There are few known risk factors or distinctive symptoms of the three most common gynecologic cancers affecting people with female reproductive organs in the United States — uterine, ovarian, and cervical — and of the three, healthcare providers are only able to perform routine screens for cervical cancers. This means that patient outcomes for these cancers rely on early detection, and the ability of patients to accurately and comprehensively discuss their reproductive health with doctors, including cycle irregularities or pain.
Dr. Kemi M. Doll, MD, MSCR, Assistant Professor of Obstetrics and Gynecology at UW Medicine, said that irregular menstrual cycles can be a sign of a temporary hormonal imbalance or a more serious health issue such as cancer. Problems can arise when women and people with female reproductive organs find it difficult to have their symptoms taken seriously.
“I think we should consider as a society how we discount women’s pain,” she said.
People who may have had a bad experience with a healthcare provider, having perhaps experienced sexism, racism, transphobia, or all three, may be unwilling in the future to continue to report their symptoms.
“That can lead to some people settling for irregular, painful cycles that are totally disruptive to their life because alternative treatments have not been presented in a way that people feel a sense of agency and choice and really understanding the risks and benefits.”
One aspect of female reproductive health that is widely misunderstood are the effects of birth control and estrogen on the body.
“An irregular menstrual cycle is often an indication of a hormonal imbalance when ovulation is not happening on a routine basis,” Dr. Doll said, explaining that high estrogen levels are one risk factor for endometrial cancer. “When this occurs, there can be build-up of tissue in the womb (endometrial tissue) that is usually shed each cycle. If this tissue is not appropriately regulated by the balance of other hormones (like progesterone) then it can become abnormal, and even lead to cancer.
There are many types and uses of birth control, which often contain the hormones estrogen and progesterone or sometimes progesterone alone. These medications can regulate this imbalance and are therefore actually protective against endometrial cancer.
Another misconception Dr. Doll said she felt was important to point out is that smoking is one of the single most important risk factors to cervical cancer. “People always talk about lung cancer, but smoking is a huge risk factor for cervical cancer because of the association with HPV, and smoking really decreases the body’s immunity to HPV.”
But in many cases, Dr. Doll said, the risks and causes of these cancers are not well understood. “For a lot of our cancers underlying major drivers are still unknown and environmental exposures are really unknown.”
This is why Dr. Doll feels strongly that healthcare and cancer care providers must center patient experience and agency. “A lot of gynecologic care relies on symptom-report, it really relies on a high-quality relationship. Because we’re not measuring a blood level, we’re measuring what’s happening to you.”
Poor communication and patient experience can have devastating results. Any community of people who have felt marginalized or oppressed by the medical system will be less likely to trust healthcare providers with their symptoms. “For example, in endometrial cancer, we can see delayed presentation of symptoms because people don’t want to come back and talk about their bleeding when it’s gone badly in the past.”
Trans men represent another community who face particular barriers to Gyn/Onc care, and Dr. Doll said while there is still a long way to go, she has seen some progress on the local level to improving access to care for these patients.
“As a society we are way behind, as a profession we need to catch up like yesterday,” she said. Adding that what she would really love to see is more continuing education provided by healthcare professionals who have focused their practices on trans health, so that more doctors all over the country are adequately equipped and can provide more outreach.
But at the end of the day, “If you have female reproductive organs then we can care for you,” Dr. Doll said, stressing that anyone who has these organs, man or woman, needs to be on top of their reproductive health, “including the signs and symptoms of cancer.”
Dr. Doll’s final message to anyone with female reproductive organs: “Reproductive health doesn’t end after reproductive capacity.” She continued, “And what I want all people who are at risk of these cancers to know is to think of them as an extension of their reproductive health and that there are a lot of providers out there and information out there to stay informed to keep this aspect of your body healthy throughout your life.”
Every five minutes someone is diagnosed with cervical, ovarian, uterine/endometrial, vaginal or vulvar cancer. The Foundation for Women’s Cancer[RK2] (FWC) is raising funds to support research, education and public awareness of gynecologic cancers through the Move4Her interactive virtual event on Sunday, October 18, at 12:00 p.m. CDT. FWC encourages anyone who has been impacted by gynecologic cancers to learn more and register at Move4Her.org. FWC is the official foundation of the Society of Gynecologic Cancer.