The most common of the female pelvic cancers is uterine, followed by ovarian and then cervical.
Dr. Lynda Roman, associate professor and director of Gynecologic Oncology at USC Keck School of Medicine, spoke about these three cancers to the women of USC Trojan Affiliates on Thursday, March 3 as part of a talk titled, “Let’s Talk Prevention: Leading A Healthy Lifestyle To Prevent Cancer And An Update On The Latest Treatment Options.”
It has been known for a long time that cervical cancer was spread sexually because “if a man’s first wife died of cervical cancer and he remarried, his second wife was far more likely to get cervical cancer,” she said. The man was clearly the carrier. It was discovered in the 1980s that the human papillomavirus (HPV) was the cause.
“HPV is responsible for 99 percent of all cervical cancers,” Roman said.
In the 1990s, a major breakthrough occurred. Doctors became able to test for HPV and find out what type was present – high risk or low risk, she said. Low risk causes genital warts and is not likely to cause cancer, while high risk types have abnormal pap smears and are more likely to have cancer.
The second big development was the vaccine, she said. Gardasil, as originally made, covers the two most common types of cervical cancer.
“When this vaccine finally came out, we were all thrilled,” Roman said.
It has now been expanded into Gardasil 9, which covers the same two types as the first Gardasil, as well as seven additional high risk types.
“It is extremely clear…that Gardasil reduces your risk of cervical cancer,” Roman said. “It is almost 100 percent effective.”
Although it does cover the most common types of cervical cancer, it does not cover every single one, she said. The Food and Drug Administration (FDA) had first only approved it for women, but that is slowly changing since both men and women can be affected.
Roman said parents often ask her, “Is it dangerous?” Her response is always a resounding “no.” It hurts more than the average vaccine, but that’s it, she added. The side effects are minimal.
“I have had zero reservations vaccinating my two daughters, and I would have zero reservations vaccinating my sons if I had any,” Roman said.
The recommendation is that the vaccine be administered at around age 12 or 13, but the real goal is to vaccinate before sexual activity begins. It is a series of three shots six months apart. Despite the vaccine, Roman said it is still recommended to get a pap smear and an HPV test every five years until the age of 55 – unless results are positive.
“It is extremely effective at telling people they have a problem,” Roman said of the HPV test, which should start around the age of 30. Before 30, the recommendation is just for pap smears starting at age 21.
“The most common reason someone will get uterine cancer is because of a hormonal imbalance,” Roman said, stating it generally affects someone with too much estrogen and too little progesterone. Obesity is another major cause.
The use of estrogen without progesterone in a woman with a uterus increases the risk of uterine cancer, she said, stating that hormone replacement therapy should be the combination of estrogen and progesterone. If done properly, the therapy will average out a person’s risk to be the same as the general population.
Hormone replacement therapy should generally be started at the age of menopause – at about 51 years old.
“Hormones are not bad,” Roman said. “Taking them beyond the age of natural menopause like anything in life has pros and cons.”
It’s a good idea to take them if symptomatic – basically miserable because of menopause, she said. Hormones help with hot flashes and brain function, possibly even reducing the risk of dementia. It also prevents bone loss.
The problem is that four years of use increases the risk for breast cancer.
Some of the warnings for uterine cancer include heavy bleeding, bleeding between periods or post-menopausal bleeding. Even just a few drops of post-menopausal bleeding is an indicator, Roman said, and a doctor should be seen immediately. Menopause means one year without a period, she clarified.
An ultrasound and biopsy are used to screen for uterine cancer. The most common treatment is a hysterectomy.
Birth control pills help with uterine cancer because they balance out a woman’s hormones. They also decrease the risk of ovarian cancer by 50 percent if used for five years or more.
“About 10 percent of all ovarian cancer is from a gene inherited from the parents,” Roman said, stating it can come from the father or the mother.
BRCA1 and BRCA2 dramatically increases a woman’s risk of ovarian cancer.
If there is a family history it sets off “alarm bells,” she said. It’s more likely to present a problem at 25 years old, and very commonly it will happen by at the age of 50.
“There is no screening test that’s effective for discovering ovarian cancer,” Roman emphasized, since the fallopian tubes are oftentimes where the cancer starts. The fallopian tubes are hollow and will never be seen on a test.
For some women, it is in the ovaries and it will show up on a screening because a mass will form.
It is difficult to know if a person is symptomatic because everyone feels abdominal distention, bloating and discomfort. To understand if there is a problem, the symptoms have to be progressive, Roman said.
“People know there’s something wrong,” she said.
If it is bad enough to warrant a colonoscopy, it’s probably a good idea to get an ultrasound at the pelvic area, Roman said.
The best way to prevent ovarian cancer is to remove the fallopian tubes and ovaries at the age of 40, earlier if the woman at risk does not want any more children.
This has dropped the risk of ovarian cancer from 40 percent to less than 1 percent, she said.