Help women lower risks for gynecologic cancers

Being overweight is a risk factor

As a healthcare provider, there are several things you can do to help women lower their risks for gynecologic cancer. From getting vaccinations, losing weight, and knowing their family history, women can lower their risk of developing certain types of cancer and improve their chances for survival if they do develop one of them.

According to the Centers for Disease Control and Prevention (CDC), five main types of cancer can affect a woman’s reproductive organs: cervical, ovarian, uterine, vaginal, and vulvar. The five cancer types are collectively referred to as gynecologic cancer; a sixth type of gynecologic cancer is fallopian tube cancer, which is very rare. According to CDC statistics, 84,155 women in the United States were diagnosed with a gynecologic cancer in 2009; 27,813 died from the disease.¹

To help women be proactive against gynecologic cancer, share the following recommendations from the Society of Gynecologic Oncology:

Providers now have a valuable prevention tool against cervical cancer in vaccines against human papillomavirus (HPV), the virus responsible for most cervical cancer. (Who should be vaccinated? See box on p. 140.)

According to the CDC, HPV is the main cause of cervical cancer in women, with about 12,000 new cervical cancer cases each year in the United States. About 4,000 deaths in women each year in the United States are attributed to cervical cancer.²

The CDC estimates there are about 15,000 HPV-associated cancers in the United States that might be prevented by vaccines each year in women, including cervical, anal, vaginal, vulvar, and oropharyngeal cancers. About 7,000 HPV-associated cancers might be prevented by vaccine each year in men; oropharyngeal cancers are the most common.²

Know family history

It is extremely important that providers talk to women about their potential increased genetic risk for cancer, says Stephanie Blank, MD, associate professor and director of the Gynecologic Oncology Fellowship at the New York (City) University School of Medicine.

"If a woman has a personal or strong family history of cancer, she may be at increased risk for gynecologic cancer," observes Blank. "Knowledge about this risk can allow patient and her doctor to look into potentially life-saving prevention strategies."

It is also important that a provider speaks to a patient with ovarian cancer about the role genetics might play in the course of her disease and how a genetic predisposition to cancer might affect her prognosis, treatment, and her family’s future, says Blank.

Each year, about 35,000 women in the United States obtain uterine cancer, according to the CDC. Being overweight is a major risk factor for developing the disease.

Counsel women that losing weight might significantly reduce their risk and might help improve survival rates if cancer does develop. In a 2013 report, three of five new cases of endometrial cancer in the United States could be prevented if women maintain a healthy weight and are physically active.

According to the analysis, 59% of cases, or about 29,500 annually, could be prevented if women were physically active for a minimum of 30 minutes per day and maintained a healthy body weight (body mass index from 18.5 to 25.0 kg/m2.)³

Detection in research

All women are at risk for gynecologic cancers, and risk increases with age. When gynecologic cancers are found early, treatment is most effective. What might providers see from current clinical trials for detection of gynecological malignancies?

Look at new findings of a prospective single-arm study led by the Houston-based University of Texas MD Anderson Cancer Center. For the 11-year study, 4,051 women were enrolled from seven sites across the country, with MD Anderson serving as the lead site. All were healthy, post-menopausal women, ages 50-74, with no strong family history of breast or ovarian cancer. The study’s primary endpoint was specificity, or few false positives. In addition, the study looked at the positive predictive value, or the number of operations required to detect a case of ovarian cancer.

Each woman received a baseline CA-125 blood-test. Using the Risk of Ovarian Cancer Algorithm (ROCA), a mathematical model based on the patient’s age and CA-125 score, women were assigned to one of three risks groups, with the respective follow-up:

• Women determined to be "low" came back in a year for a follow-up blood test.
• Those classed as "intermediate" received further monitoring with repeat CA-125 blood testing in three months.
• Those determined to be "high" were referred to receive transvaginal sonography and see a gynecologic oncologist.

Findings indicate that based on the women’s CA-125 change over time, the average annual rate of referral to the intermediate and high groups were 5.8% and .9%, respectively. A total of 117 women (2.9%) were determined to be high risk, and they received a sonography and a specialist referral. Of those women, 10 underwent surgery: four had invasive ovarian cancer, two had borderline disease, one had endometrial cancer, and three had benign ovarian tumors. There was a positive predictive value of 40%, which greatly surpasses the clinical benchmark of 10%. The specificity of the test was 99.9; the screening failed to detect two borderline ovarian cancers.⁴

Evaluation of changes in CA-125 over time are likely to be the most successful strategies in terms of early detection of ovarian cancer, says Barbara Goff, MD, director of gynecologic oncology at the University of Washington, Seattle and president of the Society of Gynecologic Oncology. Scientists await further answers on CA-125 testing from the United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS), a similarly designed study.

"I think we are on the verge of having an effective test for screening for ovarian cancer," says Goff. "The question is, will we able to make it cost-effective so it could be used in a large population of people?"

REFERENCES

1. Centers for Disease Control and Prevention. Basic information about gynecologic cancers. Fact sheet. Accessed at http://1.usa.gov/hl96HQ.
2. Centers for Disease Control and Prevention. HPV vaccine. Questions and answers. Accessed at http://1.usa.gov/dnUYnR.
3. World Cancer Research Fund, American Institute for Cancer Research. Continuous Update Project Report. Food, Nutrition, Physical Activity, and the Prevention of Endometrial Cancer. Accessed at http://www.dietandcancerreport.org.
4. Lu KH, Skates S, Hernandez MA, et al. A 2-stage ovarian cancer screening strategy using the Risk of Ovarian Cancer Algorithm (ROCA) identifies early-stage incident cancers and demonstrates high positive predictive value. Cancer 2013; 119:3,454-3,461.

RESOURCE

• The Centers for Disease Control and Prevention has developed a campaign, "The Inside Knowledge: Get the Facts About Gynecologic Cancer" to raise awareness of the five main types of gynecologic cancer: cervical, ovarian, uterine, vaginal, and vulvar. The campaign encourages women to pay attention to their bodies and know what is normal for them, so they can recognize the warning signs of gynecologic cancers and seek medical care. Materials available for free download include fact sheets, a brochure, symptom wallet card, and more. Go the campaign website, http://1.usa.gov/OkTlt1, and follow links to access the print materials.