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Gynecologic cancers: What you need to know

Just because you may be beyond the “childbearing years” doesn’t mean you can ignore your gynecologist. In fact, as you grow older, your risk for certain gynecologic cancers actually increases. Here’s what you need to know:

Cervical cancer

The cervix connects the body of the uterus (womb) to the vagina. This year, about 11,100 women will develop invasive cervical cancer and about 3,900 women will die of the disease. While the mortality rates have been in a steady decline since widespread use of the Pap test (effective in detecting early cases of cervical cancer), more lives could be saved if all women were diligent about routine screenings.

The most important risk factor for cervical cancer is infection by the sexually transmitted human papillomavirus (HPV), a group of more than 70 types of viruses that can cause warts. Since having many sexual partners, intercourse at an early age and unprotected sex at any age raises your risk of HPV, experts consider those behaviors to raise your risk for cervical cancer as well. Exposure to chlamydia, another vaginal infection, and being HIV positive also increases your risk.

Women are also at greater risk for cervical cancer as they age if they smoke, have poor diets low in fruits and vegetables, have used oral contraceptives for a long time or have a family history of cervical cancer.

Ovarian cancer

The ovaries are two small, almond-shaped organs located on each side of the uterus that produce female hormones and store eggs. Ovarian cancer is often described as a “silent” cancer because it typically causes no symptoms until it is quite advanced. The outlook for women who have early ovarian cancer is good, but only 24 percent of the cases are detected at this stage.

Contrary to what some women believe, a Pap test rarely detects ovarian cancer. Because of the lack of an effective ovarian cancer screening test, the American Cancer Society estimates that ovarian cancer will strike 21,700 women this year, and about 15,500 women will die of the disease.

Risk factors include a personal history of breast cancer, a family history of ovarian cancer or colorectal cancer, being over age 50, the presence of an inherited BRCA breast cancer gene mutation, a history of menstruation before age 12, menopause after age 50 and a first pregnancy after age 30 or no children at all.

Pay attention to warning signs, which include a feeling of fullness or discomfort in the pelvic region, abdominal discomfort or swelling, pain during intercourse and abnormal bleeding.

Endometrial and uterine cancers

The uterus is a hollow organ, about the size and shape of a medium-sized pear; the lining of the uterus is called the endometrium. The American Cancer Society predicts there will be 40,100 new cases of cancer of the uterine body this year. About 95 percent of these are endometrial cancers, with the other small percentage involving other uterine tissues.

Risk factors for endometrial and uterine cancers include a history of early menstruation (before age 12) and late menopause (after age 50); a history of infertility or having never given birth; obesity; exposure to tamoxifen (a drug used to treat breast cancer); estrogen replacement therapy or pelvic radiation therapy; a personal history of ovarian diseases, ovarian or breast cancer; a family history of endometrial or uterine cancer; a diet high in animal fat; diabetes; and age. Ninety-five percent of endometrial or uterine cancers occur in women age 40 or older.

Currently, there is no specific good screening test for endometrial or uterine cancer. Although the pelvic exam and Pap test can detect occasional cases, most are not discovered this way. However, 90 percent of patients diagnosed with endometrial or uterine cancer reported postmenopausal bleeding or irregular vaginal discharge. Although these symptoms can occur with other noncancerous conditions, it is important to have an immediate medical evaluation of any bleeding or abnormal discharge.

When to Pap

At or after age 30—if you have certain risk factors—you should follow your healthcare provider’s recommendations on Pap test frequency. And, according to the American Cancer Society:

  • After age 21, women should be screened annually.
  • Women 70 years and older who have had three or more normal Pap tests and no abnormal Pap tests in the last 10 years may choose to stop Pap tests. Discuss this with your doctor.
  • Pap tests after total hysterectomy (with removal of the cervix) are not necessary unless the surgery was done as a treatment for cervical cancer or pre-cancer. Women who have had a hysterectomy without removal of the cervix should continue cervical cancer screening at least until age 70.

Increasing the Pap’s accuracy

It’s a good test, but it can be even better with a little help from you:

  • If you are still menstruating, try not to schedule an appointment for a time during your menstrual period.
  • Do not douche or have sexual intercourse for 48 hours before the test.
  • Do not use tampons, foams, jellies or other vaginal creams or vaginal medications for 48 hours before the test.
  • Continue to have Pap tests as your physician recommends.

Although the test is an incredibly successful screening tool, it’s not perfect. Human error in reading Paps can occur even at the best laboratories, and sometimes abnormalities are missed. That’s why it’s important to have the test as often as your doctor recommends.