Help women cut cancer risks with ACOG guide

The next patient in your exam room is a 35-year-old mother of three. When you talk with her about her risks for cancer, she tells you they are low, because no one in her family has had the disease. What is your next step?

This scene is familiar. Nearly two-thirds of women believe that if there is no family history of cancer, then a woman is at low risk for developing the disease, according to results of a new national survey.1 The American College of Obstetricians and Gynecologists (ACOG) has just released a new web-based patient guide, Protect & Detect: What Women Should Know about Cancer, to help improve women's understanding of their risk of developing cancer and the lifestyle changes they can make to reduce their risks. (Editor's note: To access the free web guide, go to the ACOG web site, www.acog.org. Under "Women & Cancer," click on the Protect & Detect image.)

The guide discusses the primary cancers occurring in women — breast, cervical, colorectal, lung, ovarian, and uterine cancer — and provides information about who is most at risk, how cancer can be prevented, what available screenings are and their recommended frequency, and how cancer is treated. A key message in the guide is that cancer can occur without symptoms. Even if the symptoms are present, they might be mistaken for a harmless health condition or might not appear until the disease is advanced.

When, how to screen?

ACOG also has released new guidelines for colorectal cancer screening that recommend that women, beginning at age 50, be screened for the disease by colonoscopy every 10 years.2 The new guidance comes after the organization's partnership in a campaign with the American Society for Gastrointestinal Endoscopy (ASGE) to reduce deaths from colorectal cancer among women.

Colorectal cancer is the second-leading cause of cancer death in adults in the United States and the third-leading cause of cancer death among women, following lung and breast cancers.3 Each year, colorectal cancer causes death in more than 26,000 women, which is nearly twice as many as ovarian, cervical, and uterine cancers combined. It is estimated that one in 18 women will develop colorectal cancer in her lifetime.3

"Colorectal cancer kills over 26,000 women each year, but it doesn't have to," says Grace Elta, MD, FASGE, ASGE president. "Starting at age 50, everyone should have a colonoscopy to screen for colorectal cancer because colonoscopy allows for the detection and removal of benign polyps or growths in the colon before cancer develops."

ACOG changed its colorectal cancer screening recommendations because colonoscopy allows for direct visualization of the entire colon surface, with the concurrent ability to remove precancerous polyps. The procedure also allows access to right-sided lesions (the main type of advanced colorectal cancer occurring in women), which are more likely to be missed by other screening methods. Previously, ACOG recommended that all women age 50 and older be screened for colorectal cancer by one of several methods, with no single method being preferred over another.

According to the new ACOG guidelines, the organization does not recommend fecal DNA testing or CT colonography — also known as "virtual colonoscopy" — for screening outside the research setting, pending further data on their effectiveness.2

Results of the new survey show that women may be fearful of learning about their cancer risks. One in five (20%) women surveyed say they do not want to know if they have cancer. While 77% of women believe that seeing a health care provider regularly can help reduce their risk of cancer, only 56% saw their health care provider on a regular basis in the past year. About one-third of women surveyed (29%) had neither seen a health care provider on a regular basis nor had a Pap test or a mammogram in the past year.

When questioned further about their lack of care, about one-fifth (18%) said they didn't think it was necessary and another 14% said either they didn't know how to get screened (7%) or thought it was a waste of time (7%). However, the greatest majority of women (37%) said they could not afford care. This finding is very disheartening, says Douglas Laube, MD, MEd, ACOG immediate past president of ACOG.

Many women know what to do to help prevent cancer, but issues related to access to care remain problematic for many women today, says Laube. The greatest potential to further reduce cancer deaths in women will come from efforts to improve screening and access to preventive health care, particularly for women without insurance, he states.

"Ensuring health care coverage for uninsured women is among ACOG's top legislative priorities," says Laube. "ACOG will advocate for policies that expand access to comprehensive health coverage and highlight the special needs of uninsured women in our support for universal coverage."

References

  1. Harris Interactive for The American College of Obstetricians and Gynecologists. A Study about Women and Cancer Prevention. Washington, DC; October 2007.
  2. American College of Obstetricians and Gynecologists. Colonoscopy and colorectal cancer screening and prevention. ACOG Committee Opinion No. 384. Obstet Gynecol 2007; 110:1,199-1,202.
  3. American College of Obstetricians and Gynecologists. Protect & Detect: What Women Should Know About Cancer. Washington, DC; 2007. Accessed at: www.acog.org.