Uterine Cancer: Beating the Odds

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Most women are surprised when I tell them that endometrial (uterine) cancer, not ovarian cancer, is the most common gynecologic malignancy and the fourth most common cancer in women. The reason uterine cancer is not the first to come to mind is that since most uterine cancer is diagnosed in its early stages, comparatively few women die from it. Five-year survival for women diagnosed before the cancer has spread is 95%.

Abnormal bleeding is usually the first sign of a problem, which is why irregular periods, heavy bleeding or constant spotting should never be ignored. Any bleeding in a postmenopausal woman should be evaluated. The majority of abnormal bleeding is not an indication of cancer, but still needs to be checked out.

A sample from the lining of the uterus (no cutting involved!) is performed in the doctor’s office to detect pre-cancerous or cancerous cells. A Pap test, on the other hand, detects abnormal cervical cells and does not screen for uterine cancer.

Most uterine cancers occur because there is a hormonal imbalance that results in an abnormal buildup in the cavity of the uterus. In a normal menstrual cycle, women produce estrogen, which thickens the uterine lining. Ovulation, or the monthly release of an egg, triggers the production of progesterone, which prevents the uterine lining from getting too thick. If someone isn’t ovulating, the lining of the uterus gets blasted with estrogen but without the progesterone to balance it out, the potential for cancerous changes increases.

The only thing better than early detection of uterine cancer is to prevent it from developing in the first place. Here are 5 steps that can reduce your risk:

Lower Your Weight to Lower Your Risk
Fat cells produce estrogen, which is why obesity is thought to be one of the primary reasons endometrial cancer rates are increasing in the US. Women who are obese are more than three times as likely to get endometrial cancer.

A Pill a Day …
Every woman knows that taking birth control pills helps prevent pregnancy, but taking oral hormonal contraception for at least 12 months also decreases the risk of uterine cancer. The longer you take them, the more your risk is reduced – taking them for three years or longer may reduce risk by a whopping 30 to 80%. This protection may last for 15 years after pill use is discontinued.

Choose an IUD
Birth control pills are not the only type of contraception that reduces uterine cancer. The progestin in the Mirena™ intrauterine device also keeps the lining of the uterus from building up. Mirena IUDs are now used to treat a pre-cancerous condition called hyperplasia.

Pick Your Progestin
It has been known since the 1970s that taking estrogen therapy without adequate progestin increases the risk of uterine cancer almost tenfold. If you are taking estrogen for relief of menopausal symptoms (and have a uterus), it is crucial to take an appropriate progestin to protect the lining of the uterus. Compounded progestin creams have not been shown to offer adequate protection. The progestin molecule is too large to be absorbed well through the skin, which is why the FDA approved progestins used to balance estrogen therapy are in pill form.

Question Your Kin
Many women have heard of BRCA gene mutations that are associated with breast and ovarian cancer. But BRCA is not the only genetic mutation. Families with a Lynch mutation are not only at risk for colon and stomach cancer, but also have a 20 to 60% chance of developing uterine cancer as opposed to approximately 3% in the general population.