Cancer Screening, Risk Reduction and Prevention
CANCER SCREENING
Gynecologists serve an important role in the healthcare of women by helping to prevent and diagnose cancers. Cancers with effective screening, risk reduction and prevention programs available to all women include cervical cancer, breast cancer and colon cancer. Some women at high risk for other cancers (lung, endometrial, etc.) may also benefit from screening, risk reduction and prevention options.
Cancer screening is based primarily on an individual's age and risk. For example, a young woman in her late 20s usually does not need imaging for breast cancer screening. However, if she has a family history of breast cancers diagnosed at early ages in her family, then her risk is higher than usual and she may need imaging for breast cancer screening at an earlier than usual age.
Breast cancer is the most common cancer diagnosed among American women. Breast cancer screening is primarily performed with clinical breast exams performed at the doctor's office annually, and imaging studies such as mammogram and/or breast ultrasound, performed every 1-2 years. Some women at particuarly high risk due to their family history of breast cancers and/or their personal cancer genetic testing need high risk breast cancer screening with more frequent breast exams and imaging (every 6 months) including additional imaging studies (example: breast MRI).
Cervical cancer prevention begins with HPV vaccination for girls and women of age. HPV vaccination is highly effective in preventing development of cervical dysplasia (which is the precurser to cervical cancer) and cervical cancer. In terms of screening, cervical cancer screening with pap testing and HPV testing has been one of the most successful programs in all of medicine. Among all things ever invented in medicine, cervical cancer screening is one of the most important and successful programs ever. Among women who participate in cervical cancer screening, diagnosis of cervical cancer is rare since the vast majority of cases are prevented. However, among women who do not obtain pap and/or HPV testing, cervical cancer is common. Cervical cancer used to be the most common cause of cancer death in American women before pap testing was developed for screening. Abnormal pap results lead to further testing with colposcopy and risk reduction, if needed, with diagnostic excisional procedures, such as LEEP or conization. This algorithm is extremely effective at preventing cervical cancer, such that now cervical cancer does not rank anywhere among the top 20 causes of cancer death in American women.
Colon cancer screening is also based on age and risk, and is highly effective to decrease deaths from colon cancer. Colon cancer is currently the 3rd most common cancer among American women. Most women have multiple options such as stool based tests versus colonoscopy, with women at higher risk or having abnormal stool testing results needing colonoscopy.
rISK REDUCTION AND PREVENTION
Comprehensive cancer risk reduction is complex when fully appreciated. It begins with lifestyle, such as eating a relatively low risk and healthy diet, as well as maintaining a healthy weight. For example, colon cancer risk is well associated with dietary choices, and risks for developing some cancers such as endometrial and breast cancers is increased with obesity. Cervical, vulvar, vaginal, and some other cancers are caused by HPV infection, which is sexually transmitted. Lifestyle factors are the most significant determinates of cancer risk for most American women.
Women also benefit from evalating their family history of cancers to determine which women are at high risk for hereditary cancer syndromes, such as Hereditary Breast and Ovarian Cancer Syndrome caused by BRCA1 or BRCA2 mutations. There are several well known hereditary cancer syndromes (example: Lynch syndrome) caused by mutations transmitted at birth from generation to generation within a family. Women who are identified to carry a genetic mutation that increases their risk for cancer(s) receive personalized recommendations for risk reduction and cancer prevention depending on their age, genetics, family history, personal medical history and other individual cancer risk factors.
Some women are at increased risk for cancers that may be prevented or diagnosed early (when often curable) based on their prior medical treatments. One of the most common examples is women who have used tamoxifen to decrease their risk of recurrent breast cancer; these women have increased risks of cancers developing from the uterus. Since endometrial polyps in particular are more highly associated with endometrial cancer risk among women who use tamoxifen, women exposed to tamoxifen are evaluated for the presence of endometrial polyps and those polyps are removed when diagnosed.
Specialized care
At Southland Uro+Gynecology, LLC, we specialize in cancer screening, risk reduction and prevention for women at average/low risk, as well as for women at higher risk due to prior abnormal testing (example, abnormal paps), family history of cancers, abnormal cancer genetic testing (BRCA mutations, among others), and/or exposure to risk factors (example, tamoxifen, immunocompromize, etc.). When appropriate, we perform risk-reducing interventions such as cervical diagnostic excisional procedures. Another example is risk-reducing bilateral salpingo-oophorectomy (RR-BSO) for women at high risk for ovarian cancer.
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