Dispelling gynae-myths

the eve appealThis September is Gynaecological Cancer Awareness Month, and The Eve Appeal, the UK’s only gynaecological cancer research charity, are encouraging women across the UK to open up about talk about gynaecological health more freely without the fear of embarrassment or being judged.

Here Dr Adeola Olaitan, a medical advisor for The Eve Appeal and consultant gynaecologist at University College London Hospital dispels five common myths that she’s heard many a time during her consultations.

Smears can detect all gynaecological cancer

The Cervical Screening System is designed to protect women against cervical cancer. This is because a smear test can detect abnormal cells from the cervix that are not cancerous but if undetected and untreated, can develop into cancer over time. The cells give no symptoms, so you would not be aware you had abnormal cells if you didn’t attend a cervical screening test. The changes are fully treatable, usually by a simple outpatient procedure and treatment prevents progression to cancer. Cervical screening saves approximately 5,000 lives a year.

However cervical screening is just that – a test to protect women against cervical cancer. It does not screen for other cancers and having a normal smear does not indicate that you are protected from other gynaecological cancers such as ovarian, womb or vulval cancer.

Having High Risk Human Papilloma Virus Infection in the Cervix means you are promiscuous

The High Risk Human Papilloma Virus (HRHPV) is the virus that causes cervical cancer.

The commonest HRHPV (HPV16 and HPV18) are responsible for 75% of cervical cancer cases with 80% (4 out of 5) of us developing the infection at some stage. The HRHPV is passed on by sex or genital contact. However, you can be develop HPV even if you have only had sex once – it is a very common virus.

In most cases, the body’s immune system will get rid of the virus within a year or two. In some women, for reasons we do not fully understand, the virus infection persists. It is this persistent infection that leads to the cell abnormalities that can cause cervical cancer.

We cannot treat HRHPV infection but we can do is treat the cell changes it causes to reduce the risk of cervical cancer. So if you find out you have HRHPV infection it does not mean that you are promiscuous – it is just a very common virus.

Healthy Midlife TipsAll gynaecological cancers are hereditary

Most gynaecological cancers occur by chance to which lifestyle and environmental factors may contribute. Only a small minority of gynaecological cancers are hereditary and these occur when a woman inherits a faulty gene from one of her parents.

The commonest of these are the BRCA gene mutations – BRCA1 and BRCA2. A fault in these genes impairs the body’s ability to repair abnormalities in cells that may lead to cancer. A parent who has a BRCA gene mutation has a 50% chance of passing the gene to his or her offspring.

Women with a BRCA gene mutation have a much higher risk of developing breast and ovarian cancer than the general population. They also tend to develop these cancers at a younger age.

A BRCA1 mutation is associated with:
• 60-90% chance of breast cancer
• 40-60% chance of ovarian cancer

A BRCA2 mutation is associated with
• 45-85% chance of breast cancer
• 10-30% chance of ovarian cancer

If you have family members who have a BRCA gene mutation, or think you might, you should ask your doctor to arrange genetic counseling for you. You can then be advised about testing for the genetic abnormality.

There is no indication that the other gynaecological cancers: cervical or vulval are associated with a hereditary pattern.

There is nothing you can do to reduce your chances of getting cancer

No one can guarantee that you will avoid cancer but certain lifestyle choices can help to reduce the risk of some gynaecological cancers. Here are some things to think about:

healthy food featuredDiet and exercise:

Endometrial cancer is the commonest gynaecological cancer in the UK. It is directly associated with obesity and the number of women affected by this cancer continues to increase as the rates of obesity rise. This is because fat produces a female hormone, oestrogen which has a direct effect on the lining of the womb and can cause changes which can lead to cancer.

You can reduce your chances of getting endometrial cancer by eating a healthy diet, taking regular exercise and maintaining the right body weight for your height.

Smoking:

Everyone knows that smoking causes lung cancer but fewer people know that it also causes cervical cancer. Cervical cancer is caused by an infection called the high risk human papilloma virus. This virus is more likely to persist in the cervix if you smoke, it has a direct effect on the immune system of the cervix, but can also cause vulval cancer.

Avoiding smoking significantly reduces your chances of getting an abnormal smear and of developing cervical cancer.

Vulval Skin Conditions:

A lot of women suffer from itching of the vulva (the skin on the outside of the genital tract). This is more common in older women and some women tend to ignore it or not go to the doctor because they are too embarrassed. Some of the skin conditions that cause the itch can lead to cancer if undetected and untreated such as Lichen Sclerosus. If the diagnosis is made then the condition can be managed by steroid creams which make you more comfortable and also reduce your risk of getting cancer.

If you have an itch, do go and see your doctor so you can be referred to a specialist to get proper treatment. Do not ignore it or self-medicate.

Family History:

A small minority of gynaecological cancers are caused by an inherited predisposition. If you inherit a faulty gene then your chances of getting endometrial or ovarian cancer can increase to 50%. If you are known to belong to a high risk group then you may be eligible for monitoring or risk reducing surgery that will modify your chances of getting these cancers.

If you have a family history of breast, bowel, womb or ovarian cancer you must speak to your doctor to find out if you’re eligible for genetic testing.

Gynaecological cancers cannot be cured

All gynaecological cancers can be completely cured if diagnosed early. It is important therefore that women are aware of the signs and symptoms of gynaecological cancers and that they do not ignore these. You must see your doctor urgently if you develop any of the below symptoms:

• Bleeding after the menopause: This is always abnormal
• Bleeding after sex or between periods: Never ignore this
• A persistent smelly discharge: Vaginal discharge should never be smelly
• Vulval itching: This always needs to be investigated

To find out more information about gynaecological cancer or Gynaecological Cancer Awareness Month please visit www.eveappeal.org.uk/gcam

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