Cervical cancer, while one of the most prevalent diseases affecting women around the world, has seen markedly reduced incidence in the US over the past few decades due to a number of developments in prevention and screening. Risk factors for cervical cancer include early age at first intercourse, multiple sexual partners, multiple births, smoking, and immunodeficiency. It has further been established that the vast majority of cervical cancers are caused by “high risk” strains of the HPV, or Human Papilloma Virus, which affects cervical cells. Efforts at preventing cervical cancer in this country have focused on modifying certain lifestyle choices that put one at increased risk, as well as the development of vaccines against the HPV virus, and of course, screening with the pap smear test.

The many HPV virus subtypes are transmissable through sexual activity, including oral-genital and skin-skin contact. HPV infection is extremely common in sexually active women. In women under 30, the infection often clears in a couple of years, but in older women it can linger. Condoms do have some efficacy in preventing the spread of HPV, so it is important to use them consistently. In addition, the Gardasil vaccine, which is available here at RIM, was FDA-approved in 2006 for girls/women ages 9-26 (and more recently, for boys/men in the same age group, as well). This three-shot vaccination series protects against 2 types of high-risk HPV which are responsible for about 70% of all the cervical cancer cases in the US, as well as two types of HPV which cause genital warts. At this point, it is unknown how long the protection afforded by the vaccine lasts, and it does not yet change the pap smear screening interals for vaccinated individuals, but it does offer another level of protection against cervical cancer.

Current guidelines for cervical cancer screening in immunocompetent women vary slightly among different expert groups, but there is general consensus now that women do not need to be screened for cervical cancer until age 21, regardless of prior sexual activity. For women ages 21-30, screening with the liquid-based pap test is now recommended every 3 years, as long as the testing comes back normal. HPV screening in this age group is only done if the pap test has certain abnormal findings. For women ages 30-65, most screening groups recommend screening with the pap test and HPV testing every 5 years, assuming normal results. After age 65, most women can stop screening if they have had 3 consecutive normal pap results OR 2 consecutive normal pap/HPV tests within the past 10 years, with the last test being within the past 5 years. These guidelines do not hold in women who are immunocompromised, who have had previous high-grade abnormal screening results, or who have had a hysterectomy with removal of the cervix; these patients should discuss their individual screening recommendations with their physicians.

Prevention and treatment of cervical cancer in this country continues to move forward; the best way to protect yourself is to make careful choices about sexual activity, including the use of condoms, to consider getting the HPV vaccine if you are in the appropriate age group, to get regular pap smears, and to continue to stay informed about developments in this important area of women’s health.

Just in time for Easter, a new study has found that healthy people who eat chocolate regularly are slimmer than those who eat chocolate less often–good news for those of us with a sweet tooth! The study assessed data from more than 1000 people aged 20-85. The subjects reported eating chocolate an average of 2 times a week, while exercising an average of 3.6 times a week and following a healthy diet. Those who ate chocolate more frequently (5 times a week) had a body mass index which was one point lower than those who did not eat it as regularly. Body Mass Index, which measures body fat from a person’s height and weight, is optimally between 18 and 25. For the average American woman, who is 5’4″, a 1-point difference in BMI translates to a difference of about 6 pounds–pretty significant!

This study comes on the heels of other research over the past couple of years which has suggested a variety of additional health benefits related to chocolate. Last summer, a British study which analyzed data from over 100,000 people concluded that those who ate the most chocolate on a regular basis had a 37% lower risk of heart disease, a 31% lower risk of developing diabetes, and a 29% lower risk of stroke than the others. Earlier studies by researchers at Harvard showed associations between chocolate or cocoa consumption and decreased blood pressure, deceased LDL (bad) cholesterol, increased HDL (good) cholesterol, and decreased insulin resistance (a hallmark of Diabetes).

These positive health benefits can be traced to powerful antioxidants called Flavonoids which are found in the cocoa bean. Flavonoids help fight inflammation, improve blood vessel flow, and may have effects on metabolism. Chocolate with higher cocoa content has more flavonoids, and presumably, confers more of the benefits everyone is talking about.

A caveat of the above studies is that they did not identify the optimal amount of chocolate necessary to confer benefit, nor did they specify what type of chocolate the study subjects were eating.   And of course, much processed chocolate is loaded with sugar, fat and calories. So what is the takeaway here–how to make use of this exciting news? The answer is somewhat elusive for now, but for those who are looking for a DAILY chocolate fix, an ounce of either dark or unsweetened chocolate, with respective cocoa contents of 70% and 100%, seems to be a smart choice. An alternative is pure cocoa powder, which can be added to coffee or other foods once a day. The key is to choose chocolate with a high cocoa content–and enjoy it in moderation.

I love September, it reminds me of the excitement I felt as a kid at the start of every school year. As September begins, it’s a great time to plan for the weeks and months ahead. For me that means planning the workouts and scheduling the doctor’s appointments now. What is essential?

• Vigorous aerobic exercise at least 75 minutes weekly plus weight strengthening twice weekly
• Annual physical
• Flu shot
• Tetanus Booster (every 10 years)
• Gyn exam/ pap smear (at least every 3 years), annually if you’ve had an abnormal pap or gyn cancer
• Dental exams/ cleanings at least twice a year
• Eye exam (frequency depends on age)

Over 40:

All of the above plus:

• Mammogram (every 2 years between 40-50)

50+:

All of the above plus:

• Annual Mammogram
• Colonoscopy

60+:

All of the above plus:

• Shingelles (Zostax) vaccine
• Dexa scan
• Pneumovax (age 65) you may need this earlier

Have a great fall.

Dr. Saltzman

As you head outdoors to get the most out of these last few weeks of summer mosquitoes aren’t the only biting insects you have to worry about; ticks are also looking to make a meal out of you. Ticks can get on you if you walk through areas where they live such as tall grass, leaf litter or shrubs. Ticks are more than just a creepy nuisance, they can also transmit disease. Though most tick bites will not make you sick, you do want to remove any tick as soon as possible. Ticks can be as small as a poppy seed so when you come in from the outdoors be sure to examine you scalp and skin carefully. Don’t forget to check your ears and belly button. If you find a tick the following steps can help you remove it quickly and safely.

Gently clean the area with an antiseptic solution or soap and water. Take care not to scrub the tick too hard, just clean the skin around it.

Use fine-tipped tweezers to grasp the tick as close to the skin’s surface as possible. Do not grab the tick around its belly, you could push infected fluid from the tick into your body if you squeeze it.

Gently pull the tick straight upward with steady, even pressure. Do not twist; this can cause the mouth parts to break off and remain in the skin. If this happens, remove the mouth-parts with tweezers. If you are unable to remove the mouth easily with tweezers, leave it alone as they will normally be expelled spontaneously.

After the tick has been removed, wash the area of the tick bite and your hands with soap and water.

You can put the tick in a dry jar or ziplock bag and save it in the freezer for later identification.

Do not try to smother a tick that is stuck to your skin with petroleum jelly, nail polish, or rubbing alcohol. Do not burn the tick while it is stuck to your skin. These methods don’t get the tick off your skin and can cause the insect to burrow deeper and release more saliva which increases the chances of disease transmission.

You can reduce the likelihood of getting bit by avoiding tick-infested areas, walking in the center of trails while hiking, using an insect repellent with DEET, and wearing long sleeves and tucking your pant legs into your socks if you are going to be in high brush or hiking. Ticks can ride into the home on clothing and pets then attach to a person later so carefully examine pets, clothing, and bags. Put your clothes in the dryer on high heat for an hour to kill any hidden ticks.

If you find a tick that you think has been attached for more than 36 hours please contact the office, antibiotic prophylaxis to prevent Lyme disease may be appropriate. Though most ticks do not transmit disease be sure to come into the office if you develop symptoms such as a rash, fever, headache, fatigue, muscle aches, joint pain, or flu-like symptoms after a tick bite.