The Other Lady Parts
We hear a lot about breast cancer. Everywhere you look, it seems like you’ll find something promoting breast cancer awareness and research. Which is great. The risk of developing breast cancer as a woman in the United States is about 13%, or one in eight. I know I’m much more likely to develop this cancer than many other cancers and I’m thankful for all the developments that have allowed breast cancer to become more of a chronic disease in many cases (there’s more to be done). October is breast cancer awareness month (pink everywhere), and I’ll definitely share more information when the time comes, but September is National Ovarian and Gynecologic Awareness Month. Do not neglect those below-the-waist lady bits!
This awareness month encompasses ovarian, uterine/endometrial, cervical, vaginal, and vulvar cancers. If you are a female, you carry a risk for developing these cancers and should continue routine screening based on current guidelines, whether or not the parts are in use! I spent over three years working in gynecologic oncology, one of my favorite positions in my oncology career, and I remain passionate about women’s health.
Ovarian cancer accounts for only 3% of cancers found in women, but is associated with the most deaths among gynecologic cancers. Some genetic syndrome increase risk, but most ovarian cancers are de novo. It’s unfortunately rarely detected early due to its vague symptoms (abdominal bloating or pressure, feeling full quickly when eating, and sometimes urinary symptoms) and lack of sound early detection methods. Please advocate for yourself and press your healthcare provider if you have any persistent unusual GI or urinary symptoms without explanation.
Uterine cancer is the most common gynecologic cancer and is very successfully treated with surgical removal of the uterus when detected early. Like ovarian cancer, there really aren’t screening guidelines for uterine cancer. Oftentimes, the first symptom of uterine cancer is post-menopausal bleeding (and many are still early stage when presenting this way); so ladies, if you have gone through the change and have any spotting whatsoever, for goodness sake, get it checked out! An ultrasound and endometrial biopsy will be in your future.
Then there are cervical, vaginal, and vulvar cancers. These cancers are typically caused by the Human Papilloma Virus, which is very effectively prevented with the (not new) development of HPV vaccines. We luckily have early detection, as well, for cervical cancer, and most cases can be prevented when changes associated with the development of cervical cancer are detected and treated prior to transitioning to cancer. The pap is not a screening test for vulvar or vaginal cancers, so it is important to discuss with your provider any skin changes, sores, abnormal bleeding, etc., that you may encounter.
I had my own scare with (not quite) cervical cancer a few years ago. I went in for routine co-testing (this is when they check both the pap smear and for HPV simultaneously). Current guidelines only recommend co-testing every five years (given you have been with the same partner and your paps have been normal), but the oncology nurse in me wanted to repeat the co-testing because, you know, paranoia. I’m so glad I did. When the nurse called to tell me my results, all I heard was “carcinoma in situ” and have no idea what the rest of the conversation was (carcinoma in situ is the stage of bad cell changes right before it officially becomes cancer). I knew I had to have a colposcopy with biopsies, and it was going to be over a month before they could get me in. I immediately started preparing for my demise (in hindsight I suppose I overreacted), and texted my former boss, Dr. Elg (a wonderful gynecologic oncologist). He and my most favorite gyne onc nurse, Kathy, got me in the next day with a locum physician. I can’t remember her name but she definitely put me at ease when my own very experienced oncology NP (myself), couldn’t do it. Several biopsies were taken, which all showed low grade dysplasia. Since then, I have continued to follow the guidelines and am happy to report that I have no had any progression of dysplasia. I even completed the Gardasil series because they have increased the age of eligibility to 45 in some cases (it’s definitely recommended for routine vaccination between ages 11 and 26). Coincidentally, I’m due for my next pap in September!
For more information on gynecologic cancers, the National Ovarian Cancer Coalition is a great go-to (and where I got my stats for this blog). You can also find current screening guidelines on the CDC’s website. Now get those paps scheduled!