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Cancer ScreeningCervical CancerGynecologic CancersOvarian Cancer

Who Should Be Screened for Cervical or Ovarian Cancers?

October 2018 Vol 4 No 5
Julian Schink, MD
Chief, Gynecologic Oncology
Cancer Treatment Centers of America, Zion, Illinois

Gynecologic cancers start in a woman’s reproductive organs; the 5 main types of gynecologic cancer include cervical, ovarian, uterine (or endometrial), vaginal, and vulvar cancers. The American Cancer Society estimates that in 2018, 110,070 women will be diagnosed with a gynecologic cancer and more than 32,000 will die from these cancers in the United States.

Knowing which screenings are recommended for which cancers and understanding your risks are the first steps in arming yourself with information on early detection, when more options are likely available to treat or prevent cancer.

Screening tests are available for some types of gynecologic cancers; ordering a test must be weighed by the doctor and the woman to decide whether it is necessary. Risk factors, such as lifestyle habits, family history, other serious medical conditions (such as diabetes or heart disease), and exposure to environmental toxins, play pivotal roles in deciding when and if to screen for these cancers.

Overall, all women are at risk for gynecologic cancers, and the risk increases with age. The risk factors and screening recommendations for gynecologic cancers vary widely by cancer type.

Some gynecologic cancers result from the HPV (human papillomavirus) infection, a sexually transmitted disease. The HPV vaccine is designed to protect against cervical, vulvar, and vaginal cancers, as well as several non-gynecologic cancers. In this article, we focus on the risk factors and screening recommendations for cervical and ovarian cancers.

Cervical Cancer

The Pap smear test for cervical cancer—a routine cervical swab performed in the doctor’s office—is one of the most reliable and effective cancer screening tests, according to the American Cancer Society.

Before the introduction of the Pap smear test in the 1950s, cervical cancer was the leading cause of cancer-related deaths among women in the United States. The Pap smear has been remarkably successful in preventing cervical cancer and for pre-cancer interventions. In the United States today, the biggest risk for cervical cancer is a lack of screening.

Risk Factors

Your risk for cervical cancer increases if you:

  • Smoke or smoked in the past
  • Had multiple sexual partners
  • Had 3 or more childbirths
  • Have used birth control pills for at least 5 years
  • Have HIV or another condition that compromises your immune system.

Screening Recommendations

The U.S. Preventive Services Task Force recommends having a Pap smear every 3 years for women between ages 21 and 65, or combined testing with a Pap smear and HPV testing every 5 years for women ages 30 to 65.

Women with persistent HPV infection can have cervical dysplasia, a precancerous condition that can develop into cervical cancer. Cervical dysplasia can be detected by a Pap smear. The use of the combination of the HPV vaccine and the Pap smear has significantly decreased the rate of cervical cancer in the United States, according to the Centers for Disease Control and Prevention.

Ovarian Cancer

In 2018, about 22,240 women will be diagnosed with ovarian cancer and 14,070 women will die of ovarian cancer in the United States, according to the American Cancer Society.

Ovarian cancer accounts for only 2.5% of all female cancers, but this cancer is responsible for 5% of all cancer-related deaths, because of its low survival rate. This is largely because 4 of 5 women with ovarian cancer are diagnosed late, when the disease has advanced and has spread (metastasized) to other parts of the body.

Risk Factors

The risk for ovarian cancer is highest in:

  • Older women (most often in postmenopausal women)
  • Those with a family history of ovarian cancer
  • Women who have an inherited BRCA mutation (BRCA1 or BRCA2), have Lynch syndrome, or have other mutations, including BRIP1, RAD51C, or RAD51D
  • Women who have had endometriosis
  • Women who have not given birth or have had difficulty becoming pregnant.

Screening Recommendations

No reliable screening test is available for ovarian cancer, but the American Society of Clinical Oncology recommends that women with a genetic (inherited) mutation discuss with their doctor how to reduce their risk. This can include:

  • Preventive (prophylactic) surgery to remove both ovaries (called “oophorectomy”)
  • Preventive surgery to remove the ovaries and the fallopian tubes (which is called “salpingo-oophorectomy”)
  • Hysterectomy (removal of the uterus)
  • Tubal ligation (tying up the fallopian tubes).

Women who carry the BRCA mutation or have a family history of ovarian cancer should talk with their doctor about reducing their risk for ovarian cancer. Removing the fallopian tubes at a young age significantly reduces a woman’s risk for cancer, but also prevents conceiving a child (but other options for conceiving a child are available today). A woman having tubal ligation may also consider fallopian tube removal to further lower her risk for ovarian cancer.

Because ovarian cancer is rarely detected during a Pap smear, and no other screening tests are available for this cancer, women should watch for possible symptoms.

Bloating, having a distended abdomen, abdominal pain, changes in bowel movements, and/or frequent urination can be symptoms of ovarian cancer. By the time these signs develop, the disease has often advanced beyond the early stages, so women should talk to their doctor as soon as they notice any of these changes.

Get to Know Your Family’s Genetic History

It’s important to gather your family medical history and share the information with your doctors. Clues to the possibility of an inherited risk for cancer include:

  • Two or more close relatives on one side of the family with the same or related cancers, such as breast and ovarian cancers, or colon and endometrial cancers
  • Cancer diagnosed before age 50
  • More than one cancer diagnosed in the same relative
  • A generation-to-generation pattern of cancer
  • Breast, ovarian, or pancreatic cancer in someone with an Ashkenazi Jewish heritage.

If you have any of these, you should see a licensed genetic counselor. A genetic counselor can help you understand how your personal and family history may affect your cancer risk for gynecologic cancer, help you to measure your chances of an inherited risk for cancer, and provide comprehensive information about genetic testing.

Key Points

  • The risk for gynecologic cancers increases with age
  • The Pap smear test for cervical cancer is one of the most reliable and effective cancer screening tests
  • Because there is no screening test for ovarian cancer, this cancer is usually found at an advanced stage
  • Talk with a licensed genetic counselor to find out if you may be at increased risk for cancer

Reference

1. Lortet-Tieulent J, Ferlay J, Bray F, Jemal A. International patterns and trends in endometrial cancer incidence, 1978-2013. Journal of the National Cancer Institute. 2018;110:354-361.

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Last modified: October 27, 2018

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