Continued exams important for women after menopause

One of the most common misconceptions among post-menopausal women is that they no longer face the risk of cancer of the reproductive system. “There’s a false understanding by older women that after menopause they can stop getting pelvic exams,” says Dr. Amy Van Blaricom, acting instructor of obstetrics and gynecology at the UW School of Medicine. “But they should never stop. The theory is that if we live long enough, all women will get (a gynecologic) cancer.”

Several types of cancer occur in the pelvic region. Although uncommon, ovarian cancer is the fifth leading cause of death among women in the United States. That’s because in more than half of cases it is not detected until a later stage, as no screening test is available for it. Malignant tumors of the ovaries develop quickly and sometimes shed cancerous cells that migrate to the uterus, bladder or bowel. Possible symptoms include a sense of pelvic heaviness, vague lower abdominal discomfort, bloating and gastrointestinal problems, but often there are no warning signs.

There were 25,400 new cases of ovarian cancer in the United States last year, and 14,500 women died of the disease. More than half of them were between 55 and 74. Risk factors include infertility, repeated miscarriages, childbearing after age 30, past medical history of breast cancer or family history of various cancers, and exposure to toxic chemicals. Studies have shown that there may be a lower risk of ovarian cancer in women who have used oral contraceptives.

The only reliable test for ovarian cancer is a yearly pelvic exam. If the doctor detects a suspicious mass, an ultrasound exam and/or tissue sample will be taken by performing a laparoscopy or laparotomy. “Ovarian cancer often presents itself as a cyst which seems stuck or larger than normal,” says Van Blaricom. “It is very difficult to pick up early, and tends to be an incidental finding in early stages.”

Cervical cancer is becoming less common in the United States, with about 16,000 cases of invasive cancer, and about 50,000 pre-invasive cases, every year. The average age of diagnosis is 45 but it has been seen in women as young as 20. Its cause is unknown. Risk factors are smoking, early sexual experience, more than one sexual partner, and past sexually transmitted diseases, such as human papillomavirus (HPV), a common virus that causes genital warts. HPV has been found to cause abnormal changes in cervical cells and affects up to 46 percent of young women in the United States.

New Pap tests for cervical cancer are reducing the likelihood of false-positive results, which used to be a common problem. One of them, ThinPrep, makes it easier to spot abnormalities because the machine filters blood and mucus from the specimen without discarding any cells. Abnormal cells revealed by Pap smears can be removed before they become malignant, a slow process that can take seven to 10 years. With early detection, the chances for a cure are as high as 90 percent.

The most prevalent cancer of the female reproductive system is endometrial (or uterine) cancer, affecting some 35,000 women in the United States each year. But it also poses the least threat since it is generally caught very early. It is most common in post-menopausal women, with bleeding as the number-one symptom.

Most women who die from cancer of the reproductive system are those who neglect checkups and ignore symptoms of pelvic pain, bloating and changes in bowel habits. All women should have Pap tests at least every three years from age 18 on, depending on their level of risk. But even those who aren’t sexually active should still have yearly pelvic exams, especially if they’re over 40, to check for ovarian and uterine cancers, stresses Van Blaricom. ¶

Ellen Liang