Dr. B, can we discuss early detection and prevention of cancers of the ovary and uterus?
Sure, Susan. I will give you some information today and you discuss this further with your family doctor and/or gynecologist. Remember cancer of the uterus can be either in its body (endometrial) or in its opening (cervix).
In 1993, 606 Alberta women were diagnosed with invasive (beyond the superficial layer) cancers of the female genital organs: endometrial 256, ovary 203, cervix 122 and others 25. This does not include 1517 women who were diagnosed with in-situ (confined to the superficial layer) cancers of the cervix.
What symptoms would I have if I had cancer of the ovary or uterus?
Susan, unfortunately the early symptoms are none or very vague. Early diagnosis of ovarian cancer is more a matter of chance. Irregular vaginal bleeding may be the only early sign of uterine cancer. Hence, most of the gynecological cancers are picked up at a late stage. Of course, the Pap smear has completely changed the outcome of cervical cancers.
Doctor, are there any risk factors which I should be aware of?
Susan, for ovarian cancer, the risk factors are age (steady rise up to age 80) and family history. For endometrial cancer – age, obesity and estrogen therapy are major risk factors. For cervical cancer, the risk factors are well recognized. These are: some types of sexually transmitted disease(s), early age at first intercourse, and having multiple sexual partners.
Doctor, what about screening tests?
Susan, for ovarian and endometrial cancers, there are no recommendation for screening. But for cervical cancer, Pap smear is highly recommended. In U.S., this has reduced the incidence and death rate by 70 percent in the last 40 years.
Invasive cervical cancer is usually diagnosed between the ages of 45 and 50. But the average age of women with carcinoma in-situ is between 25 and 30 with evidence of increase in younger women. This could be related to risky health practices, such as experimenting with new ideas, relationships and activities during adolescence which may have long term adverse consequences.
Dr. B, final question! How often should a woman get a Pap smear?
Susan, for those who are not at high risk, first Pap smear should be done soon after the age of 18 or once the woman is sexually active. If this is normal and the one after a year is also normal then repeat after every three years until age 70.
It is very important for every woman to discuss her risk factors with her family doctor and/or gynecologist. Recommendations may vary. Any unexpected vaginal bleeding should be reported to your doctor to see if further investigation is required.
Thank you, doctor, Susan said as she got ready to leave my office. She continues to strive for good health for herself and her family. I admire her dedication.
(This series of articles explore the health problems of Dave and his family. They are composite characters of a typical family with health problems)
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