Attacking women's cancers ? STD and Herpes Pain Relief

Gynecologic cancers -- cervical, ovarian, uterine, vaginal and vulvar -- are not as widespread as breast cancer, but should be a major concern for women, nonetheless.

According to the latest confirmed statistics from the Centers for Disease Control and Prevention, 80,976 women in the United States were diagnosed with some form of gynecologic cancer, and 27,739 died from the disease in 2007.

In Charleston, two young female gynecologic oncologists at the Medical University of South Carolina, Dr. Jennifer Young Pierce and Dr. Whitney Graybill, promise to bring new energy to efforts to prevent and treat gynecologic cancers in the Palmetto State. Pierce and Graybill, both 36 (born just five days apart), were hired in August 2009 and August 2010, respectively, and are the only female gynecologic oncologists in South Carolina.

We talked to them about gynecologic cancers and the levels of awareness.

Q: Of the gynecologic cancers, which are the most troublesome, the most common and the ones that people know the least about?

Pierce: Ovarian cancer is the most troublesome because it's the most deadly. It is often diagnosed in a late stage. When it is incurable, it can be treatable over a period of years. That's why a lot of awareness is focused on making sure women know what signs and symptoms to look for.

The most common, uterine cancer, is on the rise because it's a cancer associated with obesity.

And I'll put a caveat in for cervical cancer because, while we've done a very good job of

getting women in for Pap smears, the ones who are diagnosed with it are the ones who don't get Pap smears. It's an easy test to undergo, if only we could get universal screening.

Q: When it comes to cancers, how much does the public know about gynecologic cancers?

Graybill: I think people are becoming more aware. Obviously, because of the media attention and funding, breast cancer and other cancers are more out there. The absolute number of patients with breast cancer is a lot larger than the number of patients with gynecologic cancers.

Pierce: I think (President) Barack Obama and (late comedian) Gilda Radner have done wonders for the awareness for gynecologic cancers. The word is getting out, and yet when Katie Couric hosted her first "Stand Up to Cancer," she did not mention the most helpful screening test to ever be invented: the Pap smear.

Graybill: I was impressed with the ovarian cancer billboard (Lowcountry Women with Wings) in downtown Charleston. I don't think you would have seen that five years ago.

Pierce: Sue Sommer-Kresse has done a great deal to increase ovarian cancer awareness in our community. There was a woman, Terry Scharstein (who died from ovarian cancer in 2008), whose story has been a catalyst for local awareness (read her story at lowcountrywomenwithwings.org/meet_terry.html). And having Jennet Robinson Alterman (executive director of The Center for Women) in your corner for causes, at least in Charleston, is all you need.

Q: Are there general risk factors for the cancers?

Pierce: When we talk about the people at highest risk, they are women with a family history of breast and ovarian cancer who carry a specific gene that puts their risk of ovarian cancer upwards of 40 to 60 percent. ... For those women, prophylactic surgery is recommended to remove their ovaries as soon as they have completed child bearing. Many, unfortunately, are diagnosed with breast cancer very young, and that can be the trigger for doing the screening (for the BRCA 1 and 2 genes).

Graybill: Then there's Lynch syndrome that we tend to screen for. It's not as common, but red flags are in young females with uterine cancer and a significant family history of uterine and colon cancer.

Pierce: Otherwise, the other main cancers we see frequently -- cervical, vulvar and uterine -- are often a product of lifestyle, whether that is obesity or smoking. And in cervical cancer, HPV. For all women under the age of 26, we highly recommend the HPV vaccine to prevent cervical cancer in the future. For all women, we recommend Pap smears as per your doctor's screening guidelines. We say on a regular basis, but that differs based on patient history. And regular pelvic exams through the course of their life.

Q: These sound fairly routine. Are the cancers occurring because these tests aren't being done?

Graybill: I'd agree, with the exception of ovarian cancer because there is no good screening test for it. There have been multiple studies that have shown that trans-vaginal ultrasound or the tumor marker 125 are not good screening tests for women. There are studies coming out looking at different biomarker assays, but as of right now, we don't have a good screening tests.

As for the other cancers, I agree it's lifestyle-related and can be prevented with routine screening and pelvic exams. Also, any postmenopausal woman who has bleeding needs to be evaluated.

Pierce: Any abnormal bleeding after intercourse or after you've gone through menopause. Then in terms of ovarian cancer, the symptoms we look for are feeling full, feeling bloated, weight loss, change in bowel habits and general gastrointestinal disquiet.

Women often write these off as changes associated with menopause. The thing we ask women to be mindful of is having the symptoms for more days than not for more than two weeks. That should be a red flag to go see your doctor. Often, doctors also miss this diagnosis because they are very nonspecific symptoms. On average, women see between three and four doctors before they are actually diagnosed with ovarian cancer. I think it's a red flag for our physician colleagues as well to then check with a pelvic exam and a transvaginal ultrasound to make sure that's not going on.

Q: Why have women lagged behind in specializing in this field?

Graybill: It's a surgical subspecialty, and if you look at the history of general surgery or surgical subspecialties, it's predominantly been a male-dominated field. Even in the field of OB-GYN, it's taking more time for the number of female gynecologic oncologists to increase. Now that we're seeing so many more women going into OB-GYN in general, we're seeing more women apply for gynecologic oncology fellowships.

Pierce: Even when Whitney and I came through and the residency was already 90 percent female -- it's been that way close to the last 10 years -- the field of gynecologic oncology is still 30 percent to 40 percent women. I think the fellows this year just crossed 50 percent women, but it's still under-represented by women.

Graybill: It's been a huge shift in the last three to four years.

Q: Why did you choose it?

Pierce: I was very attracted to general surgery as a specialty and to the opportunity to care for people when they most needed it, as opposed to doing well woman care. I entered OB-GYN in order to be a gynecologic oncologist. We're the only cancer surgeons who also prescribe and give the chemotherapy. So we have the very unique opportunity to treat the woman from the diagnosis all the way through their experience, either through a cure or their end-of-life care.

Graybill: My answer is very similar. I was always interested in a surgical specialty. ... The reason I chose gynecologic oncology is because I enjoy taking care of patients at the end of life. I know that sounds strange, but to offer them support and the compassion and the spiritual aspects, I really enjoyed connecting with patients on that level. You rarely have that bond with a patient where they will open up to you like they do at the end of life.

Source: http://www.herpespainrelief.com/3753/attacking-womens-cancers/

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