Cancer
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Three federal programs with the potential to reduce cervical cancer incidence, morbidity, and mortality, especially among underserved populations, are administered by the Centers for Disease Control and Prevention (CDC): the National Breast and Cervical Cancer Early Detection Program (NBCCEDP), the Vaccines for Children (VFC) Program, and the Section 317 immunization grant program. The NBCCEDP provides breast and cervical cancer screening and diagnostic services to uninsured and underinsured women. ⋯ Potential long-term reduction in healthcare costs resulting from HPV vaccination is also discussed. As an example of an initiative to vaccinate uninsured women aged 19-26 years through a cancer services program, a state-based effort that was recently launched in New York, is highlighted.
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Review
A review of prophylactic human papillomavirus vaccines: recommendations and monitoring in the US.
It has been estimated that genital human papillomavirus (HPV) is the most common sexually transmitted infection in the US. Nononcogenic types, such as HPV type 6 (HPV-6) and HPV-11, can cause benign or low-grade cervical cell changes, genital warts, and recurrent respiratory papillomatosis. Oncogenic types can cause cervical and other anogenital cancers; oncogenic HPV types are detected in 99% of cervical cancers worldwide. ⋯ Currently in the US, the quadrivalent HPV vaccine is recommended for routine immunization of girls aged 11 and 12 years, and catch-up immunization is recommended through age 26 years. Monitoring the impact of prophylactic HPV vaccines will be useful for understanding the population level impact of vaccination. In this report, the authors provide a brief review of the epidemiology of HPV infection and an overview of prophylactic HPV vaccines and postvaccine licensure monitoring.
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Up to 17% of men with a prostate-specific antigen (PSA) level below the accepted prostate biopsy cutoff of 2.5 ng/mL may have prostate cancer. Because identification of these patients represents a difficult task, we assessed the ability of percent free PSA to discriminate between benign and malignant prostate biopsy outcomes in men with PSA < or =2.5 ng/mL. ⋯ The risk of prostate cancer is clearly non-negligible in patients with PSA < or =2.5 ng/mL. The percent free PSA can accurately predict the prevalence of prostate cancer at prostate biopsy in these individuals.
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Relapsed or refractory mantle cell lymphoma has a very poor prognosis. The authors evaluated the response rates and survival times of patients treated with an intense regimen known to be effective against untreated aggressive mantle cell lymphoma: rituximab plus hyper-CVAD (cyclophosphamide, vincristine, doxorubicin, and dexamethasone) alternating with rituximab plus methotrexate-cytarabine. ⋯ This combination chemotherapy was effective for refractory/relapsed mantle cell lymphoma.
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Although years of potential life lost (YPLL) and mortality-related productivity costs comprise a substantial portion of the burden of cancers where human papillomavirus (HPV) may be a risk factor for carcinogenesis (called HPV-associated cancers in this report), estimates of these costs are limited. The authors estimated the mortality-related burden (in terms of YPLL and productivity costs) of HPV-associated cancers (without regard to the percentage of each of these cancers that could be attributed to HPV) and all malignant cancers in the United States in 2003. ⋯ HPV-associated cancers impose a considerable burden in terms of premature deaths and productivity losses.