This systematic review assessed the global impact and effectiveness of quadrivalent human papillomavirus (HPV) vaccination on HPV infection and disease in real-world settings over a decade of use. Substantial reductions in HPV 6/11/16/18 infection, anogenital warts, and cervical lesions have been achieved.

Vitamin and mineral supplement use is thought to be common among the 10 million adults in the United States who have been diagnosed with cancer; however, well-conducted studies of this topic are sparse. Moreover, the biologic effects of supplement use among cancer survivors are not well established and not necessarily beneficial. We present a systematic summary of studies published between 1999 and 2006, 32 in total, addressing vitamin and mineral supplement use among US adult cancer patients and survivors. Supplement use is widespread among cancer patients and longer-term survivors. In studies combining different cancer sites, 64% to 81% of survivors reported using any vitamin or mineral supplements and 26% to 77% reported using any multivitamins. In contrast, approximately 50% of US adults use dietary supplements and 33% use multivitamin/multimineral supplements. Between 14% and 32% of survivors initiate supplement use after diagnosis, and use differs by cancer site. Breast cancer survivors reported the highest use, whereas prostate cancer survivors reported the least. Higher level of education and female sex emerged as factors most consistently associated with supplement use. Up to 68% of physicians are unaware of supplement use among their cancer patients. These results highlight the need for further studies of the association between dietary supplement use and cancer treatment toxicity, recurrence, survival, and quality of life to support evidence-based clinical guidelines for dietary supplement use among cancer patients and longer-term survivors.

Context Use of antibiotics may be associated with risk of breast cancer through effects on immune function, inflammation, and metabolism of estrogen and phytochemicals; however, clinical data on the association between antibiotic use and risk of breast cancer are sparse.Objective To examine the association between use of antibiotics and risk of breast cancer. Design, Setting, and ParticipantsCase-control study among 2266 women older than 19 years with primary, invasive breast cancer (cases) enrolled in a large, nonprofit health plan for at least 1 year between January 1, 1993, and June 30, 2001, and 7953 randomly selected female health plan members (controls), frequency-matched to cases on age and length of enrollment. Cases were ascertained from the Surveillance, Epidemiology, and End Results cancer registry. Antibiotic use was ascertained from computerized pharmacy records.Main Outcome Measure Association between extent of antibiotic use and risk of breast cancer. ResultsIncreasing cumulative days of antibiotic use were associated with increased risk of incident breast cancer, adjusted for age and length of enrollment. For categories of increasing use (0, 1-50, 51-100, 101-500, 501-1000, and Ն1001 days), odds ratios (95% confidence intervals) for breast cancer were 1.00 (reference), 1.45 (1.001 for trend). Increased risk was observed in all antibiotic classes studied and in a subanalysis having breast cancer fatality as the outcome. Among women with the highest levels of tetracycline or macrolide use, risk of breast cancer was not elevated in those using these antibiotics exclusively for acne or rosacea (indications that could be risk factors for breast cancer due to altered hormone levels), compared with those using them exclusively for respiratory tract infections, adjusted for age and length of enrollment (odds ratio, 0.91; 95% confidence interval, 0.44-1.87).Conclusions Use of antibiotics is associated with increased risk of incident and fatal breast cancer. It cannot be determined from this study whether antibiotic use is causally related to breast cancer, or whether indication for use, overall weakened immune function, or other factors are pertinent underlying exposures. Although further studies are needed, these findings reinforce the need for prudent long-term use of antibiotics.