The Women-Only Cancers We Should Talk About More

Screening

There are currently no screening recommendations for uterine cancer. It is important for women to know the risk factors and early signs and symptoms, particularly postmenopausal women between 45 and 70, who are at the greatest risk. Talk to your doctor if you experience

• postmenopausal vaginal bleeding
• bleeding between periods
• heavy, frequent bleeding before or during menopause
• pain or bleeding during intercourse
• unusual vaginal discharge
• pelvic pain

Risk factors

Estrogen that’s not balanced by progesterone (or “unopposed estrogen”) in the body has been linked to uterine cancer. Specific uterine cancer risk factors include

estrogen replacement therapy (when not used in combination with progesterone)

• five years or more of Tamoxifen use
• never having children
• endometrial hyperplasia (overgrowth of cells lining the uterus)
• polycystic ovarian syndrome (hormone imbalances that cause ovarian cysts)
• obesity
• diabetes

Prevention

Healthy weight maintenance may be the most powerful preventive factor when it comes to uterine cancer. This is often easier said than done, as many factors can interfere with weight management, such as stress, lack of sleep, and hormones. A balanced diet and daily exercise are cornerstones, but much more is at play. Your health care practitioner can create an individualized plan.

Blood sugar balance is also crucial. One recent study showed that the combination of being overweight and having elevated glucose levels may give a woman a 2.6 fold increased chance of developing female reproductive cancers, including uterine cancer.

Healthy eating, exercise, and some herbs can assist with maintaining healthy blood glucose levels. For example, the herb Gymnema sylvestre has shown promise in aiding blood sugar control. Speak with your health care practitioner before trying any new herbs.

Ovarian cancer

Screening

There are currently no screening recommendations for ovarian cancer. However, regular pelvic exams may help in early detection by identifying enlarged ovaries. Women should also note symptoms such as

• abnormal vaginal bleeding
• a palpable lump in the abdomen
• an intense need to urinate
• digestive changes
• pelvic pressure
• lower back pain
• bloating

Risk factors

The strongest risk factor for the development of ovarian cancer is a family history of ovarian cancer. A family history of breast cancer is also a risk factor. Carriers of BRCA gene mutations are at increased risk for both types of cancer.

There is a higher probability of a BRCA gene mutation if a person has

a first-degree relative who has been diagnosed with breast cancer before age 40 or 50

• a family history of breast cancer in both breasts
• a family history of both breast and ovarian cancers, or male breast cancer
• Ashkenazi Jewish ancestry

Genetic testing

Genetic testing is available for those who are suspected to have, or have a high risk for hereditary cancer, which is about 5 to 10 percent of all cancers. The Hereditary Cancer Clinic (HCC) at Alberta Children’s Hospital is one facility that tests individuals and families.

“Hereditary Cancer Clinic genetic counsellors and geneticists have expertise to determine, based on an individual’s family and medical history, whether the individual is at high risk for inheriting a known cancer mutation,” explains Ruth Kohut, manager at Calgary Genetics Services. “The HCC team sees individuals and families with confirmed and suspected hereditary cancers who are referred by their family physician or specialist.

“Not all individuals at risk for hereditary cancer, however, can be offered genetic testing,” she adds.

Risk assessment and counselling help determine when testing is advisable.

“The genetic risk assessment and counselling assists individuals and families in understanding cancer, their risks of inheriting a known cancer gene, risks of developing cancer should they be identified as having inherited the cancer gene in question, and to discuss the option of genetic testing to determine if they inherited a cancer mutation,” says Kohut.

The most important question we may ask is whether genetic testing will lead to reduced incidence of and mortality due to BRCA-related cancers, and unfortunately, no studies can offer an answer. Some benefits to genetic testing include improved patient knowledge, risk perception, and psychological outcomes. Potential harms include inappropriate testing and misinterpretation of test results.

Prevention

There is little we can do about our family health histories or our genes. However, a diet rich in antioxidants, physical exercise every day, and plenty of sleep and relaxation are pillars of a preventive lifestyle.

In addition, certain supplements and foods may help to decrease risk, though further research is needed. For example, Asian women have lower rates of ovarian cancer, possibly due to their soy intake. While you should talk to a knowledgeable health professional if you wish to start supplementing with soy, having a lifetime history of moderate consumption may be protective. Vitamin D deficiency has also been linked to an increased risk of ovarian cancer.

Cervical cancer

Screening

The best prevention is adequate screening starting young, as most cervical cancer cases occur in women under 50. Current Canadian guidelines recommend regular Pap tests by the time a woman is 21 years of age if she is sexually active, at a frequency of every one to three years, depending on which province she resides in. The Pap test detects precancerous cellular changes, and swabs can test for human papillomavirus (HPV) infection.

Risk factors

The most prevalent risk factor for the development of cervical cancer is persistent infection with HPV. While an increased number of sexual partners will increase the risk of exposure, just one sexual encounter can leave a woman infected.

Infection with HPV does not equal a sentence of cervical cancer. Most HPV infections resolve spontaneously within one to two years. Only a small percentage of infections become persistent, and only a small percentage of persistent infections progress to cancer.

Other known risk factors include

• cigarette smoking
• giving birth frequently
• having a weakened immune system
• using oral contraceptives

Immigrant status as risk factor

A recent study looked at 568 women diagnosed with cervical cancer in Montreal. The researchers found that immigrant status, speaking neither English nor French, not having a regular doctor, and not having a chronic condition were significantly correlated with an increased risk of cervical cancer.

Prevention

In HPV-positive women, a diet high in antioxidants appears to reduce the incidence of precancerous cellular changes. In addition, a diet high in carotenoids may help to reduce the incidence of persistent HPV infection.

Knowledge is power. Being able to recognize changes in your body and to act on those changes could be life-saving.