Cancer Screening-What Should Women Know in 2007?

By Steven Vasilev MD  |   Submitted On January 31, 2007

We have all had friends get diagnosed with cancer. These are often friends who have lived the healthiest possible life, eating nothing but the best quality foods. We are talking about non-smoking, regularly exercising people who have lived the perfectly healthy lifestyle. Why did they get cancer?

The truth is that almost all cancers are caused by some genetic switch or another inside of us that flips on or off. Whether or not this occurs does depend to some degree on what we expose ourselves to, whether that be cigarette smoke, over exposure to the sun or some type of food additive. This is very over-simplified, but science is advancing rapidly and in the next five to ten years we may know exactly what the risk will be for any given environmental vice that we choose to engage in.

Until then, we do have knowledge about what kind of cancer we are most likely to come down with, and how effective cancer screening is against some of these. The point is that you have the power to take control and minimize the risk of cancer happening to you !!

The most common types of cancer in women living in the United States are:

breast (213,000 new cases, 40,970 deaths per year, with a 1 in 34 lifetime risk of dying from it),
lung (81,770 new cases, 72,130 deaths per year, with a 1 in 20 lifetime risk of dying from it),
colorectal (75,810 new cases, 27,300 deaths per year, with a 1 in 45 lifetime risk of dying from it),
endometrial (41,200 new cases, 7,350 deaths per year, with a 1 in 196 lifetime risk of dying from it),

skin (30,420 new cases, 3,720 deaths per year, with a 1 in 500 lifetime risk of dying from it),
ovarian (20,180 new cases, 15,310 deaths per year, with 1 in 95 lifetime risk of dying from it),

cervical (9,710 new cases, 3,700 deaths from year, with 1 in 385 lifetime risk of dying from it).

In general, in addition to taking care of yourself, a yearly examination with screening for cancer or precancerous conditions is highly recommended. Unfortunately, the cancers for which there are no effective screening tools are: endometrial, lung and ovarian.

The good news is that endometrial cancer tends to show itself early by abnormal bleeding, usually postmenopausal, which leads to a high cure rate. The additional good news for preventing endometrial cancer is that the vast majority occur in people who are overweight. So, paying attention to symptoms and keeping your weight in the normal range go a long way towards preventing endometrial cancer. Also, if you are taking estrogen, make sure you discuss the risk vs. the benefit with your physician.

Lung cancer is most often associated with smoking. Screening techniques have been ineffective in reducing mortality. Enough said. You know what to do for this one.

Ovarian cancer is a silent killer with no early symptoms and no reliable way to screen for it; at least not yet. There may be a blood test that is on the horizon that will change that in the near future. However, for today, the tests popularized in the lay literature as screening tools, particularly CA-125, are simply not effective. The best strategy is to pay close attention to persistent symptoms of increased bloating, indigestion, unexplained weight loss, pressure, abdominal or pelvic pain, or other intestinal symptoms. Having said that, these kind of symptoms are far more likely to be caused by something other than ovarian cancer, so don't panic. Just be vigilant if these symptoms don't go away. Also, although there are genetically predisposed women who get ovarian cancer in their reproductive years, the vast majority of ovarian cancers are diagnosed in the post-menopausal years. If you do have first degree relatives who have come down with breast or ovarian cancer, seek genetic counseling. Testing may be recommended.

Screening options do exist for cancers of the skin, cervix, colon-rectum and breast.

Women over the age of 40 should get mammograms every 1 to 2 years, and yearly after age 50. In addition, ask for a breast exam during your annual physical. Finally, although breast self-examination has not been proven to be effective, there is enough medical information to consider doing it regularly. You know your body best and may detect a lump earlier than anyone else. Finally, as far as preventive measures, a low fat diet , which you religiously adhere to may reduce your risk, especially if you have been on a high fat diet. Being overweight definitely increases your risk of cancer.

There has been a lot of press lately regarding cervical cancer screening. The best news here is that the combination of Pap smear and HPV testing is highly effective in detecting PRE-cancerous conditions of the cervix. This means that treatment can be effective very early and relatively non-invasive since the treatment is for pre-cancer rather than cancer. The recommendations are rather complex, vary with age and the details can be found on the American Cancer Society website. However, in general, make sure you are getting this combined test at least every 3 years.

After age 50, there are several options for colo-rectal cancer screening. Similar to cervical cancer screening, the most effective situation is detection of pre-cancerous polyps, but early cancer detection is also life-saving. The options include yearly testing of patient collected stool samples, sigmoidoscopy (examining the lower part of the colon) every 5 years, a special kind of x-ray study called a double-contrast barium enema every 5 years or colonoscopy (looking at the entire colon) every 10 years. Discuss these options with your doctor to determine what might work best for you.

Finally, especially if you are a sun-worshiper, ask your doctor to look at every inch of your body for signs of precancerous or cancerous skin changes. Make sure you use sun protection lotions which have a SPF (sun protection factor) rating of at least 15. Your risk will depend upon what type of skin you have, but these days you should pay attention to what the reported UV Index is wherever you live. This is a measure of the sun's damaging ultraviolet radiation you are exposed to on any given day when you go outside.

It's your life. Make sure you're looking out for number one!

Steven A. Vasilev MD, FACOG, FACS is a fellowship trained and board certified gynecologic oncologist, which means he is specially trained and certified to take care of women with gynecologic cancers using a broad spectrum of skills. He has practiced at academic as well as private centers, has been on the faculty of three universities and continues to be involved in research and education. You can visit http://www.gyncancerdoctor.com to learn more about screening, prevention and treatment of gynecologic cancers.

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