September is Gynecologic Cancer Awareness Month, and Becky Watson, M.D., FACOG, is encouraging women to explore their risk factors.
"Gynecologic cancers, with the exception of cervical cancer, can be difficult to detect early," said Dr. Watson, who cares for women at Lake Regional Obstetrics and Gynecology. "It's important for women to receive regular physical examinations and to use that time to talk to their doctors about their risk factors, including family history."
Know the Basics
Gynecologic cancers affect a woman's reproductive organs. The five main types are cervical, ovarian, uterine, vaginal and vulvar.
Cervical cancer begins in the cervix, which is the lower, narrow end of the uterus. Cervical cancer is highly preventable in the United States because screening tests can catch it early, when it is very treatable, and a vaccine can prevent human papillomavirus infections. "Ninety-nine percent of cervical cancers are related to the presence of a high-risk human papillomavirus, or HR-HPV," Dr. Watson said. "Routine screenings with pap smear examinations and HR-HPV testing is recommended, with screening schedules based on a woman's age."
Ovarian cancer causes more deaths than any other gynecologic cancer. It begins in the ovaries, which are located on each side of the uterus. Technically, if the cancer begins in the fallopian tubes — two thin tubes that connect the ovaries to the uterus — it should be called tubal cancer; however, research is suggesting that many cancers labeled ovarian begin in the fallopian tubes. There is no simple and reliable screening for ovarian cancer, but diagnostic tests are available for women with suspected ovarian cancer. Women should discuss testing with their doctors if they have unusual vaginal bleeding or pelvic pain; if they have had breast, uterine or colorectal cancer; if a close relative has had ovarian cancer; or if they have a genetic mutation in the BRCA1 or BRCA2 genes. And because current research suggests ovarian cancer often begins in the fallopian tubes, women should ask their doctors if it makes sense for them to remove their tubes as a preventive measure.
Uterine cancer begins in the uterus, the organ where the baby grows when a woman is pregnant. This diagnosis makes up six percent of all cancer cases in U.S. women, and U.S. women face a 1 in 41 lifetime risk for developing this cancer. The most common uterine cancer is called endometrial cancer because it forms in the lining of the uterus, called the endometrium. Risk increases with age, and most uterine cancers are found in women who are going through or have completed menopause. "Any woman, at any age, should report any abnormal bleeding to their physician," Dr. Watson said.
Vaginal cancer begins in the vagina, which is the tube-like channel between the bottom of the uterus and the outside of the body, and vulvar cancer begins in the vulva, the outer part of the female genital organs. Many vaginal and vulvar cancers are caused by the human papillomavirus, so HPV vaccination also protects against these cancers.
Know Your Family History
"When women visit their OB/GYN physicians for an annual physical exam, it's very important for them to know their family history," Dr. Watson said. "When two or more first-degree relatives are diagnosed with breast cancer, a genetic mutation could be present that increases the risk of ovarian, uterine and colon cancer."
Two genes of particular importance in gynecological cancers are BRCA1 and BRCA2. Certain changes in these genes can increase a woman's risk for getting breast, ovarian and other types of cancer at a young age.
"Women who have mutations in their BRCA genes will need to consider taking extra steps to prevent gynecologic cancers," Dr. Watson said. "These steps range from increased screening and diagnostic tests to removal of certain reproductive organs. Family history is usually the reason doctors recommend BRCA testing."
Know:BRCA Tool for Women
The U.S. Centers for Disease Control and Prevention provides an online tool to help women estimate their chances of having a BRCA gene mutation. The Know:BRCA tool looks at how many people in the woman's family have had breast or ovarian cancer, how these women are related to her and how old they were when they got cancer. Women are encouraged to share their results with their health care providers. To take the assessment, visit www.knowbrca.org.