Prevention & Recovery

Cancer: The many-headed beast

Author: Canadian Living

Prevention & Recovery

Cancer: The many-headed beast

This story was originally titled "Cancer: The Many-Headed Beast" in the October 2009 issue. Subscribe to Canadian Living today and never miss an issue!

Ask any woman – worrying about cancer can take up a lot of mental energy. But for all the anxiety around breast, ovarian, uterine and cervical cancer, many promising new surgical approaches, drugs and other discoveries are improving survival rates and women's quality of life, and best of all, preventing the onset of cancer.

"There's generally a sense of optimism," says Dr. Amit Oza, a senior staff physician and professor of medicine at Canada's leading cancer institute, Princess Margaret Hospital, in Toronto. Here's what you need to know and how you can reduce your risk of the most common female cancers.

Breast cancer
It's the second leading cause of cancer deaths in Canadian women (after lung cancer), according to the Canadian Cancer Society. The good news is that 87 per cent of women who are diagnosed with breast cancer make it to the five-year mark, and death rates have fallen in every age group since the mid-1990s.

Who's most at risk
Women over 50; women with the BRCA 1 or 2 mutations; those who have a first-degree relative (mother, daughter or sister) with breast cancer; women who have ovarian cancer; or those who had their first child after 30.

Best ways to decrease your risk
• Drink less. Even a few glasses of wine with dinner can increase your chance of developing breast cancer by 13 per cent, says a recent British study.

• Manage your weight and exercise. "Maintaining a healthy body weight helps reduce your risk, and exercise is a huge part of that," says MJ DeCoteau, executive director of Rethink Breast Cancer, a Toronto-based charity that offers support to young breast cancer patients.

• Change your diet. Toronto naturopathic doctor Jill Shainhouse advocates a low-estrogen diet, which means cutting back on fatty animal products, such as red meat. She also suggests adding flax to your diet (to remove estrogen from your body) and eating more cruciferous vegetables like broccoli.

Breast-feed. It reduces the amount of estrogen in your body and delays the return of your period. "The longer the duration of uninterrupted menstrual cycles, the greater the increase in the risk of breast cancer," says Dr. Ivo Olivotto, head of the radiation therapy program at the British Columbia Cancer Agency in Vancouver.

• Do breast self-exams and make sure you also have your breasts examined by a health-care professional. Though self-exams were controversial a few years ago, experts now recommend monthly checks.

Page 1 of 4 - Read page two to find out what you should talk to your doctor about.

The Canadian Cancer Society recommends that women ages 40 to 49 receive a clinical breast exam (a manual check of the breasts by a health-care professional) every two years. At age 50, they should get a clinical exam and mammogram every two years. There are a few exceptions:

If you have dense breasts. This means your breasts have a greater proportion of glands, ligaments and tissue to fat – size doesn't matter. The relative ratio of density to fat is different for each woman. A recent Canadian study found that women with higher breast density at a younger age may have five times the risk of developing breast cancer later in life.

"I encourage women with a family history or other known risk factors (such as extremely dense breasts) to talk to their doctor about annual screening (including a digital mammogram and an MRI) at an early age," says DeCoteau.

If you have BRCA I and 2 genes. You need to be screened vigilantly.

Find our guide to breast self-exams here!

Ask your doctor
About any changes in your breasts. These changes include a lump, thickening, dimpling, redness, nipple discharge or inversion, or any unusual pain.

About birth control. Being on the pill for a long time raises your risk of
breast cancer slightly.

About hormone replacement therapy (HRT). A 2002 study showed that women taking combined HRT had a 26 per cent increase in breast cancer risk – a risk that didn't become evident until four years after they stopped taking the drugs.

Breakthroughs in treatment
Shorter courses of radiation. Olivotto says research shows that for most patients, three and a half weeks is just as good as five weeks.

Hormonal drugs. Aromatase inhibitors such as Femara, which block the production of estrogen from fat cells in your body, are now part of the standard breast cancer treatment, says Olivotto. Women who took two to three years of Aromasin, another aromatase inhibitor, after taking tamoxifen for two to three years had a 20 per cent reduction in the relative risk of recurrence, compared with women who took tamoxifen for the full five years.

Biologic agents. Five years ago, the drug Herceptin was only given to women with metastatic cancer with a HER2 type, a specific protein produced by cancer cells. "Today if you have that type of breast cancer, Herceptin is used immediately after surgery," says Olivotto. Given with chemo, Herceptin can cut your chance of a recurrence within the first year in half.

Reconstructive surgery. Women in the U.S. can now undergo nipple-saving surgery with a mastectomy. Olivotto says this type of surgery is available in Canada, but that Canadian doctors take a more conservative approach and remove the nipple to avoid the risk of not getting all the cancer.

Find the Canadian Living complete breast guide here.

Fact: 87 per cent of women who are diagnosed with breast cancer make it to the five-year mark, and death rates have fallen in every age group since at least the mid-1990s.

Page 2 of 4 - Read page three for info on cervical and uterine cancer
Cervical cancer
Mortality rates have been declining by about 3.3 per cent per year since 1995. "This is mostly due to widespread screening with Pap tests," says Heather Chappell, acting director of Cancer Control Policy for the Canadian Cancer Society in Toronto.

Who's most at risk
Women who had sex for the first time at a young age or who have had multiple sex partners. Women who smoke or have a weakened immune system, as well as those have used birth control pills for a long time.

Best ways to decrease your risk
Get regular Pap tests and don't smoke. Limit the number of sexual partners you have. Using condoms helps, but human papillomavirus (HPV), the virus that is often a precursor to cervical cancer, can be spread by non-penetrative contact.

Testing for HPV will soon become a more common way of determining whether a woman is at risk of cervical cancer, says Janet Dollin, an Ottawa- based family physician.

Ask your doctor
About any abnormal bleeding. This includes spotting between periods or after sex; heavier or longer periods; bleeding after menopause; more vaginal discharge than normal; and pain in the pelvis or lower back, or during sex.

About the vaccine. Dollin says women over 26 should ask their doctors about
getting vaccinated for HPV.

Breakthroughs in treatment
The cervical cancer vaccine. The first vaccine for cervical cancer, Gardasil, was approved in 2006 and recommended for women ages nine to 26. A federal recommendation to vaccinate older women is expected this year.

Radical trachelectomy helps overcome infertility. Used primarily in women with cervical cancer in its early stage, the procedure involves removing the cervix and tying a stitch at the entrance of the uterus. "That's been a big breakthrough as a fertility preserving option," says Plante.

Better imaging. Positron emission tomography– computed tomography (PET-CT), a combination of two types of nuclear medicine imaging that provide very accurate pictures of your body, is being used more frequently to identify cancer cells, especially after radiation therapy, to determine if the disease is still present, adds Plante.

Uterine cancer
Uterine or endometrial cancer starts in the cells lining the uterus. The good news: you have only a 2.4 per cent chance of developing uterine cancer in your lifetime.

Who's most at risk
Post-menopausal women or women who are severely overweight. Those who started their period early, entered menopause late, did not have kids or used hormonal medications for a long time.

Best ways to decrease your risk
Manage your weight. Women who are obese have an increased risk of developing uterine cancer. If you're taking hormonal medications, talk to your doctor.

A biopsy, which involves removing a piece of the lining of the uterus, is usually necessary to make a definite diagnosis of uterine cancer.

Ask your doctor
• About any bleeding past menopause.

Breakthroughs in treatment
Less invasive surgeries. More and more uterine cancers are operated on through laparoscopy, a minimally invasive surgery, says Plante.

Reversing cancer through drugs. Plante says that in some cases in which a woman has an early stage of uterine cancer and wants to keep her uterus, high doses of hormones can reverse the disease.

A new class of drugs. Early reports suggest that mTOR inhibitors can shrink uterine tumours by halting the rapid growth of cancer cells.

Fact: You have only a 2.4 per cent chance of developing uterine cancer in your lifetime.

Read more about gynecological cancers here.

Page 3 of 4 - Read page four to learn about ovarian cancer

Ovarian cancer
If ovarian cancer is caught early, 90 per cent of women will be successfully treated, says Elisabeth Ross, CEO of Ovarian Cancer Canada. Unfortunately, many women are diagnosed at an advanced stage because the symptoms can mimic a variety of different ailments and some doctors aren't familiar with them. The good news: Ovarian cancer is not that common – it affects only one in 70 women. And patients are living longer, says Dr. Barbara Vanderhyden, the Corinne Boyer Chair in Ovarian Cancer Research at the University of Ottawa. "We're now approaching [a survival rate of] five years as not being uncommon for many women when even 10 years ago that would have been considered extremely high."

Who's most at risk
Women ages 57 to 62; those who have had breast, uterine or colorectal cancer; women with the BRCA 1 or 2 genes; and women who have never been pregnant. Talk to your doctor about the potential for an increased risk of ovarian cancer from taking HRT for a long time.

Best ways to decrease your risk

Don't smoke; maintain a healthy weight through exercise. Obesity has been linked to higher risk. According to Vanderhyden, taking birth control pills is the best way to reduce the risk of ovarian cancer because they suppress ovulation.

In high-risk women or those with symptoms, a pelvic exam followed by a transvaginal ultrasound and a blood test for a tumour marker called CA125 is the most effective approach for detection, says Ross.

Ask your doctor
About ongoing symptoms. "Women really need to take their health care in their hands," says Ross. For example, ask for more tests if your symptoms don't improve.

To check your ovaries. Doctors should check for lumps on your ovaries during a routine pelvic exam. If it's painful or they can't access them, discuss additional testing, says Ross.

Breakthroughs in treatment
Symptoms are now official. Ovarian cancer symptoms have been officially recognized by the American Cancer Society and the Society of Gynecologic Oncology of Canada. These include abdominal bloating or discomfort, changes in bowel function, unexplained weight gain, a distended abdomen, nausea and frequent urination. If these symptoms last three weeks or longer, see your doctor and explain your concern.

Interperitoneal chemotherapy works. This method of delivering chemo directly into the abdomen "has really altered the landscape of how patients are treated," says Vanderhyden, adding that this method can increase survival rates considerably.

Better surgery. Vanderhyden says that the removal of as much of a tumour as possible has had a big impact on survival rates. In the past, surgeons were less rigorous, falsely believing that chemo would kill off any remaining cancer cells.

Promising drug therapies. More targeted therapies (drugs that zero in on how cancer cells work) are on the horizon, says Oza. One such drug, Avastin, coupled with low-dose chemo, has been shown in a preliminary study to be very effective in treating ovarian cancer that has recurred, he says.

New blood test. Studies show that the He4 test, when combined with the CA125 test, improves early detection of ovarian cancer, says Dr. Marie Plante, a gynecologic oncologist at Laval University in Quebec City.

Fact: Ovarian cancer is not that common – it affects only one in 70 women. And now patients are living longer, too.

Learn how to live a full life after you've been diagnosed with cancer.

Click here for more articles about women's health.

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Prevention & Recovery

Cancer: The many-headed beast