Knowledge and Power: Gynecologic Health
Prevention & Treatment Experts from the world of gynecology give a run-down on the importance of screenings, and their advice for the best treatment options.
Mediaplanet: Is the pap test the single best tool for reducing the risk of cervical cancer?
Michael Randell: The pap test has been credited with significantly reducing the incidence of cervical cancer in the U.S. Advances, such as vaccines and the human papillomavirus (HPV) test, have helped decrease the disease rate even further. Screening with pap, plus HPV tests at the same time (co-testing), is the preferred screening strategy for women ages 30-65. Screening with pap alone is recommended for women ages 21-29.
Judy Wolf: There are several good tools to reduce the risk for cervical cancer For those age 9-26, vaccination with the HPV vaccine can reduce the risk of HPV infections. HPV infection is integral to the development of cervical cancer.
"About 20 percent of ovarian cancers are related to inherited genetic mutations."
For those above this cut-off, the Pap smear and or HPV testing either alone or in combination can help find identify pre-cancerous changes on the cervix that can be treated to prevent cervical the development of cancer.
MP: Are there any genetic screenings to determine whether an ovarian cancer patient’s daughter(s) have a hereditary risk?
MR: The greatest risk factor for ovarian cancer is a strong family history. There is a blood test available to check for specific changes in certain genes that control cell growth. Women with changes (mutations) in these genes, called BRCA1 and BRCA2, are at an increased risk of developing ovarian (and breast) cancer.
JW: About 20 percent of ovarian cancers are related to inherited genetic mutations. Anyone with a first-degree relative with the diagnosis of ovarian cancer can have a blood test to determine if they have one of these mutations. It is most ideal to test a person who already has cancer to help clarify the risk and identify the particular mutation for the rest of the family.
MP: What are the treatment options for ovarian cancer?
MR: Unfortunately, most ovarian cancer cases are diagnosed at an advanced stage, so the usual treatment is surgery and chemotherapy. However, the treatment plan may differ depending on the stage of cancer, a woman’s age and plans for childbearing. It is important that women discuss surgical and treatment options with a gynecologic oncologist.
JW: This depends on the type and stage of ovarian cancer. For most women with this diagnosis it is a combination of surgery and chemotherapy. It is important for women with ovarian cancer to have care by a specialist in treating this disease—a gynecologic oncologist—particularly for the surgery, as this can improve survival rates for this difficult disease.
MP: What are the recommendations for colonoscopy screening for women with endometrial cancer?
MR: Women with endometrial cancer may have increased risk of developing genetically-related types of colorectal cancer. Women should have a colonoscopy every 10 years, beginning around age 50 (45 years for African-American women). But those with endometrial cancer are at increased risk for colorectal cancer. Based on genetic testing, they should have earlier and more frequent screening.
"It is important that women discuss surgical and treatment options with a gynecologic oncologist."
JW: Unless you’re a woman with endometrial cancer (less than10 percent of endometrial cancers), an inherited mutation in one of several genes called the Lynch Syndrome, colonoscopy screening is the same for them as for the general population. Begin at age 50 and then every 10 years, unless abnormalities are found.
MP: Which patients can receive menopausal hormone therapy after a diagnosis of gynecologic cancer, and what is the optimal time period after diagnosis or treatment to start therapy?
MR: Women who have had non-estrogen dependent gynecologic cancers, such as cervical cancer and most types of ovarian cancers, can receive menopausal-hormone therapy (MHT). It’s not usually recommended for women with uterine cancer, as these typically are estrogen-dependent tumors. Women always need to be aware of the potential risks of MHT, including, without limitation, breast cancer and thromboembolic disease.
JW: This varies by the type of gynecologic cancer. Women with cervical cancer can safely receive menopausal hormone therapy at any time, if needed. For women with endometrial cancer, hormone therapy is not usually recommended because development of this cancer is related to estrogen.
Some patients may receive therapy after being free of cancer for a period of time and after discussion with their physicians. For ovarian cancer, in general hormone therapy is felt to be safe for most patients—again after consultation with their physician.