Preventing cancer — what's a woman to do?
Sandra Brooks, M.D., M.B.A.
Sandra E. Brooks, M.D., M.B.A.
Associate Vice President
Norton Cancer Institute
September is Gynecologic Cancer Awareness month and October is Breast Cancer Awareness month. Even if you don’t walk, race, join a team or wear a pin, you too may become involved in the movement to become aware of the risks of developing cancer in order to take action to reduce those risks and encourage others to do so as well. The time for action is now!
Breast cancer prevention
The breast is an organ that is made up of mostly fat, but contains glands that provide milk at the end of pregnancy. Both men and women have breast tissue, but breast cancer in men is quite rare. The average woman has a lifetime risk of developing breast cancer of one in eight. For women, the statistics can be frightening, but the good news is that there is something you can do. Although some of the risk factors such as aging and family history are not in your control, there are some steps you can take such as staying physically active, limiting alcohol and eating healthy (read low fat with plenty of fruits and vegetables). There is a strong link between obesity and breast cancer. As with uterine cancer, the amount of circulating estrogen in your body is linked with your risk of developing breast cancer. Regular exercise and a low fat diet will help prevent obesity. Excess fatty tissue is a source of estrogen. Alcohol use is also linked with breast cancer. To get the most protection, limit your intake to less than one drink per day.
Many women have heard about the risks of long term combination (estrogen-progestin) hormone therapy reported by the Women’s Health Initiative study. For women without a uterus, the risks of breast cancer on estrogen alone depend on other risk factors. In general, use of hormonal therapy should be limited to those with symptoms related to menopause that cannot be treated by other means. Treatment should be limited to the shortest time period with the lowest dose possible.
Regarding oral contraceptives, there is no evidence of an across-the-board link between birth control pill use and breast cancer risk. Modern contraceptives contain much lower concentrations of hormones than those used in the past — thus it is likely that older reports showing a link between oral contraceptives and premenopausal breast cancer do not exactly apply today.
Other agents linked to a risk of breast cancer are pesticide exposure and overuse of antibiotics. Research is not conclusive, but it is best to protect yourself until more information is available.
On the prevention front, studies are ongoing regarding the possible role of Retinoid, a form of vitamin A, and its ability to destroy or inhibit the growth of cancer cells. Unlike other experimental therapies, retinoids may be effective in premenopausal women and in those whose tumors aren't estrogen-positive. Research is also showing that phytoestrogens, naturally occurring compounds lower circulating estrogens in your body. Flaxseed is particularly high in one phytoestrogen, lignan, which appears to decrease estrogen production and which may inhibit the growth of some breast cancers.
In addition to lifestyle changes and avoiding toxins, be vigilant about early detection of breast cancer. Start having yearly mammograms at age 40. If you notice any breast changes, such as a new lump or skin changes, make an appointment to see your doctor for evaluation. Women with a strong family history of breast cancer may be candidates for genetic counseling, as there are other steps towards prevention that may be appropriate if you are found to gene linked with a hereditary risk of breast cancer (BRCA 1 or BRCA 2).
What should we do about pap smear screening?
The cervix is the organ at the end of the uterus, the part that dilates women a woman gives birth. Cervical cancer affects nearly 14,000 women each year in the U.S. and an even greater number of women who are found to have precancerous changes of the cervix each year.
The Pap test, the screening test for cancer of the cervix has been available for more than 50 years, but we still have not been able to eradicate the disease due to the high prevalence of the virus and the fact that not everyone has consistent Pap smear screening. Now, because of a revolutionary vaccine we may eventually eliminate cervical cancer, but that is a time far into the future. The vaccine provides protection against the virus that is linked with the development of 70 percent of cervical cancers, HPV (human papillomavirus). The best candidate for the vaccine is a woman who has never been exposed to HPV through sexual contact; thus the target population for the vaccine is young women aged 9-26. Because it does not protect against all strains of the virus that are linked with cervical cancer, it is important that these young women continue Pap smear screening. Likewise, women who are not eligible for the vaccine should continue to have regular screening exams. New technology has increased the doctor’s ability to identify an abnormality if it is there; thus the Pap is even more accurate than it was 10 years ago.
In addition to limiting lifetime sexual partners in order to reduce the chance of exposure to HPV, avoidance of tobacco is key. The toxins in tobacco are concentrated in the cells of the cervix and promote precancerous and cancerous changes in the cervix.
What about colon cancer?
The colon is a part of the intestine where water is absorbed and stool is formed. It starts where the small intestine ends at the appendix and ends at the rectum. Far and away, the best method of screening for colon cancer is colonoscopy as it can pick up nearly all tumors that are bigger than 10mm or just over 3/8 of an inch. This is a test that gets done once every 10 years for most people. Just having the test done, lowers your risk for colon cancer because the doctor can remove precancerous polyps at the time of the test. The actual procedure is a minor one, taking less than 15 minutes for most people, but it does require preparation and a light anesthetic. Getting ready for the test is the longest part of the procedure!
Preparation of a bowel is needed order to clean the colon of stool so that the doctor can look for polyps or tumors. If you have heard old stories about the prep — talk to your doctor; there are newer methods that are not as harsh on the body as in the past.
Other methods of screening for colon cancer, such as testing the stool for blood with a kit are not as accurate. Many things other than cancer can cause them to be abnormal, but they are easy to do and do not involve going to the hospital or outpatient center. These tests are not a replacement for colonoscopy, but if done, they should be performed annually.
Newer methods of screening for colon cancer through CT scans are currently being implemented in some centers; however more studies are needed to see if they are as accurate as traditional colonoscopy.
Can ovarian cancer be prevented or diagnosed early?
The answer is maybe. For years ovarian cancer has been thought of as the silent killer, but recent evidence shows that not only can some women who are at high risk be identified early through genetic testing, but that many women with ovarian cancer actually have symptoms of bloating and abdominal discomfort for weeks before they diagnosed. As the ovaries are tucked deep inside the pelvis, it may be difficult to distinguish symptoms coming from the ovaries from those originating from the gastrointestinal tract. Women who experience such persistent symptoms should seek care and be alert to the possibility of a gynecologic cause for their symptoms.
In terms of screening — the National Institutes of Health is the process of completing a study evaluating the role of screening ultrasound and CA 125 in women over the age of 50. In this group of average risk women, the incidence of ovarian cancer was quite low. Tumors were identified in just 29 women of 28,816 screened. It did appear that the combination of CA 125 and ultrasound was a better predictor than either test alone. Women with a family history of ovarian and breast cancer, particularly at an early age, may be eligible for genetic testing and should ask their health care provider for more information.
Summary
Although September and October are dedicated to making more people aware of the newest developments in women’s cancer diagnosis and treatment, it is never too late to start living a healthier, more informed life.
Nothing you do can guarantee your life will be cancer-free. But if you practice healthy habits, exercise, eat a diet low in fat and avoid excess alcohol and tobacco (we did not even begin to talk about lung cancer in women), you may at least reduce your risk of developing cancer and other diseases. As always, consult your doctor about extra measures you can take.
Dr. Brooks received her Bachelor of Science and medical degrees in a six-year combined program at Howard University. She then completed her OB/GYN residency at the Hospital of the University of Pennsylvania and fellowship in gynecologic oncology at Harvard University’s Brigham and Women’s Hospital. She also holds a Master of Business Administration degree from Johns Hopkins University.
Dr. Brooks is board certified in obstetrics and gynecology and gynecologic oncology and specializes in cancerous and precancerous conditions of the female reproductive tract. She and is the medical director of the cancer prevention and early detection program at Norton Cancer Institute in Louisville, Ky.
For information about Norton Cancer Institute and its cancer prevention program please visit Norton's Web site.
Am J Obstet Gynecol. 2005 Nov;193(5):1630-9.Ovarian cancer screening in the Prostate, Lung, Colorectal and Ovarian (PLCO) cancer screening trial: findings from the initial screen of a randomized trial.
Buys SS, Partridge E, Greene MH, Prorok PC, Reding D, Riley TL, Hartge P, Fagerstrom RM, Ragard LR, Chia D, Izmirlian G, Fouad M, Johnson CC, Gohagan JK; PLCO Project Team.
American Cancer Society; date accessed 9/3/07
Mayo Clinic; date accessed 9/3/07 |
