Gynecologic Cancer: What Every Woman Should Know
Can You Lower Your Risk?
Updated on: June 20, 2003
Andrew Berchuck, M.D., Professor, Department of Obstetrics/Gynecology Duke University Medical Center, Durham, North Carolina
There are a number of steps women can take to reduce their risks for gynecologic cancers. A recent study, for example, showed that 20 percent of all cancers in women in the U.S. may be attributable to obesity.
Interestingly, the magnitude of this effect was greatest for endometrial cancer, which was increased more than six-fold in obese women. The reason for this increase: obesity leads to chronic unopposed stimulation of the uterine lining by estrogens. Thus, in addition to its well-publicized cardiovascular benefits, maintaining an ideal body weight can also lead to a reduced risk of endometrial cancer.
Since high blood pressure and diabetes also increase endometrial cancer risk, working with your physician to address these health issues can lower your risk for this cancer as well.
Hormonal medications can also influence endometrial cancer risk. Although it has been shown that birth control pills containing both estrogens and progestins substantially decrease a woman's risk for endometrial cancer, post-menopausal hormone replacement therapy with estrogen alone increases endometrial cancer risk. This has led to the recommendation that women with a uterus who are receiving hormone replacement after menopause should also receive a progestin to protect the endometrium. Of course, the decision to use hormone replace-ment therapy should be made in the context of all potential risks and benefits – including con-cerns about increased risk for breast cancer, stroke and heart disease.
When it comes to ovarian cancer, prevention may be the best strategy for reducing risk.
Although the cause of ovarian cancer remains largely unknown, it has been noted that pregnancy and use of birth control pills strikingly decrease ovarian cancer risk. For example, women who have three children or use birth control pills for five years lower their risk for the disease by about 50 percent. What's more, the benefit appears to last for at least 20 years after women stop taking the pill. The protective effect of the pill and pregnancy likely relates to decreasing the number of times a woman ovulates and/or a direct effect of progestagenic hormones on the ovary. Although long-term cancer risks are unlikely to affect childbearing plans, the profound protection that the pill affords against ovarian and endometrial cancers represents a benefit that should be considered in deciding whether to use birth control pills for contraception.
Finally, for cervical cancer, compliance with Pap smear and new HPV screening guidelines continue to be key in lowering risk. Of the American women who die from cervical cancer each year, statistics show that at least half have not had a Pap smear for five years. Since smoking increases cervical can-cer risk, smoking cessation can also be expected to reduce risk.
Cervical cancer represents a success story of prevention and early detection that we should strive to duplicate with other gynecologic cancers!
This article by the Gynecologic Cancer Foundation originally appeared in an advertising supplement to the New York Times on Sunday, June 22, 2003.
GCF gratefully acknowledges Aventis Oncology for its generous support of this educational supplement. The content of this supplement is the work of many individuals and does not reflect commercial interests.
Aventis Pharmaceuticals
www.AventisOncology.com