Know what to expect when screening for gynecological cancer and other cancers.
By Maggie Landwermeyer, M.D.
Do you ever wonder what your OB/Gyn provider is looking for at your annual exam each year? Be prepared for your next exam with some comprehensive information on cancer screening.
Cervical Cancer
Cervical cancer is preventable. According to the CDC, every year there are 11,000 new cases of cervical cancer diagnosed in the US, along with 4,000 deaths attributed to this cancer. Cervical cancer is not genetic, it is caused by the Human Papillomavirus (HPV). HPV is a common sexually transmitted infection that many sexually active people have at some point in their life. Most people clear the virus and it doesn’t cause cancer. For those who don’t clear the virus, pap smears can identify pre-cancer early so it can be treated.
Pap smears are recommended to start at 21-years-old and should be performed every three years. At age 30, we recommend co-testing. Co-testing is a pap smear plus testing for the HPV virus to see if it is active. This helps us identify women at risk for cervical cancer. If co-testing results are normal, paps are recommended every five years until age 65. After 65-years-old, if HPV is negative, the risk of cervical cancer is very low.
Currently, it is recommended for women between the ages of 9 to 45. Ask your provider if the HPV vaccine would be helpful for you.
Vulvar and Vaginal Cancers
Many women have the misconception that after they have had a hysterectomy, there is no need to see a gynecologist. During the annual exam, we perform a visual inspection of the vulva and vagina to evaluate for lesions that could be cancerous. These cancers may also be caused by HPV, so anyone with a history of abnormal pap smears or known HPV is at risk. This is another great reason to get the HPV vaccine.
Uterine (Endometrial) Cancer
Endometrial cancer is the most common gynecologic cancer. The American Cancer Society expects around 67,000 new cases of endometrial cancer and 13,000 uterine cancer deaths. It can sometimes be picked up on a pap smear, but more commonly presents as abnormal bleeding–especially in post-menopausal women. It is very important for women of all ages to have any abnormal bleeding (even spotting) checked out by a healthcare professional.
Ovarian and Fallopian Tube Cancers
These cancers are tough for everyone because there really is not a good screening tool available at this time. I’m grouping fallopian tube cancers with ovarian cancer because many cancers that we thought started in the ovary, actually originated in the fallopian tube. These cancers are usually found in an advanced stage because there aren’t many early warning signs. The best we are able to do is identify women who are at risk for developing these cancers from a familial gene. The field of genetics is changing rapidly and there are commercially available tests to see if someone carries a gene that puts them at risk for developing ovarian cancer. If that gene is present, monitoring of the ovaries begins with periodic ultrasound exams, and consideration for ovary removal at a certain age to avoid the development of cancer.
Breast Cancer
Even though this is not technically a gynecologic cancer, gynecologists typically screen for it at yearly exams. According to the CDC, in 2021 there were 272,454 new breast cancers reported in the United States and 42,211 deaths attributed to breast cancer. The good news is that breast cancer is not the death sentence it used to be. Early detection of breast cancer is key through yearly mammograms starting at age 40 and yearly clinical breast exams from your healthcare provider. Additionally, we are learning more about genes that may predispose women to developing breast cancer in their lifetime and can make some decisions based on genetic testing.
Colon Cancer
This is another cancer commonly discussed during the annual gynecologist exam, that is not a gynecological cancer. The current screening recommendations for colon cancer include a colonoscopy at age 45. There are other screening methods for colon cancer that are more convenient than a colonoscopy; including Cologuard, which is a mail-in stool sample test that can identify cancer DNA, Shield, which identifies cancer DNA in the patient’s bloodstream. If there are any genetic risk factors or symptoms, the colonoscopy is the gold standard test to identify colon cancer or precancerous polyps.
Feel free to use this list for your next annual gynecological wellness exam. If it sparks any questions, please contact your health care provider for further guidance.
Maggie Landwermeyer is an Ob/Gyn physician at Hill Country Ob/Gyn in Austin and Dripping Springs.
