get your child vaccinated against HPV!

Why does my child need the HPV vaccine?

The HPV vaccine protects against cancers caused by human papillomavirus (HPV). HPV is a very common virus; nearly 80 million people in the United States—about 1 in 4—are infected by it. About 14 million people, including teens, are newly infected with HPV each year. HPV can cause cancer of the cervix, vagina, or vulva in women; cancer of the penis in men; and cancer of the anus or the back of the throat in both women and men.

When should my child be vaccinated?

Your daughter or son should get the HPV vaccine at age 11 or 12. The vaccine is given in three shots. The second shot is given 1 or 2 months after the first shot. The third shot is given 6 months after the first shot.

Why is the HPV vaccine recommended at such a young age?

For the vaccine to be effective, it should be given before a person is exposed to HPV. Exposure to this virus occurs with sexual activity with another person. Most people first engage in sex in their teenage or young adult years. Therefore, it is best to start the vaccination series early—before a person has sex and could potentially be exposed to HPV. Also, the HPV vaccine produces a stronger immune response in preteens than it does in older teens and young adults.

Who else should get the HPV vaccine?

Teen girls and boys who did not start or finish the HPV vaccine series when they were younger should get it now. Young women can get the HPV vaccine through age 26, and young men can get it through age 21. Men between the ages of 21 and 26 who have sex with men and/or who have poor immune systems (including those with HIV infection) can get the HPV vaccine if they did not get it when they were younger.

Is the vaccine still effective if a young person has had sex?

Yes. Even though HPV infection usually happens soon after someone has sex for the first time, a person might not be exposed to any or all of the HPV types that are in the vaccine. Females and males in the age groups recommended for vaccination are likely to get at least some protection from the vaccine.

How well does the HPV vaccine work?

Very well! Clinical trials have shown that the vaccines provide close to 100% protection against pre-cancers and genital warts caused by HPV.

How long will the HPV vaccine provide protection?

Studies show that the vaccine offers protection against HPV infection and HPV-related disease that lasts for at least 8-10 years. The vaccine has been available for only 10 years, so more will be known as time goes on. There is no evidence to suggest that the HPV vaccine loses the ability to provide protection over time.

Will the vaccine require a booster?

In the U.S., the HPV vaccine series requires three shots given over 6 months; booster doses are not recommended. Like all vaccines, HPV vaccine is monitored continually to make sure it remains safe and effective. If protection from HPV vaccine doesn’t last as long as it should, then the CDC will review the data and determine if a booster shot should be recommended.

Does someone need to restart the HPV vaccine series if too much time passes between the shots?

No. If someone waits longer than that the recommended interval between shots, she or he need not restart the series. Even if months or years have passed since the last shot, the series should still be completed.

What are some possible side effects of HPV vaccination?

Vaccines, like any medicine, can have side effects. Many people who get the HPV vaccine have no side effects at all. Some people report having very mild side effects such as pain, redness, or swelling in the arm where the shot was given; fever; headache or fatigue; nausea; muscle or joint pain; and brief fainting spells. Sitting or lying down for 15 minutes after a vaccination can help prevent fainting and injuries caused by falls. On very rare occasions, severe allergic reactions may occur after vaccination.

Will the vaccine cause cancer?

The HPV vaccine cannot cause HPV infection or cancer. By contrast, not receiving the HPV vaccine at the recommended ages can leave a person vulnerable to cancers caused by HPV. Will the vaccine cause my daughter to have trouble getting pregnant later on? No data suggest that the HPV vaccine has an effect on a woman’s ability to get pregnant in the future. In fact, getting vaccinated and protecting against cervical cancer can help women have healthy pregnancies and healthy babies. Not getting the HPV vaccine leaves people vulnerable to HPV infection; for women, this could lead to cervical cancer. Treatment of cervical cancer could leave a woman unable to have children. Even the treatment of cervical pre-cancers caused by HPV can cause preterm labor or problems at the time of delivery.

Readers are invited to photocopy Patient Education pages in the journal and distribute them to their patients.

Resources

Centers for Disease Control and Prevention. HPV Vaccines: Vaccinating your Preteen or Teen. Page last updated January 26, 2015.

Centers for Disease Control and Prevention.Fact Sheet for Parents Questions and Answers. Page last updated December 28, 2015.

Expedited partner therapy for chlamyida

You may have chlamydia. If you do, you need to be treated for it. Your sex partner was recently treated for chlamydia, an infection you can get if you have sex with a person who is already infected. Many people with chlamydia do not know they have an infection because they feel fine.

Your partner may have given you a prescription or pills (azithromycin; also called Zithromax or a Z-Pak) for you to take. This medicine was given to your partner by a healthcare provider to treat you. This type of treatment is sometimes called expedited partner therapy. It’s better for you to go to your own provider to get tested for chlamydia and other sexually transmitted diseases (STDs). But if you can’t go to get tested, then you should take the medicine in this package.

If you are a female and have symptoms of belly or pelvic pain, especially during sex, you should go see a healthcare provider to make sure that you do not have pelvic inflammatory disease (PID). PID can be very dangerous and lead to infertility, pregnancy problems, or pain that lasts a long time.

If you have any questions, please call your healthcare provider. If you think you may be having a bad reaction to this medicine, call your provider or drugstore. If you are having a serious reaction, such as trouble breathing, which is very rare, go to your nearest emergency room and bring the empty medicine packet with you.

Directions for taking azithromycin (Zithromax) 250 mg tablets

This medicine is very safe. However, you should not take it if you ever had an allergic reaction (such as a rash, trouble breathing, closing of your throat, swelling of the lips and tongue, or hives) after taking any medicines. If you are unsure about whether you have ever had an allergy to any medicines, call your provider or drugstore before taking this medicine. If you have a serious, longterm illness such as kidney disease, liver disease, heart disease, or stomach problems, talk to your provider before taking this medicine.

Swallow all of the enclosed pills. These pills should be taken one after another at the same time, not on separate days. Some people have a mild upset stomach, which does not last long, after taking this medicine.

After taking the medicine, do not have sex for at least 7 days. Do not share this medicine or give it to anyone else. It is important to tell any person with whom you’ve have had sex in the past 60 days to go to a healthcare provider and get tested for chlamydia.

Adapted from the Partner Study, Public Health – Seattle & King County and the STD Treatment Guidelines, CDC.

Gonorrhea is another STD for which expedited partner therapy is available. To find out more about gonorrhea, log on to cdc.gov. To find out more about chlamydia, log on to cdc.gov.

*Healthcare providers need to conform to their state legal requirements with respect to the use of expedited partner therapy. If the information in this Patient education page is applicable to the patients in your state and in your practice, then you are invited to photocopy the page and distribute it to patients who can benefit from this information.

Lung cancer screening*

PDF 50

 

KEY POINTS

  • Tests are used to screen for different types of cancer.
  • Three screening tests have been studied to see if they decrease the risk of dying from lung cancer.
  • Screening with low-dose spiral computed tomography (CT) scans has been shown to decrease the risk of dying from lung cancer in heavy smokers.
  • Screening with chest x-rays and/or sputum cytology does not decrease the risk of dying from lung cancer.

Tests are used to screen for different types of cancer.

Some screening tests are used because they have been shown to be helpful both in finding cancers early and in decreasing the chance of dying from these cancers. Other tests are used because they have been shown to find cancer in certain people; however, it has not been proven in clinical trials that use of these tests will decrease the risk of dying from cancer.

Scientists study screening tests to find those with the fewest risks and most benefits. Cancer screening trials also are meant to show whether early detection (finding cancer before it causes symptoms) decreases a person’s chance of dying from the disease. For some types of cancer, finding and treating the disease at an early stage may result in a better chance of recovery. Clinical trials that study cancer screening methods are taking place in many parts of the country. Information about ongoing clinical trials is available from the National Cancer Institute website.

Three screening tests have been studied to see if they decrease the risk of dying from lung cancer.

  • Low-dose spiral CT scan (LDCT scan): A procedure that uses low-dose radiation to make a series of very detailed pictures of areas inside the body. It uses an x-ray machine that scans the body in a spiral path. The pictures are made by a computer linked to the x-ray machine. This procedure is also called a low-dose helical CT scan.
  • Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
  • Sputum cytology: Sputum cytology is a procedure in which a sample of sputum (mucus that is coughed up from the lungs) is viewed under a microscope to check for cancer cells.

Screening with low-dose spiral CT scans has been shown to decrease the risk of dying from lung cancer in heavy smokers.

The National Lung Screening Trial studied people aged 55 years to 74 years who had smoked at least 1 pack of cigarettes per day for 30 years or more. Heavy smokers who had quit smoking within the past 15 years were also studied. The trial used chest x-rays or LDCT scans to check for signs of lung cancer.

The scientists found that LDCT scans were better than chest x-rays at finding early-stage lung cancer. Screening with LDCT also decreased the risk of dying from lung cancer in current and former heavy smokers. A Guide is available for patients and healthcare providers to learn more about the benefits and harms of LDCT screening for lung cancer.

Screening with chest x-rays and/or sputum cytology does not decrease the risk of dying from lung cancer.

Chest x-ray and sputum cytology are two screening tests that have been used to check for signs of lung cancer. Screening with chest x-ray, sputum cytology, or both of these tests does not decrease the risk of dying from lung cancer.

*National Cancer Institute. Updated April 27, 2015. Readers are invited to photocopy Patient education pages in the journal and distribute them to their patients.

Handout on HPV for your patients from the Centers for Disease Control and Prevention

As parents, you do everything you can to protect your children’s health for now and for the future. Today, there is a strong weapon to prevent several types of cancer in our kids: the HPV vaccine.

HPV and cancer

HPV is short for human papillomavirus, a common virus. In the United States each year, there are about 17,000 women and 9,000 men affected by HPV-related cancers. Many of these cancers could be prevented with vaccination. In both women and men, HPV can cause anal cancer and mouth/throat (oropharyngeal) cancer. It can also cause cancers of the cervix, vulva, and vagina in women; and cancer of the penis in men.

For women, screening is available to detect most cases of cervical cancer with a Pap smear. Unfortunately, there is no routine screening for other HPV-related cancers for women or men, and these cancers can cause pain, suffering, or even death. That is why a vaccine that prevents most of these types of cancers is so important.

More about HPV

HPV is a virus passed from one person to another during skin-to-skin sexual contact, including vaginal, oral, and anal sex. HPV is most common in people in their late teens and early 20s. Almost all sexually active people will get HPV at some time in their lives, though most will never even know it.

Most of the time, the body naturally fights off HPV, before HPV causes any health problems. But in some cases, the body does not fight off HPV, and HPV can cause health problems, like cancer and genital warts. Genital warts are not a life-threatening disease, but they can cause emotional stress, and their treatment can be very uncomfortable. About 1 in 100 sexually active adults in the United States has genital warts at any given time.

HPV vaccination is recommended for pre-teen girls and boys at age 11 or
12 years

HPV vaccine is also recommended for girls aged 13 through 26 years and for boys aged 13 through 21 years who have not yet been vaccinated. So if your son or daughter hasn’t started or finished the HPV vaccine series—it’s not too late! Talk to his or her healthcare provider (HCP) about getting the series for your child now.

Two vaccines—Cervarix and Gardasil—are available to prevent the HPV types that cause most cervical cancers and anal cancers. One of the HPV vaccines, Gardasil, also prevents vulvar and vaginal cancers in women and genital warts in both women and men. Only Gardasil has been tested and licensed for use in males. Both vaccines are given in a series of 3 shots over 6 months. The best way to remember to get your child all three shots is to make an appointment for the second and third shot before you leave the HCP’s office after the first shot.

Is the HPV vaccine safe?

Yes. Both HPV vaccines were studied in tens of thousands of people around the world. More than 57 million doses have been distributed to date, and there have been no serious safety concerns. Vaccine safety continues to be monitored by the CDC and the FDA. These studies continue to show that HPV vaccines are safe.

The most common side effects reported are mild. They include pain where the shot was given (usually the arm), fever, dizziness, and nausea.

You may have heard that some kids faint when they get vaccinated. Fainting is common with preteens and teens for many health-related pro­cedures, not just the HPV shot. Be sure that your child eats something before going to get the vaccine. It’s a good idea to have your child sit or lie down while getting any vaccine, and for 15 minutes afterwards, to prevent fainting and any injuries that could happen from fainting.

The HPV vaccine can safely be given at the same time as the other recommended vaccines, including the Tdap, meningococcal, and influenza vaccines. Learn more about all of the recommended pre-teen vaccines at www.cdc.gov/vaccines/teens.

Help paying for vaccines

The Vaccines for Children (VFC) program provides vaccines for children aged 18 years or younger who are under-insured, not insured, Medicaid-eligible, or American Indian/Alaska Native. Learn more about the VFC program at www.cdc.gov/Features/VFCprogram/.

Whether you have insurance, or your child is VFC-eligible, some HCPs’ offices may also charge a fee to give the vaccines.

*Readers are invited to photocopy Patient education pages in the journal and distribute them to their patients.

Healthy bones for women*

 

Osteoporosis is a disease known for slow, silent loss of bone. (In this case, the word “silent” means that you won’t feel anything as the disease starts or worsens.) Bones become thinner and weaker, so they are more likely to fracture—that is, to break. Women are more likely than men to get osteoporosis. Your risk is also higher if someone in your family has had osteoporosis or if at least one of your parents has had a broken hip. More than 1.5 million fractures each year are related, at least in part, to osteoporosis.

Your healthcare professional (HCP) can help you assess your bone health at routine visits by…

Measuring your height.
A loss in height may mean that you have had silent spine fractures. Any loss in height from year to year should be checked further.
Using your height and weight measures together to compute your body mass index (BMI).
A low BMI or a weight less than 127 pounds (thinner women) is a risk factor for osteoporosis.
Reviewing all the medicines you are taking, including prescription and over-the-counter medicines and supplements.
Medicines such as prednisone, some anti depressants, some heartburn/ulcer drugs, and others may increase bone loss.
Discussing whether you should have a blood test to measure your vitamin D level.
Vitamin D is needed to absorb calcium in your bones. A normal blood level of vitamin D is 30 ng/mL or higher. Risk factors for having a low vitamin D level include being older than 60, being obese, having a disease of the kidney or bowel, getting too little sun, having very
dark skin, having had gastric bypass surgery, and using certain medicines. If your vitamin D level is too low, your HCP will prescribe vitamin D supplements and retest your vitamin D level in a few months.
Discussing whether you should have a bone density test.
A bone density test measures bone mass in places such as the lower spine, hip, and forearm. The most common bone density test done is a DXA (dual energy x-ray absorptiometry) scan. You should have this test if you are 65 or older, if you are older
than 50 and have risk factors for osteoporosis, if you broke a bone after age 50, or if you are past menopause and are stopping the use of estrogen. Depending on your test results and your risk factors, and whether you’ve had any osteoporosis treatment, you may need another DXA scan every 2 or more years.

Using a tool called FRAX to see whether you should have a bone density test (if
you are past menopause but not yet 65).
Your HCP may also use FRAX if your bone density test shows low bone mass (but not osteoporosis) to see if you need to be on an osteoporosis prevention medicine. FRAX shows your risk of having a bone fracture in the next 10 years by looking at your risk factors and, if done, your bone density test scores.

You can maintain or improve your bone health by…

Eating the right foods and taking supplements if needed.
You need calcium to make and keep your bones strong. Adult women up to age 50 need 1,000 mg/day and women older than 50 need 1,200 mg/day. Good food sources of calcium are low-fat dairy products, calcium-fortified foods (e.g., cereals, orange juice),
kale, bok choy, halibut, and sardines with bones. Know your usual dietary intake of calcium to decide how much supplement is needed to meet daily requirements. If you take a supplement, it’s best to divide your dose so you take no more than 500 mg of calcium at one time. Calcium carbonate costs the least and is taken with meals to work best. Calcium citrate need not be taken with meals.  You need vitamin D for calcium to be absorbed by your bones. Women younger than 50 need 400-800 IU/day and women older than 50 need 800-1,000 IU/day. Most women do not stay out in the sun long enough for their bodies to make vitamin D. Good food sources of vitamin D are wild salmon, halibut, trout, sardines, and vitamin Dfortified foods (e.g., milk, yogurt, cereals, orange juice). Know your usual dietaryintake of vitamin D to decide how much supplement is needed to meet daily requirements.
Limiting your intake of sodium, which reduces calcium absorption.
Look for sodium content on food labels. Avoid processed and canned foods and
salted snack foods and nuts. Eat fresh or frozen fruits and vegetables and fresh
lean meats, poultry, and fish.
Getting regular exercise, which helps make your bones strong.
Plan to get at least 30 minutes of moderate weight-bearing exercise on most
days of the week. Weight-bearing exercises include brisk walking, running/jogging, dancing, stair climbing, tennis, and use of exercise equipment such as elliptical training and stair-step machines and treadmills. Plan to do muscle strengthening exercises 2 or 3 days each week. You can lift weights, use weight machines, or use elastic exercise bands. Yoga and Pilates can improve strength, flexibility, and balance.
Not smoking.
Smoking decreases calcium absorption and speeds up bone breakdown.
Drinking alcohol in moderation.
For women, this is no more than 2 drinks each day. One drink = 10 ounces of beer, 4 ounces of wine,or 1 ounce of liquor. Drinking heavily can lead to bone loss.

Resources for more information

National Osteoporosis Foundation
4BoneHealth
FRAX calculator

*Readers are invited to photocopy Patient education pages in the journal and distribute them to their patients.