Women's Health News

A study just published by the journal Obstetrics & Gynecology confirms that birth by cesarean increases risks of two life threatening problems in future pregnancies. The conditions, called placenta abruption and placenta previa, involve the way the placenta attaches to the inner lining of the uterus.

In a cesarean birth a surgical incision is made in the uterus causing a permanent scar. This scarring of the uterine muscle can affect the way the placenta attaches to the uterus in future pregnancies.

Placenta abruption is the premature separation of all or part of the placenta prior to the birth of the child. This decreases the baby’s oxygen supply and can cause blood loss in the mother, baby or both. If the abruption involves a large enough area, emergency cesarean birth may be required to save the life of mother and baby. Abruptions can occur anytime in pregnancy, even when the baby is still premature, further increasing danger to the newborn.

Placenta previa is abnormal growth of the placenta over all or part of the uterus’ natural opening to birth canal, or cervix. This causes damage to the placenta and severe blood loss during labor. Bleeding is also more likely to occur before labor and without warning. Women with placenta previa always require cesarean delivery prior to labor.

It is not fully understood why scars on the uterus cause these problems. Several studies in recent years have confirmed the connection between cesareans and abnormal placental attachment. The new study is one of the first to confirm a direct relation ship between the number of surgeries and the amount of risk. By reviewing over 150,000 first, second and third pregnancies, it found the risk of both complications rising as the number of surgeries increased.

Together these two problems complicate about 60,000, or 1-2 percent, of pregnancies in the U.S. yearly. In addition to cesareans, factors such as cigarette smoking, cocaine use and maternal age have also been associated with the disorders. But cesarean section is the most common surgery performed in the U.S. and has risen sharply in recent years. Since 1970 the percentage of mothers giving birth by cesarean has risen from 5% to 29% in 2003. Contrary to expectation, this has not resulted in safer births or healthier patients. Complications from the surgery are expected to grow as it becomes more common.

Other risks associated with cesarean birth are rupturing the scar in future pregnancies, increased rates of infection and blood loss, more breathing problems in newborns, less successful breastfeeding, longer healing time, longer hospital stays and more hospital re admissions.

Yet obstetricians the world over are ambivalent about cesarean birth. In surveys form the U.S., Europe, Canada, and South America, upwards of 50% of practicing OB/Gyns favor even more liberal use of cesareans. Some feel more protection against lawsuits with cesareans. Others point out that normal vaginal births also have risk, and some perceive consumer demand for “patient choice” cesarean. Recent surveys of American women find the public demand for medically unnecessary cesarean at less than 1 percent. Professional organizations tend to focus on the difference between accommodating true patient demand and creating demand, and upon accurate presentation of risk. The new study adds to the argument that unnecessary cesarean should be avoided, since the procedure creates risk in future pregnancies, and most women who have children have more than one, whether planned or not.

Also debated is whether women should be encouraged or even permitted to attempt a normal birth once a cesarean has been preformed. Recent research has suggested that vaginal birth after cesarean, or VBAC, carries risks of rupturing the old scar, another potentially life threatening complication. The new study suggests that VBAC may be beneficial if more pregnancies are planned, or if plans are uncertain.

By Patrick Thornton, CNM

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Sedgwick County, Kan., District Judge Anthony Powell on Friday recused himself from a case involving abortion provider George Tiller, who has been charged with 19 misdemeanors for allegedly violating a state law that requires an independent, consulting physician to approve some late-term abortions, the AP/Lawrence Journal-World reports (Hegeman, AP/Lawrence Journal-World, 8/18).

State Attorney General Paul Morrison (D) in June filed charges alleging that Tiller, who owns Women’s Health Care Services in Wichita, Kan., received a second opinion from physician Ann Kristin Neuhaus before performing 19 late-term abortions in 2003. Morrison said Neuhaus had financial ties with Tiller. A 1998 Kansas law says that before an abortion of a fetus of 21 weeks’ gestation or more, two physicians must determine if continuation of a pregnancy will lead to death or “substantial and irreversible” harm to a “major bodily function.” Consulting physicians cannot have legal or financial ties to abortion providers. Tiller’s attorneys have entered a not guilty plea to the alleged misdemeanors and filed a motion to dismiss the charges. If convicted, Tiller could face up to one year in jail and a $2,500 fine for each of the 19 misdemeanor charges.

Sedgwick County Chief Criminal Judge Gregory Waller earlier this month assigned Tiller’s case to Powell, who served as a Republican state legislator from 1995 to 2002. Powell voted regularly for restrictions on abortion laws, including a 1998 law restricting late-term abortions. Powell in 1998 said Tiller was “defying legal and moral authority” by performing late-term abortions. Attorneys representing Tiller last week filed a motion asking that the case be assigned to another judge (Kaiser Daily Women’s Health Policy Report, 8/15). Powell on Friday sent the case back to Waller to appoint another judge, the AP/Journal-World reports.

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Powell said he removed himself from the case to avoid the appearance of impropriety. “In a high-profile case such as this where the judiciary is on trial as much as the defendant, even a hint of impropriety or even the slightest appearance of partiality must be dealt with to protect our system of justice,” Powell said. He added that he wanted to make it clear that he was not removing himself from the case because of his views on abortion rights or involvement in the 1998 statute. “If having pro-life views would be grounds for recusal, having pro-choice views would be equal grounds for recusal,” Powell added.

Tiller attorney Lee Thompson said Powell’s decision is appropriate. Ashley Anstaett, a spokesperson for Morrison, said the attorney general’s office was not allowed to take a position on the recusal in court. Anstaett said that Morrison’s office is “not surprised” with the decision, adding, “This will not influence our case or how we go forward” (AP/Lawrence Journal-World, 8/18).

“Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved. Continue reading →

A new vaccine aimed at preventing cervical cancer is nearly 100 percent effective against the two types of the human papillomavirus (HPV) responsible for most cases of cervical cancer – strains 16 and 18. Results of an international meta-analysis study of the vaccine are published in the June 1 issue of the journal Lancet.

In the current and largest study to date, researchers combined and analyzed the data from four randomized trials that involved 20,583 women ages 15 to 26 from more than two dozen countries across Europe, North America, Latin America and Asia. Participants were randomly assigned to receive the HPV vaccine or placebo and followed for an average of three years.

Researchers found that the prophylactic administration of the vaccine was highly effective in preventing pre-malignant changes of the cervix, also known as cervical dysplasia.

“This is a much larger combined study that shows 99 percent efficacy, a clear reduction of pre-cancerous cervical lesions. We demonstrated significant protection against serious HPV-related diseases, including high-grade cervical pre-cancers, in women not previously exposed to the relevant HPV types targeted by the vaccine,” says Kevin Ault, MD, associate professor of obstetrics and gynecology at Emory University School of Medicine, one of the authors of the study and a key researcher in the development of the vaccine.

HPV strains 16 and 18 are responsible for about 70 percent of all cases of cervical cancer. In clinical trials the vaccine, manufactured by Merck under the name Gardasil, also demonstrated a high efficacy rate in protection from HPV types 6 and 11, which together cause about 90 percent of all cases of genital warts. All four types cause a large number of abnormal Pap test results and low-grade cervical lesions.

Cervical cancer is the second most common cause of cancer deaths in women worldwide, accounting for about 240,000 deaths each year. In 2007 experts predict cervical cancer will strike an estimated 11,000 women in the United States and nearly half a million women worldwide. Every day in the United States ten women die from cervical cancer, says Dr. Ault.

“Thanks to the results of this meta-analysis and a previous publication in Lancet, we now have data on three more rare cancers — adenocarcinomas in situ of the cervix, as well as vulvar and vaginal cancer. All these female cancers are caused by HPV and can be successfully prevented with the HPV vaccine.”

According to estimates from the Centers for Disease Control and Prevention (CDC) more than 20 million men and women in the United States are infected with HPV, and more than six million new infections are reported each year, making it the most common sexually transmitted disease in the nation.

“Nearly all sexually active people are going to get exposed to the virus sometime during their lives,” says Dr. Ault. For most people, HPV causes no complications and goes away on its own. However, in some cases, if left untreated, certain high-risk types of HPV can lead to cervical cancer.

“The goal of the study was to see if we could prevent precancerous cases and the results of this combined analysis show near 99 percent effectiveness. Everyone who gets cancer goes through a pre-cancerous stage,” says Dr. Ault. “There are about 50 to 60 million pap smears performed each year in the United States, and about seven percent are abnormal. We spend about 3 billion dollars each year to find and treat these pre-cancerous stages caused by some type of HPV.”

Gardasil was approved by the U.S. Food and Drug Administration last year for use in females 9 to 26 years of age. While controversy has been raised about giving pre-adolescent girls a vaccine for a sexually transmitted disease, Dr. Ault argues, “young women, young girls make very good immune responses to this vaccine, so that will enhance their protection. Widespread immunization with the HPV vaccine along with continued screening will help decrease the burden of cervical cancer and other HPV-related diseases,” he says.

Contact: Juliette Merchant

Emory University

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Using makeup to cover a severe facial blemish may not improve the quality of a woman’s life, a new study suggests.

It did not matter how severe or what kind of blemish she had, whether it was a case of severe acne, a noticeable facial scar or pronounced dark spots covering the face.

“The women who used foundations to cover these kinds of marks reported having a lower health-related quality of life than did the women who didn’t wear the same kind of makeup,” said Rajesh Balkrishnan, the study’s lead author and the Merrell Dow professor of pharmacy at Ohio State University.

While it may seem obvious that anyone with a severe blemish on their face contends with psychological issues, until this study, no one had systematically evaluated how such blemishes affect women psychologically, said Balkrishnan.

“Though they may not have much effect on physical health, severe facial marks may have a significant impact on self-image and over time, that could adversely affect a woman’s health,” he said. “In this case the psychological impact often outweighs the physical aspects of the problem – the women in our study reported having more problems with social and sexual functioning than with physical functioning.”

The study appears in a recent issue of the International Journal of Dermatology.

Of the 73 women in the study, 66 used what Balkrishnan calls “corrective cosmetics” while seven did not. Corrective cosmetics are skin-colored foundations meant to conceal serious blemishes. It’s not the kind of makeup that would typically be found in the cosmetics aisle of a drug store, and a dermatologist usually recommends these foundations to her patient.

“The women who used foundation to cover blemishes may have had a tougher time psychologically dealing with their blemishes than did the women who didn’t use corrective makeup,” Balkrishnan said. “Although it’s difficult to say why this is, it may be that the women who didn’t wear makeup to cover their blemishes felt more confident in their appearance.”

These kinds of cosmetics are also fairly expensive – one company sells a 1-ounce jar of its corrective foundation for $27.50.

The majority of women that Balkrishnan and his colleagues surveyed had severe facial scarring, acne, melasma – a pronounced pigmentation of the upper cheeks, bridge of the nose, forehead and upper lip – or hyperpigmentation, a condition in which patches of facial skin become very dark. Most of the women had only one type of blemish. Participants’ average age was 37.

The overwhelming majority of women (90 percent) reported that they used some type of corrective foundation to cover the blemish, although the researchers did not record the brands of makeup that the women wore. Overall, the women were in good physical health.

The researchers used the Blemish Area and Severity Index (BASI) to quantify the area of the face covered by the blemish and to rate the severity of the blemish. Included in the BASI survey were questions that measured health-related quality of life issues, as well as questions that measured each woman’s fear of negative evaluation by others.

The researchers asked each woman to rate their health in general – answer choices ranged from excellent to poor. The women were also asked questions about any recent problems with physical or mental health, and how often poor physical or mental health kept them from doing their usual activities.

The survey also asked women to describe what they thought life would be like if they didn’t have to contend with the blemishes.

Not surprisingly, having a severe facial blemish negatively affected how most of the women perceived the quality of their lives. But the women who wore foundations to conceal their blemishes reported having a lower health-related quality of life than did the seven women who said that they did not wear this kind of makeup.

The women who didn’t wear makeup did not necessarily have less severe blemishes, either, Balkrishnan said.

“Overall, the women who used foundation treatments felt that they were worse off physically and mentally than the women who weren’t using these treatments,” Balkrishnan said.

Whether or not they wore makeup, participants overwhelmingly felt that without their blemish other people would see them in a less negative light, and that the overall quality of their lives would improve.

Interestingly, the researchers found no difference in health-related quality of life scores based on the type and size of a blemish. For example, a woman with bad acne did not feel any worse or any better than a woman with melasma.

But the more fearful a woman was of being negatively evaluated in public, the lower she rated her health-related quality of life.

Researchers aren’t certain exactly how severe blemishes affect a woman’s mental health, and a study like this one may help in designing better treatments, including corrective cosmetics, for women, Balkrishnan said.

He conducted the study with researchers from the departments of dermatology, psychiatry and public health services at Wake Forest University School of Medicine in Winston-Salem, N.C.; the division of management and policy sciences at the University of Texas School of Public Health in Houston; and Vichy Laboratoires and Tarnier Hospital, both in Paris.

The study was funded by a grant from Vichy Laboratoires, which makes DermaBlend, a line of corrective cosmetics. Vichy Laboratoires is owned by L’Oreal. Ann Bouloc, a study co-author and a scientist with Vichy , is the only researcher in this study with a financial link to Vichy .

Holly Wagner, (614) 292-8310; Wagner.235osu.edu

Contact: Rajesh Balkrishnan
Balkrishnan.1osu.edu
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Two editorials respond to President Bush’s appointment of ob-gyn Eric Keroack — medical director for A Woman’s Concern, a pregnancy-counseling organization — as the new HHS deputy assistant secretary for population affairs. Many family planning advocates were angered by the appointment of Keroack, noting that A Women’s Concern opposes contraception and supports sexual abstinence until marriage. Keroack will administer $283 million in annual HHS family planning grants and advise HHS Secretary Mike Leavitt on issues including reproductive health and adolescent pregnancy. HHS Assistant Secretary for Health John Agwunobi called Keroack a “highly qualified and a well-respected physician” (Kaiser Daily Women’s Health Policy Report, 11/17).

Boston Globe: Keroack’s appointment “exemplifies the concerns of women’s health advocates who have long warned that the antiabortion movement will not stop at abortion,” a Globe editorial says. “[T]o name an opponent of family planning to oversee the nation’s family planning program is perverse even by the standards of a government that doesn’t much believe in government,” the editorial says, concluding, “To argue that abstinence is the only acceptable route to family planning divides the country, ignores reality and condemns millions of women to poorer lives” (Boston Globe, 11/18).

Washington Post: Keroack’s involvement with A Woman’s Concern “raises doubts about his commitment to the fundamental concept of the federal family planning program,” which offers “timely and affordable access to reliable contraception,” a Post editorial says. The editorial concludes that although Keroack’s appointment is not subject to Senate confirmation, it “should be subject … to common sense,” adding that Bush and Leavitt “should reconsider this ill-advised choice” (Washington Post, 11/19).
NPR’s “Weekend Edition Saturday” reported on criticism of Keroack’s views on family planning issues. The segment includes comments from Mark Conrad, president of A Woman’s Concern; Marilyn Keefe, interim president of the National Family Planning and Reproductive Health Association; and Dianne Luby, president and CEO of the Planned Parenthood League of Massachusetts (Smith, “Weekend Edition Saturday,” NPR, 11/18). Audio of the segment is available online.

“Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved. Continue reading →

On Mother’s Day, the New York Times and Politico published opinion pieces discussing maternal mortality and health. Summaries appear below.

~ Nicholas Kristof, New York Times: “Oddly, for a culture that celebrates motherhood, we’ve never been particularly interested in maternal health,” columnist Kristof writes, noting that U.S. women are two times more likely to die in childbirth or pregnancy than European women. Maternal deaths are “far more common in Africa and Asia,” he notes, adding, “On the 50th anniversary of the pill, it’s also worth noting that birth control is an excellent way to reduce deaths in childbirth.” He continues that the estimated $14 billion spent by consumers in the U.S. for Mother’s Day this year would be “enough to pay for a primary school education for all 60 million girls around the world who aren’t attending school,” with “enough money left over for programs to reduce deaths in childbirth by about three-quarters, saving perhaps 260,000 women’s lives a year.” According to Kristof, “There would probably even be enough remaining to treat tens of thousands of young women suffering from” obstetric fistula. “So if one way to mark Mother’s Day is to buy flower for that special mom, another is to make this a safer planet for moms in general,” he writes (Kristof, New York Times, 5/8).

~ Chris Dodd, Bill Frist, Politico: “All Americans can help more mothers and children live by supporting increased funding from Congress and pending legislation — the Global Child Survival Act (S 1966) in the Senate, and the Newborn, Child and Mother Survival Act (HR 1410) in the House,” according to Senate Foreign Relations Committee member Dodd (D-Conn.) — author of the Senate bill — and former Republican Senate Majority Leader Frist (Tenn.) — chair of Save the Children’s Survive to 5 Campaign. Dodd and Frist continue that pregnant women and children “are dying needlessly” and that Americans “know it’s wrong to let these deaths continue when we know how to prevent them.” Although the “most effective solutions are not high tech” — such as exclusive breastfeeding and increasing use of skilled birth attendants — such strategies “could prevent an estimated two-thirds of 8.8 million annual child deaths and three-quarters of 343,000 maternal deaths,” Dodd and Frist write. “The good news is that momentum for global action is running high,” as maternal mortality is scheduled to be the focus of both the G8 summit in June and the Millennium Development Goals summit in September, they continue. “By coordinating new efforts to fund and promote maternal, newborn and child health, Congress, the president and other world leaders can save the lives of millions of moms and kids,” Dodd and Frist conclude (Dodd/Frist, Politico, 5/9).

Reprinted with kind permission from nationalpartnership. You can view the entire Daily Women’s Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women’s Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.

© 2010 The Advisory Board Company. All rights reserved.

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Women are significantly less likely than men to have their LDL cholesterol controlled to recommended levels, according to a new study by the National Committee for Quality Assurance (NCQA). The study, to be published in the May/June edition of Women’s Health Issues, investigated gender differences in cardiovascular disease prevention, treatment and risk factors based on national health care quality data from commercial and Medicare managed care plans. Elevated LDL cholesterol is an important modifiable risk factor for cardiovascular disease, the leading single cause of death for both women and men.

The study, “Improving the Quality of Care for Cardiovascular Disease: Using National Managed Care Performance Data to Investigate Gender Differences in HEDIS Measures Related to Heart Disease,” analyzed data from a national sample of 46 commercial managed care plans and 148 Medicare plans across 11 HEDIS® measures of care for cardiovascular conditions and diabetes. The results, controlled for other factors such as age, income and ethnicity, showed equal or better outcomes for women on most dimensions of care – with the notable exception of cholesterol control, where significant disparities existed between men and women.

“This study highlights the importance of not just knowing your health, but also taking an active role in your care,” said NCQA President Margaret E. O’Kane. “The data show that we’ve got our work cut out for us in terms of raising awareness among both physicians and patients.”

“Women must know their risk for heart disease and how to manage it,” said Ileana L. Pi?±a, MD, National Go Red For Women Spokesperson and Professor of Medicine at Case Western Reserve University. “These study findings show an opportunity to improve patient care for women and a reason to encourage women to consider seriously how to manage their risk factors, such as elevated cholesterol especially the LDL portion of cholesterol. The American Heart Association’s Web site, GoRedForWomen, can help. It offers resources and tools for women to understand their risk and how to manage it.”

The study also looked investigated disparities in care owing to race and income level, and found significant gaps in care. For example, based on the study findings, 55.4 percent of white men with recent cardiac events who were in commercial plans met the recommended lipid control level. For other groups the comparable figures were 46.2 percent for white women, 44.8 percent for African-American men and 34.2 percent for African American women. Similar disparities were found based on income level.

These findings suggest that women and their health care providers underestimate risk for high cholesterol and heart disease, leading to poorer cholesterol control among women. The high cost of medications may also be secondary factor.

In February, the American Heart Association published updated women’s treatment guidelines in Circulation: Journal of the American Heart Association. The guidelines included more aggressive recommendations for high-risk women, including reducing LDL cholesterol to less than 70 mg/dL in very high risk women with heart disease.

The study released today demonstrates the need for more focused research to understand better gender disparities. The results of the study will be shared at a congressional briefing on Capitol Hill on May 21, where the study’s principal investigator and other experts in health care disparities will discuss clinical and policy recommendations for closing such gaps in care.

The study was funded by the Agency for Healthcare Research and Quality and the American Heart Association’s Go Red For Women movement and its sponsor Bayer. The full study is available on the Web site at the Jacobs Institute for Women’s Health at jiwh/.

About NCQA

NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations and recognizes physicians in key clinical areas. NCQA’s Health Plan Employer Data and Information Set (HEDIS) is the most widely used performance measurement tool in health care. NCQA is committed to providing health care quality information through the Web, media and data licensing agreements in order to help consumers, employers and others make more informed health care choices.

About Go Red For Women

Since 2004, Go Red For Women has captured the energy, passion, and intelligence of women to work collectively to wipe out heart disease – the No. 1 killer of women. Today, we want millions of women across America to take heart disease personally. Using the simple platform “Love Your Heart,” Go Red For Women engages these women – and the men who love them – to embrace the cause. Healthcare providers, celebrities and politicians also elevate the cause and spread the word about women and heart disease. For more information about Go Red For Women, please visit GoRedForWomen. The movement is nationally sponsored by Macy’s.

Contact: Patricia Beatty-Gonzalez

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A successful HPV vaccination program requires more than just a series of injections, says a public health expert in this week’s BMJ.

Careful planning, adequate education, and long term monitoring will be needed, argues Angela Raffle, a consultant in public health at Bristol Primary Care Trust.

Human papillomavirus (HPV) is a common sexually transmitted infection seen most often in young women and adolescents. There are more than 100 types of HPV, some cause only genital warts, but others cause cancers including cervical cancer.

Screening currently reduces deaths from cervical cancer by around 80% but a new jab can offer full protection against HPV strains linked to about 70% of cervical cancers. The UK government is now considering whether girls aged 11 or 12 should be vaccinated, before they become sexually active and can catch HPV.

Raffle believes that the only certain way of determining the long term impact of vaccination will be to follow vaccinated women for several decades, while an accompanying commentary warns that health inequality could increase in poorcountries if universal HPV vaccination is not adopted.

These views are reiterated in an accompanying editorial by Bernard Lo, a Professor of Medicine at the University of California San Francisco.

He discusses the issue of making HPV vaccine mandatory, but argues that a successful vaccination programme requires more than simply increasing uptake. A broader perspective is needed, he says, to tackle the controversial matters of adolescent sexuality, parental control, and protection of children.

Furthermore, physicians need to persuade people who have concerns about the HPV vaccine to trust in and cooperate with other measures to promote adolescent health, he concludes.

Challenges of implementing human papillomavirus (HPV) vaccination policy
BMJ Volume 335 pp 375-7
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Commentary: Health inequality could increase in poor countries if universal HPV vaccination is not adopted BMJ Volume 335 pp 378-9
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Editorial: Human papillomavirus vaccination programmes
BMJ Volume 335 pp 357-8
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Click here to view full contents for this week’s print journal.

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House Democrats appear increasingly likely to “resort to a multibill omnibus package” to clear unresolved fiscal year 2010 appropriations bills and extend programs that expire at the end of the month, CQ Today reports (Clarke/Epstein, CQ Today, 12/2). Among the remaining bills are the FY 2010 Labor-HHS-Education (HR 3293), Financial Services (HR 3170) and State-Foreign Operations (HR 3081) appropriations bills, all three of which Senate Appropriations Committee Chair Daniel Inouye (D-Hawaii) previously had said could be combined in a small omnibus with the Department of Defense appropriations bill (Women’s Health Policy Report, 11/17).

House leaders are carefully mulling their strategy to ensure that the bills can move with minimum delay through the Senate, which remains focused on the health reform debate, CQ Today reports. House Democratic aides say that one possibility “under serious consideration” is combining the unpassed bills into a single package with other items, such as a one-year Medicare physician payment fix, an increase in the debt limit, a short-term extension of the Patriot Act and possibly some economic stimulus measures. However, such a package likely would have a price tag of more than $1 trillion, making it a target for Republican attacks. Another possibility is dividing the remaining bills into two or more smaller packages.

According to CQ Today, combining several measures into a conference report on unrelated legislation could lead to delays in the Senate, since lawmakers can raise a point of order against items that were not part of either chamber’s original bill. Democrats would need all 60 votes in their caucus to override such an objection (CQ Today, 12/2).

Reprinted with kind permission from nationalpartnership. You can view the entire Daily Women’s Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women’s Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.

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Screening and vaccination efforts against the human papillomavirus should become unified in light of FDA’s approval of Merck’s HPV vaccine Gardasil, women’s health advocates said earlier this month at the second annual HPV and Cervical Cancer Summit held in Washington, D.C., United Press International reports (Dell’Amore, United Press International, 11/17). FDA in July approved Gardasil for sale and marketing to girls and women ages nine to 26. According to Merck, the vaccine in clinical trials has been shown to be 100% effective in preventing HPV infection with strains 16 and 18, which together cause about 70% of cervical cancer cases, in women who do not already have the virus, and about 99% effective in preventing HPV strains 6 and 11, which together with strains 16 and 18 cause about 90% of genital wart cases. Gardasil also protects against vaginal and vulvar cancers, two other gynecological cancers that are linked to HPV, according to a study presented in June at a meeting of the American Society of Clinical Oncology in Atlanta (Kaiser Daily Women’s Health Policy Report, 11/2). The summit — hosted by Women In Government, a not-for-profit association for women in state government — included state legislators, medical clinicians and researchers, women’s health advocates, representatives from federal health agencies and public health officials from about 40 states, according to a Women In Government release. “The availability of an effective HPV vaccine is a medical triumph” but “[a]t the same time, it is critical that women who get vaccinated do not become complacent about screening,” Marie Savard, an internist and women’s health expert who participated in the meeting, said, adding, “Screening will still be necessary to protect against cervical cancer caused by HPV types not covered by the vaccine, for women already exposed to HPV and for women who do not receive the vaccine” (Women In Government release, 11/21). Mark DeFrancesco — chief medical officer of Connecticut Women’s Health who also spoke at the summit, said — “There’s a great, tremendous, long-term benefit from vaccination,” but “[w]e can’t ignore the importance of screening.” He added that combining the Pap test with an HPV test would detect nearly all abnormal cells, giving women “100% assurance.” Women in Government President Susan Crosby said, “We have all the tools now to eradicate this disease” (United Press International, 11/17).

“Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

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