This year, more than 1,665,500 new cancer cases will be the disease and more than 585,700 people will die from cancer in the U.S., estimates the American Cancer Society. Many of these deaths could be prevented through broader screening efforts and patient self-advocacy. To protect yourself, be aware of your personal and family medical history and know the warning signs.
[cervical cancer]
Dr. Teresa Knight, Women’s Health Specialists of St. Louis:
At least 80 percent of the sexually active populations have one or more strain of human papilloma virus (HPV), which causes nearly all cervical cancers. Therefore, it’s very likely that most women will be exposed to the virus in their lifetime. Fortunately, most healthy women will fight off the infection. Like any virus (chickenpox, flu, herpes), HPV stays in the body forever. A woman with a history of HPV who now tests negative has not gotten rid of it, but rather the virus is no longer actively replicating or is dormant. There’s always a risk that HPV will reactivate, especially if the immune system is not functioning properly. Because HPV is common, the resulting dysplasia, or abnormal and potentially precancerous cells, are also common. If the infection doesn’t clear up on its own, or if it’s not treated, dysplasia can progress to cervical cancer.
At one time, cervical cancer was the leading cause of cancer death in women in the U.S. and worldwide. Thankfully, with routine screening by Pap smear, cervical cancers are now uncommon. Of the 12,000 cases that are reported annually in the U.S., half could have been prevented by following the recommended Pap smear guidelines.
Dr. Allie Alvarez-Wilson, SSM Healthcare:
Cervical cancer is an overgrowth of the cells in the cervix, which is the opening to the uterus. More than 99 percent of cervical cancers are due to an HPV (human papilloma virus) infection— a virus that causes cervical cells to grow without regulation. Screening Pap smears are the best tool we have in combating cervical cancer.
There is no reason anyone should develop or die from cervical cancer if they are keeping up with their annual exams as instructed. All women should be screening for cervical cancer starting at age 21. For women age 21 to 30, Pap smears should be done every three years. Women over the age of 30 should continue the tests every three years unless they have an HPV test done at the same time and test negative. In this case, they can space the test out to every five years. Studies are conflicting, but most agree that after the age of 70, Pap smears can be stopped. All women are recommended to see their gynecologist annually for continued breast and pelvic exams.
[genetic testing]
“Genetic testing is a powerful and valuable tool that can provide information of critical importance in the appropriate patient care setting,” says Catherine E. Cottrell, Ph.D., medical director of genomics and pathology services at Washington University School of Medicine. Increasingly, genetic testing is done on cancer patients to provide a greater degree of personalized care, Cottrell says. “Results from genetic testing can inform a physician about a patient diagnosis, provide information about patient treatment and management options, and might aid in the identification of at-risk family members to allow for appropriate follow-up and counseling.” If you have a personal or family history of cancer and are interested in genetic testing, skip the do-it-yourself testing kits available online. “Genetic testing should be performed by a certified clinical laboratory at the request of a physician who is working closely with a patient to explain the test options, as well as to provide access to counseling,” Cottrell says. “Direct-to- consumer genetic testing should presently only be considered for recreational purposes.”
[ovarian cancer]
Dr. Nick Chobanian, Mercy Hospital St Louis:
The problem with ovarian cancer is that the symptoms—pelvic pain, bloating, trouble eating or feeling full quickly, frequent urination and unexplained changes in body weight—are vague and non-specific. Because the symptoms are easy to ignore or attribute to other problems, many patients wait too long to seek medical help. In fact, 75 percent of patients present with advanced stage III or IV ovarian cancer. It’s important to pay attention to these symptoms and seek medical attention if the problems persist or worsen. For women who have a strong family history of breast or ovarian cancer (such as a mother or sister), genetic testing is important. Women who are carriers of the BRCA1 or BRCA2 mutations can have up to 40 percent risk of developing ovarian cancer. However, they can significantly decrease that risk by opting to remove their fallopian tubes and ovaries. It should be noted, however, that only 5 to 10 percent of all ovarian cancers are genetic and the vast majority are sporadic.
Dr. Caroline Werner, Genesis OB/GYN:
Ovarian cancer tends to have a high mortality rate because it is generally found later in the course of the disease. Unfortunately, there are no reliable screening tests for ovarian cancer. Ultrasounds are not an ideal screening tool because they tend also to find benign conditions, which can lead to unnecessary surgeries. Neither are the current blood tests on the market, specifically CA-125 and OVA1, which are used to determine if someone needs surgery and to follow someone after they have been diagnosed with cancer. The CA-125 test is not a good screening tool because increased levels of the CA-125 protein also can be associated with other conditions and cancers, including cirrhosis, hepatitis, pancreatitis, endometriosis and cancers of the breast, lung, liver, pancreas and bladder. Further, a negative CA-125 test does not rule out ovarian cancer because, in some cases, the protein level remains normal in women with ovarian cancer. Risk factors for developing ovarian cancer include infertility, endometriosis, low number of pregnancies and children, starting periods early, going through menopause late and living in industrialized areas. Taking birth control pills decreases your risk up to 60 percent, as do pregnancies, tubal ligation, hysterectomy and removal of ovaries.
[immunotherapy]
“Immunotherapy is a treatment designed to harness the body’s immune system and enhance its response to a disease,” says Dr. Carl Freter, SLUCare hematologist. “In the case of cancer, cancer cells are the target.” Immunotherapy is becoming a more important and powerful tool in treating cancer, Freter notes. “It’s already being used clinically and experimentally to treat a number of cancers, including leukemia, lymphoma, melanoma and kidney cancer, as well as autoimmune diseases like rheumatoid arthritis and lupus,” he says. “In the case of leukemia, oncologists are using immunotherapy in conjunction with bone marrow transplants to enhance the ability of the transplanted bone marrow to attack the leukemia and limit the attack of the transplanted bone marrow on the rest of the recipient’s body.” But it’s a far from perfect tool, Freter cautions. “We know how to give and start it and manipulate it to some degree, but it’s kind of like a bucking bronco,” he says. “We need to learn how to control it better.”
[skin cancer prevention and detection]
Dr. Larry Altshuler, Cancer Treatment Centers of America – Tulsa, Okla.:
Skin cancer is the most common type of cancer, affecting 2 million people. Several different types exist, including basal cell, squamous cell and melanoma. Each type can cause death, although melanoma is the most deadly. Diagnoses of melanoma are increasing with nearly 70,000 cases per year. The earlier you detect a skin lesion and see a doctor, the better the prognosis. Everyone should perform selfexams at least once per year (using a friend, family member or mirror to examine your backside). Use a body map, available at skincancer.org, to document location and size of abnormalities. Look at every area, including lips, nose and genitals. Use a hair dryer to help examine your scalp. People who have any of the following factors are at a greater risk for developing skin cancer: a lighter natural skin color, family or personal history of skin cancer, frequent or prolonged exposure to the sun through work and play, a history of sunburns (especially early in life) or a history of indoor tanning. Additionally, people who have blue or green eyes, blond or red hair, and skin that burns, freckles, reddens easily or becomes painful in the sun are at increased risk.
Dr. Joseph A. Muccini, MidAmerica Skin Health & Vitality Center:
The vast majority of skin cancers are caused by exposure to ultraviolet light—either from the sun or indoor tanning beds—which damages DNA. How much UV exposure is too much? If you develop a tan, you’ve damaged your skin enough to damage your DNA. And once you’ve damaged your DNA, you cannot undo that damage. What you can do, however, is make the decision to sin no more. Wear sunscreen every day, wear protective clothing and hats, and avoid the sun during peak hours to prevent any further damage. Most of the time, skin cancer is asymptomatic. Just because a mole or lesion is not bothering you does not mean you can ignore it. For basal and squamous cell carcinomas, pay attention to things that are red, growing or develop a crusty horn, bleeding or ulceration, rapid growth and rapid change. For melanomas, remember ABCDE: Asymmetry (if you draw a line down the middle, the two sides will not match), Border (uneven or coarse), Color (having multiple colors), Diameter (larger than 6 mm, the size of a No. 2 pencil eraser) and Evolution (changes in size, shape, color, elevation or symptoms).
By Sara Savat