Cancer Screening

What Women Should Know About Cancer
from the American College of Obstetricians and Gynecologists
ACOG President Douglas H. Kirkpatrick, MD

Dr. Kirkpatrick has been in private practice for 33 years in Denver and is an assistant clinical professor of OB-GYN at the University of Colorado Health Sciences Center.

Too many women are dying from cancer. Today, cancer is the second leading killer of women in the US—an estimated 270,000 women will die and over 678,000 women will be diagnosed with cancer this year. It is not surprising that cancer is one of the biggest health fears for women. Sometimes this fear can be so overwhelming that women forego screening tests that can detect cancer early, when it is most curable.
The causes of cancer are complex. We know that having a family history of cancer is a risk factor. But most cancers occur in people with no family history of the disease at all, so those without a family history of cancer cannot assume that they aren’t at risk. Also complicating matters is the fact that the disease can occur without symptoms. And even if symptoms are present, they can be mistaken for a harmless health condition or they may not appear until the disease is more advanced. While it may seem as if we have no control over cancer, there are steps a woman can take to reduce her risk. Consider this: As many as half of all cancer deaths could be prevented if people practiced simple, healthy lifestyle habits—such as not smoking, eating well, and exercising—and got recommended health screenings. This special cancer guide will help you take charge of and protect your health.

OB-GYNs are dedicated to improving women’s health, and we are deeply concerned about the state of women’s cancers. Our specialty recognizes the benefits of prevention and early detection efforts, and we want to share this vital message with you. Use this guide with your ob-gyn. Read it and ask questions. Your OB-GYN is your partner in helping you stay healthy!

The American College of Obstetricians and Gynecologists is the national medical organization representing over 51,000 members who provide health care for women.

Introduction
If you are like most women, when it comes to your health, cancer ranks high on your list of concerns. But few women have a true sense of their risk of developing cancer or the steps they can take to reduce that risk. For instance, while most of us are aware that more women in the US are diagnosed with breast cancer than any other kind of cancer each year, few are aware that more women die of lung cancer than breast, uterine, and ovarian cancers combined.

What’s more, most women don’t realize that the one doctor they see on a regular basis, their OB-GYN, can talk with them about appropriate screenings for all types of cancer— including lung and colorectal cancers. Your OB-GYN can also guide you in talking about what lifestyle changes you can make to reduce your risk of developing cancer and alert you to the important warning signs you should watch for that can lead to the early detection of cancer.
Did you know that early detection of cancer increases your chances of successful treatment?

There are several different tests available to you to detect the presence of breast, cervical, and colorectal cancers. If cervical, colorectal, or uterine cancer is detected early, your chances of beating it can be as high as 90%. Similarly, the five-year survival rate today for women with localized breast cancer is 97%. In the 1940s, only 72% of women diagnosed with breast cancer survived for five years.
Currently, there are no screening tests available to help detect lung, ovarian, and uterine cancers early. As a result, it’s vitally important to pay close attention to how your body feels and looks, have regular yearly check-ups with your OB-GYN, and talk with your doctor about any changes that concern you. It’s also true that leading a healthy lifestyle can reduce your risk of cancer. In fact, certain female reproductive cancers share the same risk factors. (ACOG) recommends that women focus on living a healthy lifestyle—lose excess weight, don’t smoke, practice safe sex, and get daily exercise.
Protect & Detect: What Women Should Know About Cancer is a guide developed by to encourage you, in partnership with your OB-GYN, to take charge of your health and gain an accurate understanding of your risk of developing cancer and the lifestyle changes you can make to reduce your risk. ACOG urges women to plan for the appropriate screenings at the right ages and to be aware of the physical warning signs that are a critical component to detecting cancer at its earliest stages.

What You Should Know About Breast Cancer

Breast cancer is the second leading cause of cancer death in the US.
One out of every eight women will develop breast cancer in her lifetime.

What is Breast Cancer?

Breast cancer usually begins as a lump or small formation of cells in the breast, typically in the lobes or ducts of the breast. Different types of breast cancer grow at different rates.

Women with a family history of breast cancer, especially mother, daughter, or sister
Women who carry a mutation in the BRCA1 or BRCA2 gene
Women who went through puberty early (before age 12) or experienced a late menopause (after 55)
Those who have not had children or had their first child after age 30
Women over age 65
Women who are obese

Exercise regularly
Control your weight
Eat a balanced, nutritious diet
Limit your alcohol intake
Discuss the use of hormone therapy and chemoprevention medications, such as tamoxifen and raloxifene, with your doctor
Women with a significant risk of developing hereditary breast and ovarian cancer often are advised to use oral contraceptives

What Should I Know about Screening for Breast Cancer?

It is important that you do breast self-exams routinely and have a physician examine your breasts annually. Mammograms are the gold standard for detecting breast cancer and are recommended every year or two for women in their 40s and annually for women age 50 or older.

If a mammogram finds an abnormality, magnetic resonance imaging (MRI) or ultrasound may be used for further evaluation. MRI also may be recommended for women with certain risk factors. A biopsy will determine if you have cancer. For women who carry the BRCA1 or BRCA2 gene mutation, some cancer experts recommend annual or semiannual clinical breast examinations, along with annual mammography, beginning at age 25 – 35 years.

A lump in the breast
Dimpling of the breast
Changes in the skin on the breast
Spontaneous nipple discharge

How is Breast Cancer Treated?
Breast cancer is treated with a combination of surgery, chemotherapy, radiation, and/or other drugs such as herceptin, tamoxifen, and aromatase inhibitors.

What If I Have a Strong Family History of Breast Cancer?

Genetic testing may be advised for women who have a strong family history of breast and/or ovarian cancer or who carry a BRCA gene mutation. Genetic counseling with a trained health care professional will help you understand the risks and benefits of the test and if it’s right for you.

If you have a BRCA gene mutation a cancer specialist can help you decide if preventive measures, such as a mastectomy (removal of the breast) or oophorectomy (removal of the ovaries), will reduce your risk of breast cancer.

What You Should Know About Cervical Cancer

Cervical cancer is one of the most common cancers in women throughout the world, but has become less common in countries where women routinely get Pap tests. Today, one in 135 women in the US will develop cervical cancer in her lifetime.

What is Cervical Cancer?

Almost all cervical cancers are linked to a common infection in the cervix called human papillomavirus (HPV).

Of the more than 100 types of HPV, many are benign, but some are linked to cancer of the cervix.

Who is Most at Risk?

Women with certain strains of HPV
Women over age 30. While it can occur in younger women, cervical cancer rarely occurs in women younger than age 21
Women who smoke are about twice as likely as nonsmokers to develop cervical cancer
Women who have problems with their immune system
Women with the human immunodeficiency virus (HIV) infection
Women who were exposed to diethylstilbestrol (DES) before birth
Women with a previous precancer of the cervix

Get regular Pap tests—they can detect cervical changes before they become cancerous
Girls and women ages 9 – 26 should get the HPV vaccine. ACOG recommends the HPV vaccine be routinely given to all girls ages 11 – 12; however, it can be given to girls as young as 9
Be monogamous and practice safe sex
Don’t smoke

What are the Warning Signs of Possible Cervical Cancer?

Abnormal vaginal bleeding
Spotting or discharge
Bleeding after sex
Signs of advanced cancer include pain, problems urinating, and swollen legs

The Pap test is the best way to detect abnormal cells on the cervix. Sexually active women between the ages of 21 and 29, and those younger than 21 who have been sexually active for at least three years, need an annual Pap test
ACOG recommends that women over 30 who have had three or more normal annual Pap tests can be screened every 2 – 3 years
Other options include combining a Pap test with an HPV test to see if you have a highrisk type of the virus, or continuing to be tested annually
Slightly abnormal Pap results may be followed up by an HPV test, a repeat Pap test, or colposcopy, which uses a magnifying instrument to view and biopsy abnormal cells. Pap tests that are more abnormal require colposcopy
Many women who have had a hysterectomy may be able to discontinue routine Pap testing. Pap testing can be discontinued if the surgery removed the cervix and was done for reasons other than cancer or precancerous changes. Women who had precancerous changes before their hysterectomy should be screened annually until they have three consecutive, normal Pap tests; then they can discontinue routine screening

Precancers can be removed with a LEEP biopsy (loop electrosurgical excision procedure), which uses an electrified loop of wire to remove cells, cryotherapy (which freezes the cells), laser therapy (which vaporizes the cells), or a cone biopsy (in which a cone shaped wedge is removed from the cervix)
Cervical cancer may require a radical hysterectomy and radiation with or without chemotherapy.

When found early, the cure rate is more than 90%

What You Should Know About Colorectal Cancer

Colorectal cancer is the No. 2 cancer killer of adults in the US and the third leading cause of cancer death among women in the US, behind lung and breast cancers. Each year, colorectal cancer takes the lives of over 26,000 women—nearly twice as many as ovarian, cervical, and uterine cancers combined. One in 18 women will develop colorectal cancer in her lifetime.

What is Colorectal Cancer?

Colorectal cancer (often referred to as colon cancer) is a slow-growing cancer that affects the cells in the colon and rectum and can spread to other parts of the body. Its exact causes are unknown.

Who is Most at Risk?

The risk of developing colorectal cancer increases with age. About 9 out of 10 people with colorectal cancer are older than 50. Obesity is also a major risk factor.

Personal or family history of colon polyps or colorectal cancer
Personal history of inflammatory bowel disease, such as ulcerative colitis or Crohn’s disease
Family history of colorectal cancer syndromes
The American College of Gastroenterology recommends that African Americans begin screening at age 45

What Should I Know about Screening for Colon Cancer?

Colon cancer can be stopped before it starts if precancerous polyps are found and removed. Screening allows the detection of early colon cancer, when it is highly curable. ACOG recommends the following colorectal cancer screening options for women age 50 and older:

Colonoscopy every 10 years

Yearly patient-collected fecal occult blood test (FOBT) or fecal immunochemical test (FIT) or
Flexible sigmoidoscopy (with or without annual FOBT or FIT) every five years or
Double-contrast barium enema every five years

If abnormalities are found with these tests, diagnostic colonoscopy will be necessary. A biopsy will determine if you have cancer.

What are the Warning Signs of Possible Colon Cancer?

A persistent change in bowel habits, such as narrowing of the stool
Bleeding from the rectum or blood in the stool
Cramping pain in the abdomen
Unexplained weight loss
Fatigue

Is My OB-GYN the Right Person to Talk to about Colon Cancer?

For many women, an OB-GYN is the only physician they see on a regular basis. Your OB-GYN can provide counseling and appropriate screening recommendations, including when to begin screening and the benefits, limitations, and frequency of the different testing options.

Control your weight
Exercise regularly
Stop smoking
Limit your alcohol intake

How is Colon Cancer Treated?

Surgery is the most common treatment for colorectal cancer.

Chemotherapy or radiation therapy also may be used.

What You Should Know About Lung Cancer

Lung cancer is the leading cause of cancer death in both women and men in the US. One in 17 women will develop lung cancer in her lifetime. This year alone, it is estimated that over 98,000 women will be diagnosed with lung cancer; it will kill nearly 71,000 women.

Women who smoke are 12 times more likely to get lung cancer than women who have never smoked
Women are more susceptible to lung cancer than men
Secondhand smoke also increases your risk of lung cancer
More nonsmoking women are getting the disease than ever before:

About 1 in 5 women who gets lung cancer never smoked.

How Can I Prevent Lung Cancer?

The best way to protect yourself from lung cancer is not to smoke. ACOG urges women who smoke to seek advice on how to stop. In addition, smokers who quit can stop or reverse the damage caused by cigarettes. Heart attack risk decreases by 50% within the first year after quitting, and the chances of developing lung cancer, heart disease, and other ailments fall to nearly that of a nonsmoker in the first few years.
What are the Warning Signs of Possible Lung Cancer?

A persistent cough
Phlegm streaked with blood
Chest pain
Repeat bouts of pneumonia or bronchitis
Hoarseness
Weight loss and loss of appetite
Shortness of breath or wheezing

What Should I Know about Screening for Lung Cancer?

There are currently no recommended routine screenings for lung cancer. Those that do exist have not been shown to be effective. Many tests are used to diagnose lung cancer, including blood tests, imaging tests, and biopsies.

Is My OB-GYN the Right Person to Talk to about Lung Cancer?

For many women, an OB-GYN is the only physician they see on a regular basis.
Your ob-gyn can refer you to smoking cessation programs that can help you quit and can provide lifestyle recommendations that can decrease your risk of developing lung cancer. Your doctor also may prescribe nicotine replacement products and/or medications that can double your chances of quitting.

What is Lung Cancer?

Cancers that begin in the lungs, usually in the cells lining air passages, are divided into two main types—non-small cell lung cancer and small cell lung cancer, depending on how the cells look under a microscope.

A woman who smokes cigarettes shortens her life by 14.5 years
Lung cancer is the only major cancer that’s not on the decline in women
Secondhand smoke is responsible for an estimated 3,000 lung cancer deaths among US nonsmokers each year
Smoking can harm a woman’s reproductive health. Women who smoke are at increased risk of having fertility problems, pregnancy-related complications, cervical cancer, incontinence, and earlier menopause
Smoking during pregnancy is associated with preterm birth, low birth weight, and sudden infant death syndrome

How is Lung Cancer Treated?

Treatment depends mainly on the type of lung cancer and its stage. Options include surgery, chemotherapy, radiation therapy, or a combination of these; they often do not cure the cancer.

What You Should Know About Ovarian Cancer

About 3% of all new cancers found in women are ovarian cancers. One in 68 women will develop ovarian cancer during her lifetime. Because its symptoms are so vague, ovarian cancer often isn’t found until the late stage, after the cancer has spread.
What is Ovarian Cancer?

Epithelial is the most common form of ovarian cancer (85% to 90% are this type); these are the cells that cover the surface of the ovaries
Germ cell tumors form on the cells in the ovary that develop into eggs
Sex cord-stromal tumors occur in the connective tissue inside the ovary

Reducing the number of ovulations you have in your lifetime reduces your risk for ovarian cancer. Therefore, pregnancy and breastfeeding may have protective effects
Using oral contraceptives also reduces your risk for ovarian cancer and is often recommended for women who are at high risk for developing hereditary breast and ovarian cancer
If you have a BRCA gene mutation a cancer specialist can help you decide if preventive measures, such as surgery to remove the ovaries or a hysterectomy, are right for you
Also, be alert to changes in your body and bring them to your doctor’s attention

What are the Warning Signs of Possible Ovarian Cancer?

Unexplained bloating
Pelvic or abdominal pain
Back pain
Increased abdominal size
Difficulty eating
Unexplained weight loss
Urinary incontinence
Frequent urination
Constipation
Fatigue
Indigestion

What Should I Know about Screening for Ovarian Cancer?

While there is no routine screening for ovarian cancer, for those who experience symptoms, have a family history, or who have a BRCA gene mutation, a pelvic exam and an ultrasound are used for evaluation. Surgery is used to diagnose ovarian cancer.

How is Ovarian Cancer Treated?

Surgery is used to remove the cancer, often followed by chemotherapy or radiation. Women whose cancer is treated before it has spread have a 90% chance of living five years or more after treatment. Unfortunately, only 19% of women with ovarian cancer are diagnosed at this stage.

Women who have never had children or who were pregnant after age 30
Women who have never used birth control pills
Women with a family history of breast, endometrial, ovarian, or colorectal cancers, or who carry a mutation in the BRCA1 or BRCA2 genes
Women between ages 50 and 75
Women who experience late menopause (after age 55)
Women who are obese

What You Should Know About Uterine Cancer

Uterine cancer is the most common gynecologic cancer in the US. About 2 or 3 women in 100 will develop endometrial cancer (the more common of the two forms of uterine cancer) in their lifetime.

What is Uterine Cancer?

Endometrial the more common form of uterine cancer; it occurs when the lining of the uterus becomes too thick
Sarcomas tumors that form from muscle or other tissue; it is more aggressive than endometrial cancer and has different symptoms

Women who have passed menopause, particularly from age 65 to 70; it is rare among women younger than 40
Women who are obese
Women who are infertile or have menstrual problems such as irregular ovulation or frequently missed periods
Women with a family history of uterine cancer
Women who have never given birth
Women who have polycystic ovary syndrome, diabetes, endometrial hyperplasia, or who have had cancer of the ovary, breast, or colon
Women who have taken unopposed estrogen (estrogen without progestin)
Postmenopausal women who have taken tamoxifen
Women who went through puberty early (before age 12) or menopause late (after age 55)

How Can I Prevent Uterine Cancer?

Avoid prolonged exposure to unopposed estrogen (estrogen without progestin)
Use of oral contraceptives may reduce your risk
Lose excess weight
Get a yearly pelvic exam

What Should I Know About Screening for Uterine Cancer?

There is no routine screening for uterine cancer, so it’s crucial to be alert to early symptoms.

Unusual vaginal bleeding
Spotting or discharge
Heavy menstrual bleeding
Postmenopausal bleeding or spotting
Symptoms that come and go
Abnormal bleeding or discharge, especially after menopause

Endometrial cancer can be diagnosed only by examining tissue from the uterus: Most women with endometrial cancer have normal Pap test results
There are various methods for examining the uterine tissue, including:
Endometrial biopsy: a test in which a small amount of the tissue lining the uterus is removed and examined under a microscope
Vaginal ultrasound: a test in which sound waves are used to check the thickness of the lining of the uterus
Hysteroscopy: a surgical procedure in which a slender, light-transmitting device is used to view the inside of the uterus or perform surgery
Dilation and curettage (D&C): a procedure in which the cervix is opened and tissue is gently scraped or suctioned from the inside of the uterus

Surgery is done to treat the disease and decide if further treatment is needed. During the surgery, the stage of disease is determined, which can affect the treatment and outcome
Most patients have both a hysterectomy and removal of the ovaries and fallopian tubes, known as salpingo-oophorectomy, because women with uterine cancer have an increased risk of ovarian cancer
Some cases may also require radiation; in rare cases, chemotherapy is used
Treatment with progestin may be tried in women who want to preserve their fertility or who are not candidates for surgery

Age/Schedule Recommendations
20+ Breast Exam‡ Breast Cancer Yearly
21+ Pap Test & Cervical Cancer Yearly
30+ Pap Test Cervical Cancer Yearly or every 2 – 3 years if Pap tests have been normal
40+ Mammography‡ Breast Cancer Every 1 year
50+ Colonoscopy‡° Colorectal Cancer Every 10 years

* There are no screening tests available to detect lung, ovarian, or uterine cancer, so it’s important to be aware of the warning signs and see your doctor if you experience them. Warning signs for each cancer are listed on previous fact sheet pages.

‡ If you have a family history of breast or colon cancer, your doctor may recommend starting screening earlier and continuing screening more frequently.

? The Pap test is recommended for women about three years after first sexual intercourse or by age 21, whichever comes first.

° Other options for colorectal cancer screening are available, but they need to be done more often.

Cancer Prevention Behaviors to Undertake

Type of Cancer Prevention Activities

Exercise regularly and eat a balanced diet
Control your weight
Limit your alcohol intake
Discuss the use of hormone therapy, as well as tamoxifen and raloxifene, with your doctor

Get regular Pap tests
Girls and women ages 9 – 26 should get the HPV vaccine
Be monogamous and practice safe sex
Stop smoking

Undertake colonoscopies starting at age 50 (earlier if you have risk factors)
Control your weight
Exercise regularly
Stop smoking
Limit your alcohol intake

Stop smoking
Limit your exposure to secondhand smoke

Be aware of symptoms
Consider using oral contraceptives
Pregnancy and breastfeeding may also have protective effects

Avoid prolonged exposure to unopposed estrogen (estrogen without progestin)
Consider using oral contraceptives
Control your weight
Get a yearly pelvic exam

Easy Reference

Cancer Screening Methods and Recommendations

The annual well-woman visit is very important for preventive health care. Sexually active adolescents younger than 18 and all women 18 or older need annual gynecologic exams, including a pelvic exam.

Your Personal Cancer Risk Assessment
Following is a list of questions important for women to consider throughout the stages of their lives.
Use this information to help launch meaningful discussions with your doctor at your next OB-GYN visit.

Have you ever been diagnosed with any type of cancer?
Have you ever been diagnosed with benign breast disease that resulted in a breast biopsy?
Do you have a family history of cancer in a first-degree blood relative (mother, sister, daughter, or father)?
Do you have any other relatives with a history of breast, ovarian, endometrial, or colorectal cancer?

Do you perform regular breast self-exams?
If you are 40 – 49, did you get a mammogram in the past two years? Or in the past year, if you are over 50?
Are you getting regular Pap tests?
Did you have a pelvic exam in the past year?

Have you ever had an abnormal Pap test?
Have you ever been diagnosed with human papillomavirus (HPV)?
Do you smoke?
Have you taken tamoxifen postmenopause?
Do you carry the BRCA1 or BRCA2 genes?
Did you experience a late menopause (after age 55)?
Have you ever had ulcerative colitis or Crohn’s disease?
Do you usually drink more than one alcoholic drink per day?

Do you have regular periods?
Did you get your first period after age 12?
Do you practice safe sex?
Do you take birth control pills?
Have you given birth? If so, was your first pregnancy before age 30?
Do you eat fruits or vegetables often?
Do you exercise regularly?

Conclusion
(ACOG) urges women to take charge of their health. It’s important to know that there is a great deal you can do to prevent and detect cancer early, which will have a lasting impact on your life and on your family. Make sure you visit your OB-GYN for an annual exam and the screenings appropriate for your age. Be sure to discuss your family history, your specific risk of developing cancer, and the lifestyle changes that you may be able to make to reduce that risk. Also, know your body and be alert for any changes that may be warning signs.

ACOG recommends that this guide be used both to deliver the facts about cancer to women and as a vehicle for building a strong partnership with your OB-GYN. Bring this guide with you as a reference to your doctor’s appointment and work together to prevent and detect cancer. Be informed, be healthy.

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