One of the most important reasons to see a physician and have an annual exam is for cancer screening. Common female cancers include breast, cervical, endometrial, ovarian, and uterine cancer. Listed below are a few fast facts for review. Please further discuss with your doctor the importance of proper cancer screening.
Breast Cancer Screening
- Most common cancer in women
- Lifetime risk is every one in eight people, or about 12%
- If tumors are detected and successfully treated when they are small (1cm or less) and confined to the breast there is a 98% chance of five-year survival or longer. A breast mass that can commonly be felt is approx 2cm or 1 inch big.
Guidelines based on ACOG & American Cancer Society for a woman at average risk:
- Clinical breast exam every 1-3 years starting age 20 and yearly starting age 40
- Annual mammogram starting age 40
- Breast self-awareness (e.g. self examinations, noticing any changes)
- Breast MRI is reserved for and recommended for women with hereditary breast cancer risks such as genetic mutation BRCA-1or BRCA-2, or a breast cancer risk greater than 20% based on risk assessment tools
Pap Smears and Cervical Cancer Screening
Cervical cancer is almost 50 times more common in countries without pap smears and cervical cancer screening. Research has recently shown that many precancerous and cancerous changes of the cervix are caused by certain HPV viruses. An appropriate immune response is needed to fight this HPV virus. Only a small fraction of infections persist or progress. Smoking greatly blunts the immune response for this virus and hence greatly increases a woman’s risk of abnormal pap smears and even cervical cancer.
Current screening recommendations are age specific as follows:
- HPV vaccinations for females age 9-26
- Pap smear screening should be started at age 21
- Women age 21-29 years should have a pap smear every 3 years.
- Women age 30-65 years should have a pap smear every 3 years or a co-testing with HPV virus detection every 5 years.
- Women age 65 years and older that have had normal pap smears do not need cervical cancer screening any longer.
- Women with a history of moderate to severe cervical dysplasia should continue with screening for 20 years after, including after age 65.
- Women who have had a total hysterectomy with a history of normal pap smears do not need any further screening.
- The previous list does not apply to women with HIV, immunocompromised (low immune systems), or women previously treated for CIN 2, CIN 3, or cancer
Ovarian Cancer Screening
- Ovarian cancer has the highest mortality rate of all types of female cancers and is very difficult to detect in early stages. It is a fairly uncommon cancer, with an age-adjusted incidence of only 13 per 100,000 women.
- Currently the US Preventive Service Task Force, American Cancer Society, and American College of Obstetrics & Gynecology do not recommend specific screening tests for women without symptoms. If there is a strong family history of ovarian cancer, they recommend genetic counseling, possible genetic testing (BRCA-1 and BRCA-2), and possible screening tests including a blood test called CA-125 and pelvic ultrasounds.
- For asymptomatic women without a strong family history, a yearly pelvic exam is recommended.
- Factors that help reduce the risk of ovarian cancer include use of oral contraceptives, pregnancy, bilateral tubal ligation, breastfeeding, and removal of the ovaries.
- Cancer of the uterus is the most common pelvic cancer.
- About 50,000 cases of uterine cancer will be found in 2013 and about 8,000 women will die from the disease. 98% of these cases are endometrial cancer.
- This cancer is rare in women under age 45 and most women carry a life time risk of 1 in 37.
- It is recommended that all women around the age of menopause should be counseled regarding the symptoms and risks associated with endometrial cancer. Abnormal uterine bleeding and changes in menses should always be discussed with your doctor.
Ryan B. Empey, MD is an obstetrician/gynecologist who practices in West Jordan and Riverton, Utah. Appointments can be made by calling 801.569.5500.
Originally printed in Granger Medical Clinic’s magazine, Spring 2014.