Female Dangers

While breast cancer is the biggest and most publicized cancer threat American
women face, it is not the only female-specific cancer. Cervical, ovarian and uterine
malignancies affect thousands each year. Learn what to look out for so you don’t fall victim.

By Lisa James

May 2006

If someone says the words “female” and “cancer” to you, the first word that probably pops into your head is “breast.” After all, the numbers are hard to ignore: Almost 213,000 American women develop breast malignancies each year…and more than 40,000 die from them.

But a woman overlooks her reproductive tract at her peril; just ask actress Fran Drescher, who graced the cover of last year’s Annual ET Cancer Issue. In her book, Cancer Schmancer (Warner Books), Drescher explains how she saw nine doctors—count ’em, nine—before her uterine cancer was finally discovered and treated, leaving her unable to bear children. “Women need to understand gynecological cancers and the tests that can help detect them,” she writes. “We have to…become educated consumers, network among ourselves, and gain information and insight into getting diagnosed and getting treatment. Someone gimme a podium!”

Taking our lead from “The Nanny,” ET presents what you need to know about three cancers—cervical, ovarian and uterine—that should be on every woman’s radar. (Statistics given are 2006 estimates from the American Cancer Society [ACS].)

Uterine Cancer: A Hormonal Challenge

What it is: Most are endometrial cancers; they arise in the inner lining (endometrium) of the uterus, the part that grows and is shed over the course of a woman’s menstrual cycle. Tumors called sarcomas can develop in the muscle tissue, but account for only 2% to 4% of all uterine cancers.
Number of women affected: 41,200 cases of endometrial cancer (the most common reproductive-tract malignancy) and 7,350 deaths. It is one of the more treatable cancers though, with a five-year survival rate of 84%.

At greatest risk: Roughly 70% of all women affected are between the ages of 45 and 74. Endometrial cancer shares a lot of risk factors with ovarian cancer because excessive estrogen exposure promotes overgrowth of the uterine lining. Taking the drug tamoxifen for breast cancer also increases risk, as does having undergone pelvic radiation therapy. Genetic history is another factor, particularly in families affected by hereditary nonpolyposis colon cancer (HNPCC).

The symptoms: Abnormal bleeding, especially after menopause. Pain and weight loss can be signs of late-stage disease.

The tests: There are no standard screening tests for this kind of cancer. Abnormal bleeding may prompt your doctor to perform an endometrial biopsy, in which a thin needle is passed through the cervical opening to collect cells in the uterine lining.

Vital info: Try your best to drop those extra pounds. Obesity ups the risk of hormonally driven cancers because fat tissue can transform other hormones into estrogen. That makes weight loss a good strategy for preventing a number of malignancies, including all three of the cancers covered in this story plus breast cancer. Limit your intake of animal fat in particular, which appears to increase risk, and get plenty of exercise, which seems to lower it. (Obesity plays a pivotal role in the development of type 2, or adult-onset, diabetes, which may explain why diabetes has also been linked to endometrial cancer.)

You can do worse than to adopt a more Japanese-influenced diet. Partaking of soy foods, which are eaten more commonly in the Far East than in the US, has been linked with a drop in endometrial cancer risk, especially among heavier women. And kelp, a brown seaweed often found on Japanese dinner plates, has lowered estrogen levels in animals.

To learn more: Women’s Cancer Network, part of the Gynecologic Cancer Foundation—www.wcn.org, 312-578-1439 (Chicago).

Cervical Cancer: A Viral Link

What it is: Cancer that forms in the lining of the cervix, which connects the uterus to the vagina. Between 80% and 90% are squamous cell carcinomas, arising from the flat cells that cover the part of the cervix closest to the uterus; the rest are adenocarcinomas, which develop from mucus-producing cells.

Number of women affected: 9,710 cases of invasive cancer, with roughly four times as many noninvasive (in situ) occurrences, and 3,700 deaths.

At greatest risk: Half of all diagnoses are in women between the ages of 35 and 55. But older women are still susceptible; the ACS recommends regular screening until at least age 70. The biggest risk factor is being infected with human papillomavirus, which can also cause genital warts. Others include being exposed to DES (a drug used between 1938 and 1971 to prevent miscarriages) before birth, being infected with HIV or having a weakened immune system.

The symptoms: None in the early stages; in later stages the most common sign is abnormal bleeding, including spotting or light bleeding between periods, or following intercourse or douching.

The tests: Cervical cancer is generally foreshadowed by precancerous tissue changes.

Fortunately, these changes can be detected by a Pap smear, which involves having cells painlessly swabbed from the cervix during a standard pelvic exam. According to the ACS, a woman should start going for annual tests no later than age 21 (or every other year, if a newer liquid-based test is used); the time between tests may be increased at age 30 if a woman has had three normal tests in a row. Thanks to the Pap smear, cervical cancer deaths in the US plummeted 74% from 1955 to 1992 and continue to drop by almost 4% a year.

Vital info: It’s absolutely crucial that you go for regular Pap exams. Roughly 80% of all women will have been exposed to HPV at some point by age 50 but many never develop symptoms while other cases go away on their own, especially in younger women. What’s more, not all HPV strains (of the more than 100 that exist) are potentially dangerous. The Food and Drug Administration (FDA) has approved a test for high-risk HPV as a screening tool (along with Pap smears) for women over 30 and for individuals with minor cervical abnormalities to determine if additional testing is needed. On the near horizon: A vaccine that protects against HPV—the first-ever vaccine specifically designed to fight cancer.

Load up on fruits and vegetables, which contain abundant anti-cancer nutrients. For example, low levels of the B vitamin folate have been linked to cervical malignancies. Certain foods, including cabbages and cranberries, also feature compounds that show promise in forestalling cervical cancer. Don’t smoke; the cervix is one of the many organs that may develop tumors in tobacco’s presence. And being in a mutually monogamous relationship is a plus, since a woman’s chances of acquiring HPV go up as her number of sexual partners increases.
To learn more: National Cervical Cancer Coalition—www.nccc-online.org, 1-800-685-5531.

Ovarian Cancer: A Quiet Killer

What it is: Most tumors arise in the epithelial cells that cover the outside of the ovary; some are outright cancerous, while others are low malignant potential (LMP) growths. Cancers can also develop in the egg-producing germ cells or hormone-secreting stromal cells within the ovary.

Number of women affected: 20,180 new cases and 15,310 deaths, making it the deadliest reproductive-tract cancer.

At greatest risk: Two-thirds of the women affected are 55 and older. However, younger women with a family history of ovarian cancer are also at risk. Other risk factors include obesity, starting menstrual cycles before age 12 and/or entering menopause after age 50, having no children (or starting a family after age 30) and having had breast cancer, all of which tend to increase a woman’s exposure to estrogen. The risk of women taking estrogen-only hormone replacement therapy (HRT) for more than 10 years is almost double that of women who never took HRT; the risk for women taking combined estrogen and progesterone HRT is not as well-defined. A slight risk has been associated with the use of talcum powder in the genital area, but that may be because talcum powder was sometimes contaminated with asbestos in the past. (Talc has been asbestos-free by law for more than 20 years.)

The symptoms: Ovarian cancer is infamous for not producing symptoms until it has spread. What’s more, the problems it does cause—including abdominal pain and discomfort, back pain, bloating, constipation or diarrhea, fatigue and frequent urination—can be attributed to diverse minor complaints. As the disease progresses prolonged abdominal swelling, abnormal bleeding and pelvic pressure may occur.

The tests: One reason ovarian cancer isn’t often diagnosed early is because there is no reliable screening method like the Pap smear for cervical cancer. Elevated blood levels of a protein called CA-125 are present in many women with ovarian tumors; however, some cases don’t produce noticeable amounts. Some benign conditions can also increase levels, leading to unnecessary surgeries (not to mention needless worry).

Vital info: If ovarian and/or breast cancer runs in your family consider testing to see if you have inherited mutations of what are called the BRCA1 or BRCA2 genes. (A family history of breast cancer that doesn’t involve these mutations has not been linked to increased ovarian risk, although research continues on more powerful screening methods that seek out specific cancer-related proteins.) Some women with defective genes actually have their ovaries removed before any signs of cancer occur, although such pre-emptive strikes are under debate in the medical community because they throw women into sudden menopause; only you and your healthcare practitioner can decide if surgery makes sense in your particular case.

Eating a healthy diet is always a sensible idea. A broccoli-and-soy stir fry may be an especially smart choice, since research has linked both foods to reduced risk of BRCA-associated ovarian cancer, and spicing it with ginger might be nice, since this common herb has zapped ovarian cancer cells in the lab. And you’ll want to wash your anti-cancer dinner down with tea; in one study, women who drank two or more cups a day were 46% less likely to develop the disease compared with women who didn’t take tea.

The latest anti-cancer all-star may be ginkgo biloba, an herb better known for boosting brainpower. One early-stage investigation matched 600 women suffering from ovarian cancer with 640 healthy women of similar ages and lifestyles; the ones who took ginkgo for six months or longer experienced a risk reduction of 60%.
To learn more: Facing Our Risk of Cancer Empowered (FORCE)—www.facingourrisk.org,
1-866-824-RISK (7475).

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