Gardasil to Prevent HPV Infections & Cervical Cancer

In Blog, Cancer, Cervical Cancer, Gynecology, Infections, Preventative/Primary Care by Dr. Gary Goldman

Gardasil – the HPV vaccine, remains shrouded in controversy, for reasons I can’t fathom. I am a gynecologist. I’m the doctor who does the pap smears and calls with bad news: there’s an abnormality, caused by having sex, that could lead to cancer. Next comes fear, regrets, gynecologic procedures or surgery, sometimes a cancer diagnosis, and long-term follow-up care… and most of this could be avoided – with the effective and safe vaccine against HPV we already have. Modern medicine has created wonderful opportunities for better health, but the two most important factors in lowering rates of death and disease …

Cologuard as a Screening Test for Colon Cancer

In Blog, Cancer, Gynecology, Women's Health Topics by Dr. Gary Goldman

“You are due for a routine colonoscopy.” Not everyone’s favorite message from his or her doctor. But colorectal cancer is the second leading cause of death from cancer, and colonoscopy to detect pre-cancerous lesions or early colon cancers has been demonstrated to significantly decrease this death rate. While most of my patients understand this advice as sound, the process of undergoing a bowel prep and having a colonoscopy remains a point of contention. Two days ago, the FDA approved a new non-invasive test that also screens for both early colon cancers and pre-cancerous lesions, just by providing a stool sample …

Breast Cancer, Ovarian Cancer, and the PALB2 Gene

In Blog, Breast Cancer, Cancer, Gynecology, Ovarian Cancer by Dr. Gary Goldman

A publication in today’s New England Journal of Medicine describes another important gene responsible for some hereditary breast and ovarian cancers. Dr. Antoniou and colleagues at Cambridge University found that mutations in the PALB2 gene were associated with a 9.5 times higher rate of breast cancer, and a 2.3 times higher rate of ovarian cancer in women. They also found an 8 times higher risk of male breast cancer. A family history of breast cancer was also important in calculating risk. If there was no family history, the lifetime risk of breast cancer was 33%. With a family history, the …

Do Birth Control Pills Increase the Risk of Breast Cancer?

In Blog, Breast Cancer, Cancer, Gynecology by Dr. Gary Goldman

Do birth control pills increase the risk of developing breast cancer? This question has been debated for years, with various studies concluding yes, no, and maybe. Yesterday a new study was published in Cancer Research by Elisabeth Beaber which you will surely hear quoted in the news. Her findings were as follows: recent users of the pill, longer-term users, users of higher dose formulations, users of triphasic style pills (pills that change their dose three times in one cycle), and users of certain brands containing particular types of progesterone had a greater risk of developing breast cancer. The good news …

How Should We Screen for Ovarian Cancer?

In Blog, Cancer, Gynecology, Ovarian Cancer by Dr. Gary Goldman

I am frequently asked about screening tests for ovarian cancer. This is a dreaded disease which strikes without warning, and can frequently be deadly. Wouldn’t it be great if we could detect it early and prevent its terrible consequences? You may receive the same emails that I do, presumably from Gene Wilder, encouraging women to have a CA-125 blood test; Gene’s wife, Gilda Radner, died from ovarian cancer. Unfortunately, it’s not a very good test. And what’s worse, it’s about the best test we have. We have studied a variety of blood tests, sonograms, and even screening by symptoms, as …

Morcellators in Laparoscopic Surgery

In Blog, Cancer, Gynecology, Surgical Procedures by Dr. Gary Goldman

Morcellators cut tissue into smaller pieces which can be removed through the tiny incisions made during laparoscopic surgery. The advantage of using this tool is obvious: smaller incisions equates with faster hospital stays, better cosmetics, less pain, fewer wound complications and quicker return to work. But like all surgery, there are risks, one of which is spread of an occult malignancy of the uterus called a sarcoma. Sarcoma’s account for 1/350 – 1/1,000 fibroids, which are the much more common benign growths found in the uterus. Unfortunately, sarcomas and fibroids cannot be differentiated pre-operatively. The FDA “discouraged” use of morcellators …

Routine Mammogram Recommendations

In Blog, Breast Cancer, Cancer, Gynecology by Dr. Gary Goldman

Mammograms – a hot topic for discussion. Today let’s begin with timing: when should a woman get her first mammogram? The US Preventive Services Task Force suggested last year that the baseline study should be done at age 50, conflicting with the recommendations of the American Cancer Society and most other groups, which all recommend starting at age 40. One recent study concurs with the 40 year old baseline, pointing out that about half the breast cancer deaths occur in women below the age of 50, and 71% of them had never had a mammogram. Read more here:

Gardasil 9 Approved for More Effective Prevention of Cancers

In Blog, Cancer, Cervical Cancer, Gynecology, Infections by Dr. Gary Goldman

Last week, the Food and Drug Administration approved the new Gardasil 9 vaccine, for the prevention of various diseases caused by nine types of Human Papillomavirus (HPV). It is not yet available for clinical use but should be over the next several months. The prior vaccine Gardasil, which was approved in 2006, covered four types of HPV: the two ‘low-risk’ types 6 and 11, which account for 90% of genital warts, and the two ‘high-risk’ types 16 and 18, which account for 70% of cervical and some additional cancers. Gardasil 9 affords the same protection against those same four types, …