What is HPV and what is an HPV screening test?

HPV means Human Papilloma Virus.  HPV is a group of virus types that can affect skin and mucus membranes in the body.  They are the most common skin-to-skin contact transmitted virus types worldwide.  There are numerous sub-types which have been discovered and can be detected.  Many of these sub types cause no symptoms, while others may cause genital warts.  High risk sub types are more often associated with precancerous tissue changes of the cervix (cervical dysplasia) that may lead to cervical cancer, if left untreated over years.  An HPV screening test can be performed together with a PAP smear test.  The sample is collected from the surface of the cervix just like PAP smear testing. 

Protection from HPV

The most effective way to protect oneself from HPV affection is not to get in touch with HPV. Once there is an HPV contact, depending on a person's individual immune response and local immune competence, it may lead to an infection.  HPV infection commonly does not show any symptoms or cause complaints.  In up to 90% of the cases, it is a self-limiting infection resolving within 2 years by itself.  There is still in 10% of the cases women stay chronically infected and may therefore develop abnormal intra-epithelial cervical lesions over time. The risk of an HPV affection and infection can be decreased but not 100% eliminated by protecting oneself.

HPV Vaccination

An additional option of primary prevention is an HPV vaccination against the high risk sub-types HPV type 16 and HPV type 18. About 70% of all cervical cancer lesions are caused by these two virus types. With the option of a targeted HPV vaccination, this risk can effectively be minimized. The greatest benefit of an HPV vaccination can be obtained by applying a first vaccination loading dose and its consecutive follow up boosting doses prior to onset of sexual activity in teenagers. Vaccination is recommended to both, girls and boys. The antibodies build up as an immune response to vaccination can thereafter protect from virus invasion into the skin and body mucous membranes and prevent from a chronic virus infection. 

Two vaccines are available and they do both target HPV high risk virus types HPV 16 and HPV 18. Vaccination does not cover all high risk HPV sub-types known. A yearly check up and regular PAP smear testings therefore remains crucial for women. Still, experiences with vaccinating women against HPV 16 and HPV 18 over the past years has shown, that vaccination may also be beneficial and protective against other potentially oncogenic virus types in addition. This so-called cross-protection can be explained by similarities in virus surface structure and mode of action, that allows immune response cells identify and attack several virus types.

One of the two vaccines available additionally prevents from infection with HPV low risk types HPV6 and HPV 11, known to be causing non-malignant genital warts.  A new vaccination that was recently introduced is targeting nine virus types and therefore seems to be a promising option.  All vaccines itself do not contain any oncogenic or cancerous changes causing ingredients. Risks and side effects of a vaccination are comparable with those of other well established recommended vaccinations in childhood and teenage years. Vaccination is a highly recommended option of primary prevention in teenagers, both boys and girls in the age from 9 to 15years. But also later in life vaccination is advisable. Also women in her fertile ages exceeding this main target group can profit from a boost in their local immune response and should ask their gynecologist for more information and an individualized consultation. Still, a regular check up and PAP smear remains crucial in all women.

Visit us for more information. We are happy to answer all your questions.

Dr. Amelie Hofmann-Werther

Specialist in Obstetrics & Gynaecology

(Facharzt Germany)

Cervical Dysplasia & Coloscopy

Master Class in Fetal Medicine

http://www.fetalmedicine.ae/#dr-amelie

The cycle of women, the circle of life

Bad hair days, skin problems, feeling heavy, retaining of water in the tissue, rumbling stomach and bloated tummy that will just not fit in the favorite jeans! Most women notice details and experience changes in their hormone balance without knowing that most of our everyday life minor aliment, issues and struggles originate from  women´s hormone imbalance. Sleeping disorders, such as problems in falling asleep, calming down and finding peace before going to bed or problems in sleeping through the night may seem familiar to you. Sleep is restless, and dreams may be fragmented. Digestion disorders vary from slow metabolism and constipation to diarrhea prior to onset of menstrual bleeding.  Phases of keen ravenous appetite being greedy after salts or sweets in the middle of the night or at any other unusual time and occasion may happen as well occasionally, apparently out of the blue! Morning headache, lower back pain or lower abdominal pain in menstrual bleeding are a common finding in women. Putting on weight or just not losing weight although you are strictly sticking to your diet, lumpy breast swellings, sudden discomfort wearing a bra or sleeping on your belly are typical cycle related complaints.

So are mood swings and volatility varying from thin-skinned depression longing for tenderness and a shoulder to lean on to feeling combatively loaded. Sometimes our mind turns inwards, we may be easy to hurt, more likely to quarrel. From feeling desirable to just not interested in romantic quality time with the partner, anything is possible….

You are not alone!

This is a good time for learning new skills. Initiate a change!

Your doctor can help you become more self-aware, so that plans and new goal settings develop easier. Your doctor can help you understand your own individual cycle process and analyze it. Show you how to increase strength, spurt energy, feel balanced, enjoy socializing, feel more light-hearted. By guiding your way determining your personal physical energy and activity peak times as well as your individual lazy leisure time hide aways. Optimization of your Resources should include Nutrition education, Stress-Relief and Detox, physical fitness for more range of motion and flexibility as a holistic approach for hormone balancing.

Dr. Amelie Hofmann-Werther

Specialist in Obstetrics & Gynaecology

(Facharzt Germany)

Cervical Dysplasia & Coloscopy

Master Class in Fetal Medicine

http://www.fetalmedicine.ae/#dr-amelie

The Anomaly Scan at 18-22 weeks

An anomaly scan, also known as detailed morphology scan, intends to take a closer look at the baby and the uterus. 

The Fetal Medicine Specialist will check how the baby is developing plus the position of the placenta. 

Anomaly scan is often called a 20-week scan; however, a patient may have it any time between 18 weeks and 22 weeks. 

Although the main target of the scan is as mentioned above, the gender, however, may be revealed by the Fetal Medicine Specialist if desired by the patient.  By 12 weeks gestation, gender accuracy is 95% while at 16 weeks, it is 99%++.

The whole scan takes about 30 minutes for a single gestation.  The Fetal Medicine Specialist will assess the fetal organs.

Major organs are mostly checked by cross section and measured, these are:

·         

    The shape and structure of the head and brain.

·         The Face - Cleft lip and Palate are checked while focusing on the face.

·         The Spine, its length and in cross section, making sure that all the bones            align, and that the skin covers the spine at the back.

·         The Heart. Normal structure, location, normal rhythm pattern.

·         The Abdominal wall making sure it covers all the internal organs at the              front.

·         The Stomach.

·         The Kidneys, confirming that the baby has 2 kidneys and bladder is visible.

·         Fetal Extremities. Arms, Hands, Fingers, Legs, Feet, Toes

The placenta location and structure, umbilical cord and the amniotic fluid are also checked.

To see how well the baby is growing, the HC (head circumference), AC (abdominal circumference) and FL (femur length-thigh bone) measurements should match up depending on when is the expected delivery date.

Authored by Dr. Afshin PourMirza, MD, PhD

Obstetrics and Gynaecology – Maternal Fetal Medicine

Managing Director of Feto Maternal and GenetYX Center

Hereditary Breast Cancer

The body is made up of trillions of living cells. These cells grow, divide, and die in an orderly fashion. This process is tightly regulated and is controlled by the DNA machinery within the cell. When cells of the body at a particular site start to grow out of control, they may become cancerous. Cancer cell growth is different from normal cell growth. This shift from normal cellular growth to abnormal cellular growth is caused by a damage of specific genes or DNA controlling cellular division.

DNA damage known as mutation may be inherited from parents; this will result in hereditary cancer. However, it may result from spontaneous problem that occurs during the lifetime of a person. DNA damage may also be triggered by exposure to certain environmental toxins such as those present in cigarette smoke, this will result in sporadic cancer. Hereditary form often occurs earlier than the sporadic form of the same cancer.

Breast cancer follows the same rules as other cancers. BRCA1 and BRCA2 are the most common genes involved in hereditary breast and ovarian cancers. Breast cancers linked to these mutations occur more often in younger women and more often affect both breasts than cancers not linked to these mutations. Women with these inherited mutations also have an increased risk for developing other cancers, particularly ovarian cancer. Tests that measure likelihood for a disease are called “predictive genetic tests.” Testing these genes does not detect whether a person has cancer or not; it indicates whether a person carries a change in one of these genes which can increase cancer risk.

Other gene mutations can also lead to inherited breast cancers. These gene mutations are much rarer and often do not increase the risk of breast cancer as much as the BRCA genes. If you have a family history of breast cancer, you should see genetic specialist to determine your risk and to explain for you the procedure to follow to determine if you have genetic susceptibility for breast cancer.

 

For early detection of sporadic breast cancer, every female has to do self-breast examination monthly starting at 20 years old. She should have a breast exam by doctor at least every 3 years starting at 20 and every year starting at 40 years. Mammogram is also recommended every 2 years starting at 40 years.

For hereditary breast cancer genetic counselling and genetic tests are not the only things to do. The screening strategy is more frequent with breast self-exam monthly from 18 years, clinical breast exam by doctor every 6-12 months from 25 years and annual Mammography screening from 25 years or younger if family history of breast cancer before 25 as well as annual MRI screening.

Early detection is very important as it will affect treatment modalities with better prognosis and lower risk of recurrence.

Dr. Azza Abd El Moneim Attia Mohamed

French Board

Consultant Clinical Genetics

Feto Maternal and GenetYX Center