5 Cancers that Women Need to Talk About More
According to a report by FICCI and Ernst & Young (EY), called 'Call for Action: Expanding Cancer Care for Women in India, 2017', India’s real cancer incidence for women is estimated at 1 to 1.4 million cases per year. The same report states that in 2015, cancers of the breast (19%), cervix uteri (14%) and ovary (7%) contributed to 40% of all cancers among women. Presently, Indian women have the third highest number of cancers, just after the USA and China.
Here are some of the cancers affecting women and reasons why we need to talk about them.
Breast cancer occurs when the cells in the breast grow uncontrollably or abnormally. This is the most common of all cancers that occur in women. The Indian Council of Medical Research (ICMR) in its 2016 report titled ‘Consensus Management for Breast Cancer’ stated that close to 1,44,000 women are diagnosed with breast cancer every year. Doctors say that for every two women diagnosed, one woman dies of the disease.
Cervical cancer starts from the cervix, which is the lower, narrow part of the uterus. Though the average age at which it is detected is 38, cervical cancer can be detected in girls as young as 15 years. The National Institute of Cancer Prevention and Research (NICPR) reported that in India, one woman succumbs to cervical cancer every 8 minutes. Cervical cancer is caused by the HPV Virus (Human Papilloma Virus) and is transmitted through sexual intercourse .
Cancer in the ovaries, the female organ that produces eggs, may be diagnosed late because the symptoms often go undetected. Patients ignore the early and non-specific symptoms of the disease like bloating, distension and heaviness in the lower abdomen. Late diagnosis of ovarian cancer means fertility in women of child bearing age could be affected; there is also a lower survival rate.
Uterine cancer, also known as cancer of the endometrium, starts in the inner lining of the uterus. Endometrioid tumours are often detected early because of the abnormal bleeding that comes with them. Doctors say that if patients are detected in Stage 1, when the cancer is often localised, surgically removing the uterus often cures the cancer and the 5-year survival rate goes up to approximately 95%.
Colorectal Cancer (CRC)
This cancer develops in the colon and/or rectum, both of which are part of the digestive tract.
Environmental and genetic factors can increase the likelihood of developing CRC . Although genetic predispositions are the most common risk factors, doctors say that the majority of CRCs are sporadic, and may not be due to inherited susceptibility. Colorectal cancer is the third most common cause of cancer-related deaths in the world, according to the World Health Organization.
Role of Screening and Impact on Survival Rate
When detected early, cancer is often treatable with good results. But cancer screenings for women in India is still very low.
Screening Tests to Detect the 5 Cancers Early
Regular screening in women can detect premature symptoms of cancer and can lead to effective treatment outcomes.
- Self-examination: 20 years and older
- For a woman who is older than 40 years of age, the early screening protocol is as follows:
- A yearly examination by a qualified and trained medical personnel is a must.
- From 40 to 50 years of age, yearly mammography is recommended.
- After 50 years of age, mammography may be done every 2 years.
Women with certain risk factors like family history, obesity, hormone replacement therapy, and other medical conditions will have to follow doctors instructions on their screenings.
No screening - Sexual history is not a consideration
Cytology every 3 years. (A cytology is where cells are examined for diagnosing and screening diseases). In cytology, the pap smear is one of the most common cytology based screenings for cervical cancer
Preferred: Co-testing HPV and cytology every 5 years
Acceptable: Cytology alone every 3 years
Screening can be discontinued after either three consecutive negative cytology tests or two negative cytology and HPV tests within 10 years, provided the most recent test was within 5 years
Women with a history of cervical intraepithelial neoplasia (CIN) 2, CIN 3, or adenocarcinoma in situ should continue routine age-based screening for at least 20 years
After total hysterectomy
No screening necessary
Applies to women without a cervix and without a history of CIN 2, CIN 3, adenocarcinoma in situ, or cancer in the past 20 years
After HPV vaccination
Follow the same age-specific recommendations as unvaccinated women
- Transvaginal Ultrasound (TVUS): 30 years and older
- CA 125: 30 years and older
Who should be screened for ovarian cancer?
It is not clear who should be screened for ovarian cancer. For now, experts agree that:
- Women with the highest risk and who must get screened include those who have had genetic tests showing that they:
- Carry genes known as the ‘BRCA’ genes
- Have a genetic condition called Lynch Syndrome (also called hereditary nonpolyposis colorectal cancer or "HNPCC")
- Women who have a family history of ovarian cancer or a gene that increases their chances of getting ovarian cancer, should opt for screenings.
- Women who are at low risk for ovarian cancer do not need to be screened. This includes women who do not have a family history of ovarian cancer or have verified through gene testing that they do not have the cancer gene present in their bodies.
Uterine (Endometrial) Cancer
Strategies for screening and prevention of endometrial cancer include
- Endometrial sampling
- Risk-reducing hysterectomy
However, routine screening for endometrial carcinoma for most women is not recommended. Women with Lynch Syndrome (hereditary nonpolyposis colorectal cancer), have a lifetime risk of endometrial cancer of 27% -71% compared to 3% of the general population, and must be tested.
Women with an average risk of colorectal cancer should begin screening at age 50. Any one of the following screening strategies is recommended :
- Colonoscopy: Every 10 years.
- Computed tomographic colonography (CTC): Every 5 years.
- Flexible sigmoidoscopy every 5 years, with or without an immunochemical stool test.
- Stool testing every year (for guaiac and immunochemical occult blood test).
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