1Lung Cancer Care May Be Guided by Genetic Analysis
28 August 2008
A combination of DNA analysis and clinical data could lead to smarter, structured treatment modalities, study reveals
The activity (expression) of certain genes might enable doctors in the future to identify which lung cancer patients require more aggressive treatment and which do not, a far-reaching genetic study suggests.
However, the results also call attention to the difficulty of stating such predictions, particularly in cases wherein the disease is in its earliest forms, when aggressive treatment modalities could be greatly valuable.
According to experts, the target is to establish effective predictors founded on gene expression (activity) and utilize them as a guide in deciding which treatment is best.
But to go about that, researcher David Beer, a professor in the department of thoracic surgery at the University of Michigan said that you need to know the possible issues that might affect how well gene expression might be able to predict. “I guess the bottom line from this study is that because of the heterogeneity of lung adenocarcinoma, it is not an easy problem. There are still significant issues,” he further said.
Nevertheless, this study – the most comprehensive so far – could open the way to more structured lung cancer therapy which is founded on gene expression profiles, according to an expert.
Dr. Edward Kim, an assistant professor of medicine in the department of thoracic/head and neck oncology at the University of Texas M.D. Anderson Center in Houston said that the target is that five years from today, if he got some findings on a stage 1 or stage 2 lung cancer patient, he could say to his patient, “Hey, you have a very low-risk profile, you don’t need chemotherapy.”
According to Kim, it is just similar to what is done for breast cancer, where certain markers are employed to help doctors decide what treatment modality is to be adopted. “This is a step in that direction for lung cancer,” he said.
The findings of this study were published online July 20 in Nature Medicine.
Beer, together with James Jacobson of the U.S. National Cancer Institute, spearheaded the study sponsored by the NCI Director’s Challenge Consortium for the Molecular Classification of Lung Adenocarcinoma. The study also includes researchers at the H. Lee Moffitt Cancer Center in Tampa Fla., the Memorial Sloan-Kettering Cancer Center in N.Y., the Dana –Farber Cancer Institute in Boston, and the Ontario Cancer Institute in Canada.
The consortium first collected 442 lung adenocarcinoma specimens from six institutions and then divided them into four sets of tests. For every specimen, the researchers gathered gene expression profile on some 22,000 genes found in these cancer specimens. They also examined clinical data like cancer stage as well as patients’ outcomes.
The members of the consortium then employed two of the test sets, integrating outcome information to establish prognostic markers – groups of genes whose modifications in activity (protein expression or production, for instance), whether increased or decreased, predict patient outcome. The researchers then applied these markers - generally, eight were enhanced – in the other two test sets in what is considered a validation step. Unlike in the initial “training phase” of the study, information on patient outcome during this phase was “blinded.” The researchers had to depend on gene signatures, with and without clinical information, in predicting patient prognosis. These predictions were then compared with the actual clinical data to determine if they were accurate.
According to Beer, the findings were mixed.
He said that they discovered several markers that function well on one test set but not on both, and that very few markers function well on both. Furthermore, a number of the published signatures did not work very well at all.
Beer further noted that compared with situations involving exclusive concentration on stage 1 disease, performance was improved for cancers of all stages. However, clinical data supplementation considerably improved the predictions in majority of the cases.
For Beer, the data underscore the complications of applying this method in such an unpredictable disease as lung cancer which can be caused by both genetic and environmental (like smoking) factors.
Beer said that it would be great if this was quite simple and could be done with accuracy, but actually it does not work as well as expected, and that they are trying to understand the reason for this. “Why does it work well in some patients but not in others? How do you improve it? How do we identify genes that are prognostic for everybody, or at least for specific subgroups of patients?”
However, a cancer microarray expert at the University of Michigan who was not associated with this study, Dr. Arul Chinnaiyan, commended its design. He is most particularly impressed with the study’s size, blinded use of specimens, and multi-institutional setting.
He also admired the ability of the research team to develop and recognize genetic signatures that work across the different study sites.
Chinnaiyan said that a lot of biomarkers as developed frequently do not bear up across facilities. He further mentioned that early on, investigations are conducted in a simple way at a singe institution. And often times it cannot be validated by another researcher doing the same thing. “That is what is so impressive, that it held up at all these institutions. That points to the robustness of the signature they identified, that it probably will hold up in a clinical setting," he added.
Kim concurred that the size of the study gives it strength.
According to him, this work is very important since the research has brought everyone together, analyzed 442 specimens for which sound genetic expression data and clinical information are available. He further said that the target “is to grow this so it can be used in a prospective study and hopefully, then, be integrated into our daily clinical practice.”
Chinnaiyan said that the latest data indicate that as in the case of breast cancer, the prognosis of lung cancer can be predicted using data on gene expression through a diagnostic test. MammaPrint of Agendia and Oncotype DX of Genomic Health are two clinical tests which have already started employing the expression of the genes 70 and 21 respectively, as a means of identifying breast cancer patients who are at risk of experiencing disease recurrence, for whom more aggressive treatment modalities might be more beneficial.
It is hoped that strategies similar to that might work well for lung cancer which is an even bigger killer.
Chinnaiyan said that this is extremely comparable.
2Higher Bone Density as a Risk Factor for Breast Cancer
28 August 2008
Breast cancer risk may be associated with higher bone mineral density levels, a new study shows
A woman’s risk of developing breast cancer may be determined by calculating her bone mineral density (BMD).
According to a recent study, the chances of developing breast cancer is higher in women with high bone mineral density levels, regardless of how her risk fares in the frequently used Gail model.
The research team said that the two dimensions may be utilized together to better estimate the risk of developing breast cancer.
The results of the study, which were expected to come out in the Sept. 1 issue of the journal Cancer, are quite reflective of other investigations associating various aspects of bone status with the risk of breast cancer. At the yearly conference of the American Society of Clinical Oncology in May a study presented that Zometa (zoledronic acid), a medication for osteoporosis, decreased recurrence of breast cancer in pre-menopausal women.
Another study that came out this spring discovered that breast cancer women who suffered from vitamin D deficiency when they were diagnosed had a higher tendency of having a recurrence or dying from their disease. Vitamin D is also an essential factor of bone status.
The Gail model integrates pertinent data such as family background, age, and other factors to predict a woman’s risk of developing breast cancer over five years and over her entire life. However, the model does not incorporate findings on bone mineral density, which has been considered a risk factor for breast cancer.
Spearheaded by researchers at the University of Arizona, Tucson, this investigation integrated Gail scores and hip BMD levels on almost 10,000 postmenopausal women who joined in the Women’s Health Initiative.
The women were followed-up on an average of almost nine years, and it was found that women with high Gail scores were, generally, 35 percent more at risk of developing breast cancer. In addition, a woman’s risk increased by 25 percent for each unit of elevation in her total hip BMD.The risk increase was specifically greater for women yielding the highest BMD and Gail scores.
According to Dr. Jay Brooks, chairman of haematology/oncology at Ochsner Health System in Baton Rouge, Louisiana, women with high BMD are mostly suffering from obesity, a condition which increases their chances of developing breast cancer and which may be serve as the common denominator.
He said that in his opinion, this provides more information showing a connection between weight gain, obesity, and breast cancer development. Another specialist however said that the picture for women stays complicated. Dr. Mary Daly, director of the Cancer Prevention and Control Program at the Fox Chase Cancer Center in Philadelphia said that despite these supplemental findings, “it’s still not clear what the precise relationships are between estrogen, bone density and breast cancer.”
3Some Women Fail to Complete Breast Cancer Radiotherapy
28 August 2008
A number of women diagnosed with breast cancer do not complete their radiotherapy hence supporting more women to be able to finish their treatment is quite imperative, a new study reveals.Out of the 24, 500 U.S. women with breast cancer diagnosis between1992 and 2002, the research team discovered that only 87 percent was able to complete radiotherapy after surgery.
In a report published in the journal Cancer, the investigators wrote that although the 87 percent figure is “reasssuring,” the remaining 13 percent of patients who failed to see their treatment through to the end still embodies a quite big population of women.
According to Dr.Tomasz P. Srokowski of the University of Texas M.D. Anderson Cancer Center in Houston and colleagues, this is a point to be concerned about as women undergoing radiotherapy after surgery for breast cancer are less likely to experience cancer recurrence.
The research team used the data obtained from a government cancer surveillance system as the basis of their findings. They concentrated on the records of 24,510 women 66 years old and over who were treated with surgery and radiation for breast cancer in the early to middle stages - cancer that had not yet metastasize or spread to other body parts.
Overall, the researchers found that women who underwent a mastectomy had a higher tendency of failing to complete radiotherapy than those who had gone through a less extensive surgical treatment. The likelihood for black women to complete radiation therapy was higher than that of white women – 16 percent did not undergo a complete radiotherapy course, as against only over 12 percent of white women who had done the same.
As for the patients who had undergone mastectomy, the researchers conjecture that after such radical surgery, some women, together with their doctors, may consider follow-up radiotherapy to be less important, compared with women who had only undergone tumor removal.
However, Srokowski’s team says that they have found no valid and clear reason for the racial difference, which does not seem to be influenced by factors such as income and level of educational attainment.
Generally, the risk of cancer recurrence was a little greater for women who fail to finish radiotherapy over the next five years. But the huge majority of both who completed and failed – over 95 percent in both cases – did not experience any recurrence during the said period.
The researchers however still say that more studies should investigate the reason behind the failure of some women to complete their breast cancer therapy, and what measures should be taken to address it.
Yet it is somewhat evident in the current study that there is an improvement in the situation. The likelihood of completing radiotherapy after surgery was higher in women diagnosed more recently than others.
Srokowski and colleagues said that this may be a sign that radiotherapy has improved and has minimized side effects, and that awareness of post surgery radiotherapy’s potential benefits has increased.
4Prostate Cancer
6 August 2008
Prostate Cancer Defined
The body is made up of many types of cells. Normally, cells grow, divide, and produce more cells as needed to keep the body healthy and functioning properly. Sometimes, however, the process goes wrong — cells become abnormal and form more cells in an uncontrolled way.
These extra cells form a mass of tissue, called a growth or Tumor. Tumors can be Benign, which means not cancerous, or Malignant, which means cancerous. Prostate cancer occurs when a malignant tumor forms in the tissue of the prostate, a gland in the male reproductive system. In its early stage, prostate cancer needs the male hormone Testosterone to grow and survive.
The prostate is about the size of a large walnut. It is located below the Bladder and in front of the rectum. The prostate’s main function is to make fluid for semen, a white substance that carries sperm.
Prostate cancer is one of the most common types of cancer among American men. It is a slow-growing disease that mostly affects older men. In fact, more than 65 percent of all prostate cancers are found in men over the age of 65. The disease rarely occurs in men younger than 40 years of age.
Sometimes, cancer cells break away from a malignant tumor in the prostate and enter the bloodstream or the lymphatic system and travel to other organs in the body.
When cancer spreads from its original location in the prostate to another part of the body such as the bone, it is called metastatic prostate cancer — not bone cancer. Doctors sometimes call this “distant” disease.
Today, more men are surviving prostate cancer than ever before. Treatment can be effective, especially when the cancer has not spread beyond the region of the prostate.
Causes and Risk Factors
Scientists don’t know exactly what causes prostate cancer. They cannot explain why one man gets prostate cancer and another does not. However, they have been able to identify some risk factors that are associated with the disease. A risk factor is anything that increases your chances of getting a disease.
Age is the most important risk factor for prostate cancer. The disease is extremely rare in men under age 40, but the risk increases greatly with age. More than 65 percent of cases are diagnosed in men over age 65. The average age at the time of diagnosis is 70.
Race is another major risk factor. In the United States, this disease is much more common in African American men than in any other group of men. It is least common in Asian and American Indian men.
A man’s risk for developing prostate cancer is higher if his father or brother has had the disease.
Diet also may play a role. There is some evidence that a diet high in animal fat may increase the risk of prostate cancer and a diet high in fruits and vegetables may decrease the risk. Studies to find out whether men can reduce their risk of prostate cancer by taking certain dietary supplements are ongoing.
Scientists have wondered whether an enlarged prostate, a condition also known as benign prostatic hyperplasia or BPH, might increase the risk for prostate cancer. They have also studied Obesity, lack of Exercise, smoking, radiation exposure, and a sexually transmitted virus to see if they might increase risk. But at this time, there is little evidence that any of these factors contribute to an increased risk.
5Drug Blocks the Growth of Breast Cancer
6 August 2008
Laboratory and Mouse Studies Show Targeted Drug Blocks the Growth of Breast Cancer Cells that Spread to the Brain
Using laboratory and mouse models of human breast cancer, researchers have found that small molecule capable of targeting specific proteins on the surface of breast cancer cells can inhibit the growth of breast cancer cells that migrate to the brain. The small molecule used in the studies was the drug lapatinib (Tykerb), which disrupts an important breast cancer Metabolic process called the Her2/neu signaling pathway. Lapatinib inhibits the activation of growth signaling proteins and their signaling pathways as well as cell migration and proliferation. Using the mouse model, the drug reduced the number of brain lesions that resulted from the injection of human cells.
The study, which appeared online July 29, 2008, in the Journal of the National Cancer Institute, was conducted by researchers at the National Cancer Institute (NCI), part of the National Institutes of Health (NIH).
“Brain metastases are rarely treated with drugs because many drugs do not cross the Blood-brain barrier, a special wall of Blood vessels in the brain that prevents the passage of most foreign substances from the bloodstream into the brain and Spinal cord,” said Patricia S. Steeg, Ph.D., head of the Women’s Cancers Section in NCI’s Center for Cancer Research. “For example, Trastuzumab (Herceptin) is an FDA-approved antibody that targets HER2, and it can inhibit breast cancer’s growth. These antibodies are too large to pass the blood/brain barrier to impact the cancer cells that have migrated to the brain. However, our mouse model suggests that lapatinib may successfully get across. If successful in humans, the drug may provide a new approach to treating brain metastases.” Currently, treatment options for breast cancer patients with brain metastases are limited to Steroids, Radiotherapy, and surgery.
Brain metastases from breast cancer occur in approximately one-third of all cases of HER2-positive, metastatic breast cancer. About 20 percent to 25 percent of breast cancers are HER2-positive, meaning they have too much of, or overexpress, the protein HER2 on their surface. These tumors tend to grow faster and are more likely to recur than tumors that do not overexpress HER2.
Lapatinib inhibits the activation of both HER2 and the epidermal growth factor receptor (EGFR). Lapatinib in combination with the drug capecitabine has been approved to treat patients with HER2-positive breast cancer whose disease has progressed after treatment with trastuzumab in combination with certain other
breast cancer therapies, including an anthracycline (a type of antitumor antibiotic) and a taxane (a drug that blocks cell division).
“Lapatinib was tested in a human clinical study of brain metastases and showed only modest results,” said Steeg. “However, we asked a different question. Rather than asking lapatinib to melt a golf ball-sized Metastasis in the brain, we asked if it would be more effective at preventing micrometastases, or small,
undetectable metastases, from growing into large metastatic tumors.”
To explore the effects of lapatinib on micrometastases, the research team injected human breast cancer cells that overexpressed EGFR only, or overexpressed both EGFR and HER2, into mice. Five days later, lapatinib or a Placebo solution was administered twice daily for 24 days. When the researchers examined the mouse brains for metastatic breast cancer tumors, they found that lapatinib reduced the development of large brain metastases by 50 percent or more compared to the placebo solution and that it also hit one of its targets — it reduced the activation of HER2.
To gain a better understanding of how lapatinib was working, researchers investigated its effects on breast cancer cells in the lab. They found that breast cancer cells that expressed more of the targeted receptors had greater sensitivity to the drug. Those that expressed high levels of both EGFR and HER2 were approximately
30 percent more sensitive to the growth inhibition effects of lapatinib than cells that expressed high levels of only one of these receptors. However, cells that only expressed EGFR or HER2 were equally sensitive to the drug. The researchers also found that lapatinib inhibited activation of the EGFR and HER2 proteins,
as well as of proteins that are involved in cell signaling pathways that regulate gene expression, cell division, and cell survival — and which, ultimately, may contribute to the development of cancer.
“These findings indicate that lapatinib may be beneficial in the treatment of patients with HER2-positive breast cancer who may have micrometastases and are thus at risk for the development of brain metastases,” said Steeg. Having completed their studies in the lab and in mice, the researchers await the results of ongoing Clinical trials of lapatinib where it is given in addition to the primary therapy, such as the Adjuvant Lapatinib And/Or Trastuzumab Treatment Optimisation study, or ALTTO trial, which opened in 2008. This study was funded by NCI and the Department of Defense Breast Cancer Research Program.
For more information on Dr. Steeg’s research, please go to http://ccr.cancer.gov/staff/staff.asp?profileid=5851.
For more information about cancer, please visit the NCI website at http://www.cancer.gov , or call NCI’s Cancer Information Service at 1-800-4-CANCER (1-800-422-6237).
6Breast Cancer
6 August 2008
|
Breast Cancer Defined The body is made up of many types of cells. Normally, cells grow, divide and produce more cells as needed to keep the body healthy. Sometimes, however, the process goes wrong. Cells become abnormal and form more cells in an uncontrolled way. These extra cells form a mass of tissue, called a growth or Tumor. Tumors can be Benign, which means not cancerous, or Malignant, which means cancerous. Breast cancer occurs when malignant tumors form in the breast tissue. Breast cancer is one of the most common cancers in American women. It is more common among older women than younger women. Men can get breast When cancer grows in breast tissue and spreads outside the breast, cancer If the cancer has reached these nodes, it When cancer spreads from its original location in the breast to another Breast cancer is not contagious. A woman cannot “catch” breast cancer Today, more women are surviving breast cancer than ever before. Over There are several ways to treat breast cancer, but all treatments work Every day researchers are working to find new and better ways to detect Causes and Risk Factors No This chart shows what the approximate chances are of a woman getting
Ages 30 to 40 | Chances are 1 out of 257 Ages 40 to 50 | Chances are 1 out of 67 Ages 50 to 60 Ages 60 to 70 | Chances are 1 out of 28 Ages 70 to 80 Older age and the following risk factors increase a woman’s chance of Breast cancer among one or more of your close relatives, such as Having no children or having your first child in your mid-thirties Having your first menstrual period before age 12 increases the risk. Gaining weight after Menopause, Race can be a factor. White women are at greater risk than black Five percent to 10 percent of all breast cancers are thought to be When breast cancer first develops, there may be no symptoms at all. Warning signs of breast cancer: A lump or thickening in or near the breast or in the underarm area. A change in the size or shape of the breast. Nipple discharge or tenderness, or the nipple is pulled back or inverted Ridges or pitting of the breast. The skin looks like the skin of A change in the way the skin of the breast, areola, or nipple looks You should see your doctor about any symptoms like these. Most often, they Some women believe that as they age, health problems are due to “growing Testing and Diagnosis When breast cancer is found early, it is more likely to be treated successfully. Checking for cancer in a person who does not have any symptoms During a clinical breast exam, the doctor or other health care professional Several studies show that mammography screening has reduced the number Scientists are continuing to examine the level of benefit that mammography If you are a woman in your 40s, you should have mammography screening If you are a woman age 50 and older, you should have mammography If you are a woman who is at higher than average risk for breast Between 5 and 10 percent of mammogram results are abnormal If needed, the most common follow-up test a doctor will recommend is With fine needle aspiration, doctors numb the area and use a thin needle If the fluid is clear, For a needle biopsy, sometimes called a core biopsy, doctors use a needle In a surgical biopsy, a surgeon removes a sample of a lump or suspicious Doctors are studying another type of surgical biopsy that removes less Eighty percent of U.S. women who have a surgical breast Treatment and Research There Planning Treatment If People with cancer often are treated by a team of specialists. The team Before starting treatment, you may want another doctor to review the What is Staging? Once Staging will let the doctor know the size of the tumor and exactly where it is in the breast if the cancer has spread within the breast if cancer is present in the lymph nodes under the arm if cancer is present in other parts of the body Here are the stages of breast cancer: Stage 0 — This is very early breast cancer that has not Stage I and stage II also are early stages of breast cancer. Stage Stage III is called locally advanced cancer. Here the tumor has spread Stage IV is metastatic cancer. In this stage the cancer has spread The choice of treatment is based on many factors. For stage I, II or Standard Treatments There Here is what the standard cancer treatments are designed to do: Surgery takes out the cancer. Hormone therapy keeps cancer cells from getting the hormones they Radiation therapy uses high-energy beams to kill cancer cells and Chemotherapy uses anti-cancer drugs to kill cancer cells. Treatment for breast cancer may involve local or whole body therapy. If you have early-stage breast cancer, one common treatment available to In a lumpectomy, the surgeon removes only the tumor and a small amount The survival rate for a woman who has this therapy If you have breast cancer that has spread locally — just to other parts Doctors first shrink the tumor with chemotherapy and then In the past, doctors would remove a lot of lymph nodes near breast tumors If the breast cancer has spread to other parts of the body, such as the Treatment and Research - Latest Research Several new Researchers are testing another technique to help women who have undergone New drug therapies and combination therapies continue to evolve. Findings This mix of drugs may increase the length of time you will live or the New research shows women with early-stage breast cancer who took the Herceptin® is another drug commonly used to treat women Approximately 20 to 25 percent of breast cancers produce too much HER2. Results from two recent clinical trials show that those patients with Cancer treatments like chemotherapy can be systemic, meaning they affect Because of the availability of these two drugs, an international The goal of TAILORx is important because the majority of TAILORx seeks to examine many of a woman’s genes simultaneously and use Several methods show promise in reducing the risk of breast cancer. In The approval of tamoxifen followed a clinical trial sponsored Tamoxifen does have side effects. The most serious in some women are The Study of Tamoxifen and Raloxifene (STAR) is a more recent clinical Raloxifene, marketed as Evista®, has been approved for use to lower the Results of the STAR trial show that raloxifene works as However, taking raloxifene raised the risk of blood clots and fatal strokes |
7Cervical cancer
23 July 2008
The Cervix is the lower part of the Uterus, the place where a baby grows during pregnancy. Cervical cancer is caused by several types of a virus called human papillomaviruses (HPV). The virus spreads through sexual contact. Most women’s bodies are able to fight HPV infection. But sometimes the virus leads to cancer. You’re at higher risk if you smoke, have many children, use birth control pills for a long time, or have HIV infection.
Cervical cancer may not cause any symptoms at first, but later, you may have pelvic Pain or bleeding from the vagina. It usually takes several years for normal cells in the cervix to turn into cancer cells. Your health care provider can find abnormal cells by doing a Pap test - examining cells from the cervix under a microscope. By getting regular Pap tests and pelvic exams you can find and treat changing cells before they turn into cancer.
A vaccine for girls and young women protects against the four types of HPV that cause most cervical cancers.
Causes
The American Cancer Society provides the following list of risk factors for cervical cancer: Human Papillomavirus (HPV) infection, smoking, HIV infection, Chlamydia infection, dietary factors, hormonal contraception, multiple pregnancies, use of the hormonal drug diethylstilbestrol (DES) and a family history of cervical cancer.
Human papillomavirus infection The most important risk factor in the development of cervical cancer is infection with a high-risk strain of human papillomavirus. Women who have many sexual partners (or who have sex with men who had many partners) have a greater chance.
More than 60 types of HPV are acknowledged to exist (some sources indicate more than 200 subtypes). Of these, 15 are classified as high-risk types (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73, and 82), 3 as probable high-risk (26, 53, and 66), and 12 as low-risk (6, 11, 40, 42, 43, 44, 54, 61, 70, 72, 81, and CP6108),but even those may cause cancer.
Types 16 and 18 are generally acknowledged to cause about 70% of the cancer cases. Although most HPV infections clear up on their own, the infections could increase to major abnormalities or cervical cancer.
The presence of strains 16, 18 and 31 is the prime risk factor for cervical cancer, and Walboomers et al. (1999) reported that the presence of HPV is a necessary condition for the development of cervical cancer. A virus cancer link with HPV has been found to trigger alterations in the cells of the cervix, leading to the development of cervical intraepithelial neoplasia and cancer.
Genital warts although caused by different HPV types have no relation to cervical cancer.
The medically accepted paradigm, officially endorsed by the American Cancer Society and other organizations, is that a patient must have been infected with HPV to develop cervical cancer, and is hence viewed as a sexually transmitted disease, but not all women infected with HPV develop cervical cancer.
Use of condoms does not always prevent transmission. Likewise, HPV can be transmitted by skin-to-skin-contact with infected areas. In males, HPV is thought to grow preferentially in the epithelium of the glans penis, and cleaning of this area may be preventative.
Despite the development of an HPV vaccine, some researchers argue that routine neonatal male circumcision is an acceptable way to lower the risk of cervical cancer in their future female sexual partners. Others maintain that the benefits do not outweigh the risks and/or consider the removal of healthy genital tissue from infants to be unethical as it cannot be reasonably assumed that a male would choose to be circumcised.
There has not been any definitive evidence to support the claim that male circumcision prevents cervical cancer, although some researchers say there is compelling epidemiological evidence that men who have been circumcised are less likely to be infected with HPV. However, in men with low-risk sexual behaviour and monogamous female partners, circumcision makes no difference to the risk of cervical cancer.
In the Canadian provinces of Ontario, Prince Edward Island, Newfoundland and Nova Scotia, free vaccinations to protect women against HPV are slated to begin in September 2007 and will be offered to girls 11-14 in age. Similar vaccination programs are also being planned in British Columbia and Quebec.
Australia has decided to fund the HPV vaccine under the National Immunisation Program commencing in the 2007 school year.In the U.K. a similar free vaccination program is being considered, while in the United States, many states are preparing bills to handle issuing the HPV vaccine.