Cancer can afflict anyone. Worldwide, the burden of the disease impinges on the lives of tens of millions annually. Common gynaecological cancers according to prevalence can be listed as breast, uterine cervix (neck of the womb), ovary and uterine corpus (womb). In Sri Lanka, the incidence of breast cancer is 16 per 100,000, cervix is 13, ovary 10 and uterus 7.
Breast cancer
Breast cancer is the most common malignancy affecting women, with more than one million cases occurring worldwide annually. Affluent societies carry the greatest risk. Risk factors for breast cancers specially concern the reproductive life of the women.
There is an increased risk in females with early menarche (early first menstrual cycle), nulliparity (no children), late menopause and hormonal factors (long-term use of oral contraceptives and hormonal replacement for menopause).
There is also evidence that obesity and diet may also be contributory factors. The role of contaminants and certain pesticides remains controversial. Radiation, particularly at times of breast development, causes cancers.
Genetic risk factors contribute to 10% of breast cancers and the most important genes identified in the context of familial breast cancers are BRCA 1 and BRCA 2.
How to reduce the risk?
Breast cancer prevention starts with healthy lifestyle habits.
Limit alcohol - the more alcohol you drink, the greater your risk of developing breast cancer. If you choose to drink alcohol, including beer, wine or liquor, limit yourself to no more than one drink a day.
Control your weight - being overweight or obese increases the risk of breast cancer. This is especially true if obesity occurs later in life, particularly after menopause.
Eat healthy food- research shows that eating a diet rich in fruits and vegetables does have an effect in protecting you against breast cancer. In addition, dietary fat (saturated) is also linked with the development of breast cancer.
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| Eat healthy diet to reduce the risk
of cancer |
Eating a healthy diet may decrease your chances of developing diabetes, cardio-vascular risk and strokes. A healthy diet can also help you to maintain a healthy weight -- a key factor in breast cancer prevention.
Get plenty of physical activity -- being physically active can help you maintain a healthy weight, which in turn, helps prevent breast cancer. Moderate exercises such as brisk walking or swimming will be helpful.
Breast-feeding -- breast-feeding may play a role in the prevention of breast cancer. The younger you feed, the greater the protective effect.
Discontinue hormone therapy -- long-term combination hormone therapy increases the risk of breast cancer. If you are taking hormone therapy after menopause it should be short-term. In case you are hoping to take it on a long-term basis, you should consult your physician to assess the risk /benefits. Non-hormonal therapies such as physical activity should be considered.
Avoid exposure to environmental pollutants -- while further studies are needed, some research suggests a link between breast cancer and exposure to the polycyclic aromatic hydrocarbons found in vehicle exhaust and air pollution.
Breast cancer and oral
contraceptive pills
Current evidence suggests that the use of oral contraceptives does not increase the risk of breast cancer. While older research showed a slight increase in risk, those studies included pills with higher oestrogen doses than what is available today.
What else can I do?
Be vigilant about breast cancer detection. Examine your breasts and if you notice any changes in your breasts, such as a new lump or skin changes, consult your doctor for an evaluation. Ask your doctor when to begin mammograms and other screening procedures to detect breast cancer.
Cervical cancer
Cervical cancer is the second most common cancer of women worldwide. About 500,000 cases are detected annually in the world out of which 80% occur in developing countries. The molecular epidemiology study has shown that high risk Human Papilloma viruses (HPV) are associated with the disease.
These viral infections which are sexually transmitted can cause certain cell changes in the cervix leading to abnormalities called pre-cancer lesions. Many years after, these pre-cancer lesions can progress into cancer. Cervical cancer is preventable.
How to reduce the risk?
Get a regular pap smear – a pap smear is a simple test where the neck of the womb is scraped and the cells are examined under the microscope for any abnormality. This helps detect changes before they turn into cancer.
Quit smoking -- smoking cigarettes increases your risk of developing many cancers, including cervical cancer. Smoking combined with HPV infection accelerates cell changes.
Confine yourself to one partner -- as HPV is a sexually transmitted disease, having more partners increases the risk of developing cervical cancers.
Get the HPV vaccine – vaccinations targeting HPV subtypes 16 and 18 which are responsible for a majority of cervical cancers are available now. Many developed countries have approved these vaccines and incorporated them into school immunization programmes as the recommended age for vaccination is between 12 and 25 before starting sexual activity.
Endometrial cancer
(cancer of the womb)
Endometrial cancer arises from the lining of the uterus and is common in patients after menopause. It is linked to reproductive life with an increased risk for women undergoing early menarche (first menstrual cycle) and late menopause (last menstrual cycle). It is also common in nulliparous women (those with no children).
The endometrium usually responds to hormones and the aetiology is based on excess production of oestrogen. Therefore, it is also common in obese patients and those with excess oestrogen production (tumours). Other risk factors include a history of colonic and breast carcinoma (familial). The disease is clearly associated with patients with high blood sugar and high blood pressure.
How to reduce the risk?
- Maintain a healthy body weight – excess weight will produce a high level of oestrogen from fat cells.
- Breast feeding
- Exercise regularly
- Eat a diet rich in fruits, vegetables and fibres
- Decrease your intake of animal fats.
- If hormones are taken after menopause, take a combined preparation. (oestrogen and progestogens)
- If there is bleeding after menopause, see a physician immediately.
Ovarian cancer
Ovarian cancer is common after menopause and has got an insidious onset. The symptoms are vague. The disease spreads silently and often when detected, it is in an advanced stages. Ovarian cancer carries the worst prognosis out of all gynaecological cancers.
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| Exercise regularly to reduce
cancer risk |
The risk factors include age (common in old age), nulliparity, familial (10% of the ovarian cancers run in families due to changes in the gene material), having breast cancer and fertility drugs (research has shown that unsupervised use of fertility drugs increases the risk). There are no screening tests available to prevent ovarian cancer.
How to reduce the risk?
- Multiple children -- women with children have a 45% decrease in the risk of ovarian cancer relative to those who have no children. Each child is associated with a 10-15% reduction in risk.
- Breast feeding
- Oral contraceptive pills
- Sterilization operations (fallopian tubes) – 33% reduction
- Dietary factors – A diet containing high fat, refined sugars and red meat will increase obesity and ovarian cancer incidence. Research has shown vitamin A may protect against both breast and ovarian cancers. Fruits, vegetables and tea may also provide protection
- Deliberate removal of ovaries (prophylactic oophorectomy) can be considered in patients with inherited or familial ovarian cancers. Genetic counselling will benefit these patients.
The cancers of the external genitalia of the female reproductive system are extremely rare. Studies have shown that HPV infection contributes at least 40% to the development of these cancers.
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