Good News About Down-There Cancer

Getty ImagesYou probably dont need a Pap every year.
Women ages 30 and up whove had three consecutive normal Pap smears (which screen for cervical cancer) can go three years before their next, according to the latest guidelines from the American College of Obstetricians and Gynecologists. “These new guidelines basically try to keep things safe without doing a lot of overkill (too many Pap smears) for low-risk women,” says Jubilee Brown, MD, an associate professor of gynecologic oncology at the University of Texas MD Anderson Cancer Center.
The logic? “The chances of developing cervical cancer in that window of time are extremely low, because the human papillomavirus (HPV) has a long latency period between infection and causing any abnormalities,” Dr. Brown explains. Just dont go more than three years between Paps—60 to 80 percent of women diagnosed with invasive cervical cancer havent had a Pap in the past five years.

More about HPV

An HPV test helps docs screen for cancer.
Getting an HPV test along with your Pap smear as part of your cervical cancer screening regimen may help your doctor diagnose abnormal cell growth earlier, a recent study in The Lancet Oncology suggests. (The test determines whether you carry any of the 13 “high-risk” types of HPV most likely to cause cervical cancer.) Experts agree that the HPV test should accompany—not replace—Pap screening, since the test will show if you have HPV even if it hasnt caused any abnormal cell changes. That means it could lead to false positives and unnecessary follow-up tests if done alone, especially in younger women. (While 75 to 80 percent of us have been exposed to HPV at some point in our lives, our immune systems clear it up in the vast majority of cases, says Bobbie Gostout, MD, chair of the obstetrics and gynecology department at the Mayo Clinic.) Ask your doctor if shes running the test as part of your primary screening—some do, while others run it only if Pap results are abnormal.

Next Page: The HPV vaccine may work for older women, too. [ pagebreak ]The HPV vaccine may work for older women, too.
The vaccine Gardasil—which protects against the four types of HPV responsible for most cases of cervical cancer and genital warts—is currently approved by the Food and Drug Administration (FDA) for ages 9 to 26. (A newer vaccine, Cervarix, is also approved only for girls and young women.) But research shows that Gardasil may also be nearly 90 percent effective in women up to age 45. As of this writing, the manufacturer has asked the FDA to extend approval for the vaccines use accordingly.
But do you need it? “You need to have a frank talk with your health-care provider,” Dr. Gostout says. “As a doctor, Id ask about the number of sexual partners the woman has had, the likelihood of exposure to new partners in the future, any history of abnormal Pap tests, and if she smokes, since smoking puts her at risk for not clearing the virus if shes exposed.” Concerned about safety? The Centers for Disease Control and Prevention has investigated reports of adverse effects linked to Gardasil and considers the vaccine safe as approved.

Ovarian cancer can be caught early if you know the symptoms.
Of all gynecologic cancers, ovarian cancer is the number-one killer—and its so deadly because it often goes undetected until a late stage. Thats why for many years women have been urged to be on the lookout for signs of this disease, including bloating, frequent urination, and abdominal pain or pressure. (Menstrual-type cramps arent considered a typical ovarian cancer symptom.
In general, however, any pelvic discomfort thats unusual for you is worth getting checked out by your doctor.) But recently, researchers calculated that only 1 out of 100 women evaluated for symptoms like these would actually have ovarian cancer. That doesnt mean you should dismiss those signs as nothing, though. “If you have more than one of these symptoms, and theyre occurring daily and getting worse day after day for two weeks, you should contact your doctor,” says Beth Karlan, MD, director of the Womens Cancer Research Institute at The Samuel Oschin Comprehensive Cancer Institute at Cedars-Sinai Medical Center in Los Angeles. As for lowering your odds of developing ovarian cancer, women who take birth control pills for five or more years have a 50 percent lower risk than those who have never taken the Pill.

Losing weight may lower your uterine cancer risk.
With the rise in obesity rates, more women under 40 are being diagnosed with uterine, or endometrial, cancer, according to Dr. Brown. (Being overweight puts you at much higher risk for this disease—the most common, but also one of the most curable, of reproductive cancers—because estrogen is made in fatty tissue, and over time it can stimulate cell growth and abnormalities in the uterine lining.)
If you experience any significant changes in your menstrual bleeding—or youre postmenopausal and have any bleeding (even pink staining)—tell your doctor. The good news? “There are options for treatment of early endometrial cancer that can preserve fertility; it doesnt always mean a hysterectomy,” Dr. Brown says. To lower your risk, drop those extra pounds and exercise regularly. As with ovarian cancer, taking birth control pills may also reduce your risk.

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