Women’s “Silent” Cancers by Leslie Laurence

Awareness of and screenings for ovarian, uterine, and other gynecological cancers need to be vastly improved. Women’s lives are at stake.

In December 2006, actress Fran Drescher went to Washington. But unlike Frank Capra’s wide-eyed junior senator, Mr. Smith, Drescher was no babe in the woods. As the author of Cancer Schmancer, her 2002 book about the fact that it took eight doctors and two years for her to get a diagnosis of what proved to be stage 1 uterine cancer, she came to town on “a very dedicated lobbying effort,” she says. Her agenda was to use her celebrity to push for passage of the Gynecologic Cancer Education and Awareness Act, also know as Johanna’s Law, after Johanna Silver Gordon, who died from ovarian cancer in 2000. Drescher’s efforts proved fruitful. In January 2007, President Bush signed the bipartisan bill, which authorized the launch of a national campaign to educate American women and healthcare providers about the symptoms of gynecologic cancers.

In fact, ovarian cancer patients had been pushing to get their illness on the national radar for some time. In 1997, seven grassroots organizations had come together to form the Ovarian Cancer National Alliance (OCNA). Among their goals were lobbying for more federal funding and bringing much-needed public attention to the disease’s risks and symptoms.

The nascent advocacy hopefully will help change what has been a tragic reality for decades. Research into gynecologic cancers — ovarian, uterine, and cervical — has been underfunded. Counted together, these are the third most common cancers in American women. More than 72,000 were diagnosed in 2007. While more women get breast cancer (there were 178,000 new cases last year), a higher proportion of women with cancers of the reproductive tract die. In 2007, the National Cancer Institute (NCI) reported spending of nearly $600 million for breast-cancer research and $296 million for prostate cancer. By contrast, only $97 million was earmarked for research into ovarian cancer — the most dangerous of these cancers though one of the rarest. More than 20,000 new cases are diagnosed and 15,000 women die of the disease each year. And funding for uterine and cervical cancers combined was a mere $98 million.

While the overall five-year survival rate for women with breast cancer is 89%, it is just 46% for those with ovarian cancer (cervical is about 72% and uterine is 83%). What is more, 80% of ovarian cancers and 25% of uterine cancers are found at stage 3 or 4, when they have already spread and are less curable. Today, thanks to mammograms, 61% of breast cancers are found at stage 1.

The delay in diagnosis has many causes. For starters, even for women who see a gynecologist annually, the standard physical exam usually does not pick up early-stage uterine or ovarian cancer. And while there is a universally accepted screening test for cervical cancer — the Pap smear — there is no reliable screener for ovarian or uterine cancer.

In fact, when women report symptoms that should send up a red flag for gynecologic cancer, many physicians routinely attribute these complaints to other conditions, such as peri-menopause, stress or indigestion. Result? Women don’t receive the tests that could distinguish between something benign, such as indigestion, and cancer.

Much needs to change, but perhaps the most critical step of all is for women to become more proactive about their reproductive health.

Are Gyno Checkups in the Dark Ages?

Your first protection against cancer of the reproductive tract is an annual visit to the gynecologist — more often if your doctor recommends it.  She should start by taking or updating your medical history and paying attention to factors that increase your cancer risk, such as having a family history of these cancers, being overweight, and not having had children.

She should perform a pelvic and rectal exam.  While these exams — standard medical practice for many years — don’t typically detect ovarian or other reproductive tract cancers in early stages, they do allow a doctor to feel the uterus and ovaries and, potentially, find tumors that could be cancerous.  Studies have found that manual exams alone don’t save lives.  Especially when it comes to ovarian cancer, you also need testing.  During a pelvic exam, the doctor will get a sample for the Pap and HPV tests, if needed, to screen for cervical cancer,

There is still no routine screening test for ovarian or uterine cancer that is given without the presence of symptoms.  At least one outspoken advocate, Fran Drescher, believes that a transvaginal ultrasound (TVU), which lets doctors see abnormalities of the uterus and ovaries, including tumors and cysts, should be a routine part of every woman’s gynecologic checkup.  Most mainstream health organizations, though, support the use of TVU only when a woman reports symptoms associated with ovarian or uterine cancer.  They also support CA-125 testing in women who have symptoms associated with ovarian cancer, as it measures a blood protein that tends to spike in women with the disease.  Women with a family history of ovarian cancer or who carry a genetic mutation for breast cancer should get both tests every six months.

If you have to fight your doctor to get these tests, consider switching to one who will order them.  Without possible ovarian cancer symptoms, your insurance company may not cover the cost of either — an average of $60 for the CA-125 test and $250 for TVU.

Neither test is ideal.  Both risk false positives that require more testing.  But Drescher feels strongly that women should be able to decide whether or not they want these tests.  “Being diagnosed with a gynecologic cancer beyond stage 1 is unacceptable,” she says.

Ladies’ Home Journal 

September 2008