Vaccines in Cancer Care and Risk Reduction January 9, 2019

For our first chat of 2019, we had twenty-eight participants discussing Vaccines in Cancer Care and Risk Reduction. You may find the transcript here and additional analytics here.

Some responses to our questions may be found below.

T1: What vaccines are available before you develop cancer to reduce your risk? Are there different types? 

• T1 The #HPV vaccine is cancer prevention for six cancers-cervical, vaginal, vulvar, penile, & oropharyngeal. #gyncsm
• T1: Cancers that are caused by viruses can be vaccinated against. HPV vaccine protects against cervical and other HPV-related cancers. The HepB vaccine can help protect against liver cancer
• the #HPVvaccine has been available since 2006 -- initially it offered protection against HPV16 and HPV18, the types of HPV that causes 70% of #cervicalcancer #gyncsm
• the FDA approved Gardasil 9 in 2014 -- which protects against another 20% of the most dangerous subtypes of #HPV #gyncsm 

T2: What cancers can be caused by HPV? How does the HPV vaccine reduce the risk of HPV-related cancers?

• T2 Cervical, vaginal, vulvar, anal, penile, & oropharyngeal cancers are caused by HPV. Every year in the US, HPV causes 33,700 cancers in men and women
• #HPV can cause #cervicalcancer and some types of ear-nose-and-throat, vulvar, vaginal, penile, and anal cancer. The CDC recently release a report about trends in HPV-related cancers. #gyncsm cdc.gov/mmwr/volumes/6…
• T2 -- interestingly, in recent years oropharyngeal cancers are now the most common type of HPV-related cancer. #HPV #gyncsm
• T2 The HPV vaccine protects against an HPV infection-persistent infection can lead to cell abnormalities & cancer.
• T2: It takes a long time for a persistent HPV infection to cause cervical disease and pre-cancer. The vaccine helps keep the body from being infected after exposure. Approx 80% of people are exposed to HPV at some point in their life
• It's better to get vaccinated before exposure to #HPV - that way your body is already immune!
• A2 from @cochranecollab Among women aged 15 to 26 years, vaccines reduced the risk of cervical precancer associated with HPV16/18 from 341 to 157 per 10,000. HPV vaccination reduced also the risk for any precancer lesions from 559 to 391 per 10,000.

T3: What are the current U.S. recommendations for HPV vaccination? Who should get vaccinated, when and how many doses?

• T3 The HPV vaccine is recommended for all girls & boys who are 11 or 12 years old. The series can be started as young as 9 years. #gyncsm
• T3 -- currently the @CDCgov suggest offering vaccination for boys and girls starting at age 9, and recommends it starting at age 11-12.
• T3 -- however, in October 2018 the @US_FDA has approved the use of Gardasil 9 for men and women up to age 45. #hpvvaccine #hpv #gyncsm https://www.statnews.com/2018/10/06/fda-expands-hpv-vaccine-use-to-age-45/
• And Vaccines for Children (VFC) Program offers vaccines ( including HPV) at no cost for eligible children cdc.gov/vaccines/progr…
• Yes -- for individuals who start the vaccine series younger than age 15, two shots of the #hpvvaccine is recommended.
• The @HPVRoundtable has a bunch of great parent materials.
• You can also check out yesterday's tweet blast by @StopHPVCancer for some great HPV resource links 

T4: What are cancer treatment vaccines? How do they work? When are they used - after front-line?

• T4: There are cancer vaccines that can be created the patient's own tumor! They have been explored in #ovariancancer as a maintenance strategy after primary treatment #gyncsm
• Specific #HPVVaccines are being combined with #immunotherapy to treat #cervicalcancer and head and neck cancers @MDAndersonNews
• T4: "Cancer treatment vaccines boost the immune system's ability to recognize and destroy antigens. Often, cancer cells have certain molecules called cancer-specific antigens on their surface that healthy cells do not have." https://www.cancer.net/navigating-cancer-care/how-cancer-treated/immunotherapy-and-vaccines/what-are-cancer-vaccines
• T4: Some cancer vaccines are made from the person's tumor sample for them. Other cancer vaccines target specific cancer antigens and are given to people whose tumors have those antigens on the surface of the tumor cells.
• T4 this article talks of the steps producing the vaccine Provenge for prostate cancer and examples of types of cancer vaccines. #gyncsm historyofvaccines.org/content/articl…   

T5: In which gynecologic cancers are treatment vaccines being studied? Has there been progress in this area?

• I found 15 clinical trials when I searched on clinicaltrial.gov for ovarian cancer vaccines https://clinicaltrials.gov/ct2/results?term=vaccine&cond=Ovarian+Cancer&Search=Apply&recrs=a&age_v=&gndr=&type=&rslt=
• Results from one #ovariancancer trial last spring via @ocrahope ocrahope.org/2018/04/vaccin…
• Cancer Vaccines in Ovarian Cancer: How Can We Improve? gives overview of research being done in this area in 2016 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5344251/
• T5 -- to me, it seems that the most progress with vaccines as a treatment strategy has been in #ovariancancer. There certainly is a lot of interest in this area given the innovation in #immunotherapy #gyncsm cancertherapyadvisor.com/gynecologic-ca

Additional resources shared during the chat may be found at the end of this post. 

Be sure to join us next month on February 13, 2019 at 9pm ET for our chat "Getting Into a Clinical Trial". 

You can also join us for a collaborative chat across all #cancer communities presented by #LCSM this Thurs Jan 10th at 8pm ET/5pm PT on "Immunotherapy: What Patients Need to Know". More here: https://lcsmchat.com/2019/01/06/lcsm-chat-2019-01-06-immunotherapy-what-patients-need-to-know/ 

And on January 16 at 9pm ET join the #CervivorChat (@IamCervivor) for support and discussion about HPV and cervical cancer. 

See you there!

Dee
Co-moderator #gyncsm Chat

RESOURCES: 

Trends in HPV 
https://www.cdc.gov/mmwr/volumes/67/wr/mm6733a2.htm

Hepatitis B Vaccination : What Everybody Should Know 
https://www.cdc.gov/vaccines/vpd/hepb/public/index.html 

Recap from our #gyncsm Feb 2017 chat on HPV and Cervical Cancer 
http://gyncsm.blogspot.com/2017/02/hpv-and-cervical-cancer-chat-2817.html

@theNCI site 
https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-vaccine-fact-sheet 

HPV vaccine: A smart way to protect kids from cancer @jburzawa
https://www.mdanderson.org/publications/cancerwise/hpv-vaccine-a-smart-way-to-protect-kids-from-cancer.h00-158830434.html 

American Academy of Pediatrics - HPV 
https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/adolescent-sexual-health/Pages/HPV.aspx 

Vaccines for Children (VFC) Program 
https://www.cdc.gov/vaccines/programs/vfc/parents/qa-detailed.html 

NCI-designated Cancer Centers Urge HPV Vaccination for the Prevention of Cancer http://www.cinj.org/sites/cinj/files/documents/NCI_HPV_Consensus_Statement_012716.pdf 

Cancer.Net 
https://www.cancer.net/navigating-cancer-care/how-cancer-treated/immunotherapy-and-vaccines/what-are-cancer-vaccines

Phase 2 Trial on HPV Indications 
http://ir.inovio.com/news-and-media/news/press-release-details/2018/Inovio-Announces-Initiation-of-Phase-2-Trial-in-New-HPV-Indications/default.aspx

Cancer Vaccines in Ovarian Cancer: How Can We Improve? 
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5344251

First Chat of 2019 - Vaccines in Cancer Care and Risk Reduction 1/9/19

"Vaccine therapy is a type of treatment that uses a substance or group of substances to stimulate the immune system to destroy a tumor or infectious microorganisms such as bacteria or viruses." - NCI

We have talked in this community about how the HPV vaccination reduces the risk of cervical cancer (HPV and Cervical Cancer - 2/2017). Did you know it may also help reduce head and neck cancers caused by HPV? Did you know that the Hepatitis B vaccine helps reduce long term infection with HPV which can lead to liver cancer? Did you know that vaccine research to treat ovarian cancer is currently taking place? 

If you would like to learn more about the use of vaccines to treat and reduce your risk of cancer, please join us on Wednesday January 9, 2019 at 9pmET (8pmCT, 6pmPT) as the #gyncsm community chats about Vaccines in Cancer Care and Risk Reduction.

Since January is Cervical Cancer Awareness Month, we will include the HPV vaccine and latest CDC recommendations. We will also look at current ovarian cancer trials and how a patient's immune system can be trained to fight cancer tumor cells.

Guiding our discussion will be the following Topic (T:) questions:

T1: What vaccines are available before you develop cancer to reduce your risk? Are there different types?

T2: What cancers can be caused by HPV? How does the HPV vaccine reduce the risk of HPV-related cancers?

T3: What are the current U.S. recommendations for HPV vaccination? Who should get vaccinated, when and how many doses?

T4: What are cancer treatment vaccines? How do they work?

T5: In which gynecologic cancers are treatment vaccines being studied? Has there been progress in this area?

You may learn about our topic on this Cancer.Net page:
https://www.cancer.net/navigating-cancer-care/how-cancer-treated/immunotherapy-and-vaccines/what-are-cancer-vaccines

See you on Wednesday!
Dee
Co-moderator

What's on your Mind? #gyncsm Open Mic Night -July 12, 2017

We didn't have a set series of topic questions for this month's chat but rather allowed our participants to share what was on their minds. We had nineteen participants and over 1.4M impressions. You may find more analytics from Symplur here.

The hour's discussion revolved around these main areas:

Emotional support of women after treatment

• I'm struggling in post treatment life. Unknowns, grief, plus effects from chemo, rads. :/
• Post-treatment is really tough for so many people. It's tough to go from the intensity of treatment to the uncertainty of after. 

A petition to make July Sarcoma Awareness Month which led to a discussion of - What is sarcoma? Which are gynecologic?

• Via @suziesiegel Sarcoma is a cancer of connective tissues. The main types of gyn sarcoma are leiomyosarcoma ,low- & high-grade endometrial stromal sarcoma, & undifferentiated uterine sarcoma. Some include carcinosarcoma
• Risk factors include exposure to radiation & use of Tamoxifen, plus genetic issues such as Li-Fraumeni Syndrome

Educating the public about the importance of HPV vaccination

• Caleb's Feet Foundation http://www.calebsfeetfoundation.org/ brings information about cervical cancer and the HPV vaccination to the community. 
• studies show pediatricians have a huge influence on whether kids get vaccinated - parents do listen to doc rec
• good to focus on doc's and then community influencers - churches, centers
• The @GlobalGenes site has some amazing free toolkits for health advocates. Can also check out blogs from @JBBC re: health marketing 
• HPV vaccination could reduce global deaths from #cervicalcancer by as much as two-thirds

Support for women cancer researchers 

• I really want to (1 day) discuss the lack of funding 4 female researchers, tasked w/ post BrCa Dx research
• Issues affecting women's health still does receive equitable share in research dollars. It's time that changes
• Awarding rates 4 female applicants (14.9%) are systematically lower than those for male applicants (17.7%) 

The science behind the connection between genetic mutations (other than BRCA) and how they may raise the risk of  Breast, Ovarian Color Cancer 

• I'm in a FB group for CHEK2 and many previvors reporting getting ovaries out though science isn't there yet on that.
• CHEK2 is the name of a gene...when there is an inherited change (mutation) in CHEK2 = some increased risk for specific cancers
• Risks to removing ovaries in these young women-->early menopause w/o known cancer risk reduction benefit

There is now more detail about Lynch-syndrome related ovarian cancer risk (also shows how little we know)! #gyncsm #gencsm pic.twitter.com/CUS0Vy4YoI

— Erica Bednar (@EMBOSU) July 13, 2017

You may find the complete chat transcript here.

Please scroll down for Resources mentioned during the chat.

Remember you can always join our discussion on the Smart Patients Platform. (https://www.smartpatients.com/partners/gyncsm )

Be sure to join us next month on Wednesday August 9, 2017 at 9pm ET | 8pmCT | 6pmPT  as we discuss "You never heard of Primary Peritoneal Cancer or GTDisease?".

Remember to tweet things of interest to our community by using the #gyncsm hashtag.

See you in August!

Dee
#gyncsm Co-founder

RESOURCES:

Petition to make July Sarcoma Awareness Month
https://petitions.whitehouse.gov/petition/officially-designate-july-sarcoma-awareness-month

Calebs Feet Foundation
http://www.calebsfeetfoundation.org/

Magenta Study Genetic testing study at MD Anderson
https://magenta.mdanderson.org/magenta_mobile/index.html

Sex Bias in Surgical Research
http://www.physiciansweekly.com/sex-bias-in-surgical-research/

@nccn guidelines for "Hereditary Colorectal Cancer"
https://www.nccn.org/about/news/ebulletin/ebulletindetail.aspx?ebulletinid=294

HPV and Cervical Cancer Chat - 2/8/17

During this month's chat discussion on HPV and Cervical Cancer the community learned vital information about screening, vaccination, fertility and how to better educate women on the risks and treatment of cervical cancer. We were joined by forty-nine participants and had over 2.4 million impressions.

Here is a sample of the responses to our topic questions.

T1: Which HPV (Human Papilloma Virus) types cause cervical cancer? How does the HPV vaccination prevent cancer? 

• HPV causes nearly all cases of cervical cancer. While there are over 150 HPV types, ~14 are known to cause cervical cancer.
• Usually HPV 16 and 18. But several others. Vaccine prevent against many cancer and wart causing types of HPV
• Just because you are infected with #HPV - doesn't mean that you will DEFINITELY develop #cervicalcancer
• Because we can't be sure who will develop cancer - best to PREVENT with #HPVaccine
• It is also important to note that the HPV infection can develop years after exposure
• @theNCI comprehensive cancer ctrs statement on HPV vaccination tinyurl.com/je8tujx

T2: What other health issues and cancers are associated with HPV? Why is the vaccine recommended for both boys and girls?

• @GYNcancer :vaccinate both girls & boys between 11- 13 years. 2 doses . Vacc + screening prevent virtually all CervCa
• Other HPV-related cancers include: vagina, vulva, penis, anus, rectum, and oropharynx (cancers of the back of the throat) 
• As of 10/2016, CDC recommends that 11-12 year-olds receive 2 doses of HPV vaccine at least 6 months apart instead of 3
• Cigarette smoking and conditions that lower the immune system like steroids [increase risk]
• Cervical dysplasia (not yet cancer) can be as emotionally and mentally taxing for young women
• The best time to vaccinate is well before any sexual skin to skin contact. 

T3: What are the tools we have to catch cervical cancer in the pre-cancer and early stages? What do we need to know re: guidelines? 

•  If there is concern based on pap and/or HPV test, then colposcopy (a closer look) is done in office.
•  HPV test should be first test for cervical cancer screening. Detects 14 high-risk HPV types. via @US_FDA
• Continued importance of pap/HPV screening based on ASCCP guidelines--this and vaccination best way to protect 
• ACOG infographic on screening acog.org/Patients/FAQs/…
•  Imp- Guidelines are based on average risk and should be starting point of discussion with your doctor about your personal risk!

T4: What are options for fertility preservation? What fertility and general resources can help women diagnosed with cervical disease? 

• There are onco fertility specialists. Fertility should always be part of the conversation when treating cervical disease.
• There are many fertility sparing options for patients w a new dx of #cervicalcancer - make sure you ask your surgeon!
• Newest screening guidelines for cervix CA try and decrease unnecessary procedures that could affect fertility
• Clinical trials investigating less radical surgery & neoadjuvant chemotherapy 
• Fertility preservation in women with early-stage cervical cancer via Up-to-Date http://www.uptodate.com/contents/fertility-preservation-in-women-with-early-stage-cervical-cancer-beyond-the-basics 

T5: There is still a lot of stigma surrounding women's cancers. How can we ensure ALL women receive the necessary education.

• Take stigma off of HPV as a "sexually transmitted" disease and change to "human contact" 
• Keep talking about it until it's not a stigma - it's just a health condition to treat!
• Recent news @NewsHour @DrJenCaudle #cervical cancer kills more african american women http://www.pbs.org/newshour/bb/cervical-cancer-killing-many-african-american-women-thought/ 
• Australia has implemented school-based vaccination w/ success in vaccine rates and decreased disease
• It would help if our education about bodies included penis, vagina, ovaries, testes, etc as consistently as we say "elbow."
• More education programs in junior high and high schools. School vaccination programs 
• Celebrities with cervical cancer diagnosis speaking out 
• Organizations like American Indian Cancer Foundation americanindiancancer.org/cervical help educate and raise awareness
• Organizations like @iamcervivor work to share stories - stories touch emotions and emotion leads to actions
• Cancer treatment is far worse than the "stigma" of people knowing you're sexually active

Please scroll down for additional resources. To read the entire transcript please click here.

Remember that patients and caregivers are invited to continue our #gyncsm discussions on the Smart Patients platform at https://www.smartpatients.com/partners/gyncsm  .

We invite you to join us next month, Wednesday, March 8, 2017 at 9pm ET for our chat on Gyn Cancer Disparities. 

See you next month! And please use the #gyncsm hashtag to share important information with our community.

Dee
Co-Founder #gyncsm

RESOURCES

@GYNCancer HPV Facts and testing http://www.foundationforwomenscancer.org/educational-materials/cervical-cancer-edmaterials/

@CDCgov has info and resources about #HPV available at     https://www.cdc.gov/hpv/parents/whatishpv.html

ASCCP guidelines available for public http://www.asccp.org/asccp-guidelines

SGO webpage about HPV with good resources sgo.org/hpv/

FDA Resource - Improving odds of cervical health fda.gov/forconsumers/c…

Fertility Preservation in Patients With Cervical Cancer | Cancer Network  http://www.cancernetwork.com/oncology-journal/fertility-preservation-patients-cervical-cancer

#cervicalcancer rates and disparities nytimes.com/2017/01/23/hea…

Time Magazine : Cervical Cancer Rates http://time.com/4643570/cervical-cancer-death-rates-study/

HPV vaccine: A smart way to protect kids from cancer  https://www.mdanderson.org/publications/cancerwise/2013/06/hpv-vaccine-a-smart-way-to-protect-kids-from-cancer.html

How to Talk to Your Kids about HPV https://www.mdanderson.org/publications/focused-on-health/january-2017/HPV-vaccine-talk-to-your-kids.html

Treatments for cervical cell changes: cancer.gov/types/cervical…

Who should be vaccinated against #HPV, and when? Tips from our Dr. Haddad: http://blog.dana-farber.org/insight/2017/01/who-should-get-the-hpv-vaccine/  

Feb. 8, 2017 HPV and Cervical Cancer Chat

While January is officially Cervical Health Month, we're going to continue sharing information and discussing HPV (Human Papilloma Virus), the HPV vaccination, and cervical cancer treatment and survivorship right into February - and beyond.

Cervical cancer forms in the cells lining the cervix. It generally takes several years for normal cells to develop into cervical cancer. The Pap test detects those precancerous cells and the HPV test detects the presence of high-risk HPV types known to lead to cervical cancer.

The most recent numbers available on the incidence of cervical cancer in the U.S. is from 2013. In that year, 11,955 women were diagnosed with cervical cancer (CDC ). The five-year survival rate is 68%. Over the past forty years, death due to cervical cancer has dropped by more than 50% due to the use of the Pap test (http://www.cancer.net/cancer-types/cervical-cancer/statistics).

HPV is responsible for nearly all cases of cervical cancer, with HPV 16 and 18 accounting for more than seventy percent of all cervical cancers. HPV is a very common virus that is transmitted by skin-to-skin contact. Many HPV infections go away by themselves but when they persist they can lead to cervical cancer. Other cancers also associated with HPV include cancer of the vagina, vulva, penis, anus, rectum, and oropharynx (cancers of the back of the throat, including the base of the tongue and tonsils). The goal of vaccination is to prevent a lasting HPV infection after a person is exposed to the virus. (http://www.cancer.net/navigating-cancer-care/prevention-and-healthy-living/hpv-and-cancer)

We hope you will join us and learn more about cervical cancer.

We will use these questions to guide our chat:

T1: Which HPV (Human Papilloma Virus) types cause cervical cancer? How does the HPV vaccination prevent cancer? 

T2: What other health issues and cancers are associated with HPV? Why is the vaccine recommended for both boys and girls?

T3: What are the tools we have to catch cervical cancer in the pre-cancer and early stages? What do we need to know re: guidelines? 

T4: What are options for fertility preservation? What fertility and general resources can help women diagnosed with cervical disease? 

T5: There is still a lot of stigma surrounding women's cancers. How can we ensure ALL women receive the necessary education.

Feel free to read the Cancer.Net website (http://www.cancer.net/cancer-types/cervical-cancer/introduction) and the CDC website (https://www.cdc.gov/cancer/hpv/statistics/cases.htm) for more information on cervical cancer and HPV.

See you on Wed the 8th!

Dee
#gyncsm Co-Founder