Today s Woman Staying Healthy

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1 Today s Woman Staying Healthy Risk Factors and Warning Signs for Women s Cancers Women s Cancer Research Institute at the Samuel Oschin Comprehensive Cancer Institute

2 WHAT IS A GYNECOLOGIST, AND WHAT DOES HE/SHE DO? A gynecologist is a doctor who takes care of women and their bodies. The gynecologist is a resource for you to talk about women s issues, including the following: Birth control Menopause Menstruation Osteoporosis Pelvic pain Pregnancy Reproductive cancers Sexuality HOW OFTEN SHOULD I SEE MY GYNECOLOGIST? If you are 18 years or older, you should see a gynecologist every year to stay healthy. You should see a gynecologist at a younger age if you become sexually active before you are 18. If you suspect you have a female problem, you should call your gynecologist to schedule an appointment. WHAT ARE THE WOMEN S CANCERS THAT GYNECOLOGISTS CAN OFTEN DETECT? Gynecologists perform yearly examinations to assess for cancers of the breasts, cervix, fallopian tubes, ovaries, uterus, vagina and vulva. More than 250,000 thousand women are diagnosed with breast or gynecologic cancer each year. Breast cancer is the most common women s cancer. One in eight women in the United States will get breast cancer during her lifetime.

3 WHAT ARE SOME TESTS THAT ARE HELPFUL IN THE ASSESSMENT AND SCREENING OF WOMEN S CANCERS? CA-125 (ovarian cancer) - a blood test for measuring the level of a specific protein that may increase when a tumor is present Dilation and curettage (uterine cancer) - a procedure that scrapes the lining of the uterus (the endometrium) to see if there are cancer cells or other abnormalities Mammography (breast cancer) - an X-ray image of the breast that can detect early tumors Pap smear (cervical cancer) - an examination of cells that have been swabbed from the cervix (or the opening of the womb) to determine if they are normal Surgical biopsy (all of the women s cancers) - removal of a piece of tissue to see if there is cancer or precancer present Transvaginal ultrasound (ovarian and/or uterine cancer) - test in which sound waves create a picture image of a woman s pelvic organs to see if there is a tumor or other abnormal growth No test is perfect, and tests must be evaluated individually by your caregiver. WHAT ARE THE SCREENING RECOMMENDATIONS FOR BREAST CANCER? According to the American Cancer Society (ACS), if you are over 40, you should have a mammogram each year. Between 35 and 40, you should have a baseline mammogram. You should do monthly self-breast exams starting at age 20. You should self-check seven days after menstruation or for postmenopausal women, around the same day of each month. You should also have a clinical breast exam by your physician once a year.

4 WHAT ARE THE SIGNS OF BREAST CANCER? Possible signs of breast cancer include: A painless lump or thickening in the breast (most commonly in the upper, outer quadrant of the breast) Bleeding from the nipple Thickening or puckering of the skin over the breast Unexplained weight loss or gain WHAT ARE THE RISK FACTORS FOR BREAST CANCER? Simply being a woman is a major risk factor for developing breast cancer. Breast cancer can affect men, but it is about 100 times more common in women. One in eight women in the United States will get breast cancer in her lifetime. Other risk factors include: A close relative with bilateral breast cancer (breast cancer in both breasts) A close relative with breast and ovarian cancer Ashkenazi Jewish descent Early age of menarche or late onset of menopause Family history of premenopausal breast cancer (i.e., diagnosed when the person was younger than 50 years old) More than seven alcoholic drinks a week Obesity Personal history of breast cancer in the opposite breast Women who have never been pregnant or who have their first pregnancy after age 30 Discuss your personal risk factors for breast cancer with your gynecologist to see if there are ways for you to reduce your risk.

5 WHAT ARE THE SCREENING RECOMMENDATIONS FOR OVARIAN CANCER? Ovarian cancer is hard to diagnose because none of the current tests are definitive when used on their own. There is no routine screening test for ovarian cancer. Transvaginal ultrasound and CA-125 may be effective, especially when used in combination. However, even these tests can miss ovarian cancers that have spread beyond the ovaries. The only way to confirm a diagnosis of ovarian cancer is through surgical biopsy of the tumor tissue. WHAT ARE THE SIGNS OF OVARIAN CANCER? Ovarian cancer has been called the disease that whispers because symptoms are not specific and often appear only when the cancer is already advanced. Ovarian cancer symptoms may include: Because all women may have some of these signs at some time, notify your gynecologist if these symptoms persist daily or worsen for longer than two to three weeks. Abdominal pain or tenderness Bloating Change in your usual bowel habits, such as constipation or diarrhea Inability to eat normally, especially feeling full quickly Increased frequency of urination

6 Increased size of abdomen/tightness of your clothes Indigestion Irregular or abnormal vaginal bleeding or periods Nausea Postmenopausal bleeding Unexplained weight loss or gain WHAT ARE THE RISK FACTORS FOR OVARIAN CANCER? Risk factors include: Ashkenazi Jewish descent Close relatives with ovarian, peritoneal or fallopian tube cancers or early onset breast cancer Early age at onset of menses Infertility Late onset menopause Never having children Personal history of breast cancer WHAT ARE THE SCREENING RECOMMENDATIONS FOR CERVICAL CANCER? You should have a Pap smear at least one time each year after age 18 or after first intercourse. Birth control pills can reduce the risk of ovarian cancer. Removing the ovaries to prevent ovarian cancer may be recommended if you have a high risk of ovarian cancer. You may be considered high risk if you have a strong family history of cancer. You should discuss this with your gynecologist if you have any questions.

7 WHAT ARE THE SIGNS OF CERVICAL CANCER? Signs may include: Abnormal vaginal bleeding (i.e., after sex, between periods or after menopause) Back pain Blood in urine Pelvic pain Swelling in one leg Unexplained weight loss or gain Often women do not show any symptoms. A Pap smear is the best way to screen for early cervical cancer. Cervical cancer is very curable if caught early. WHAT ARE THE RISK FACTORS FOR CERVICAL CANCER? Risk factors include: Cigarette smoking Early age of first intercourse Human papilloma virus (HPV) infection or genital warts Multiple sexual partners Women who are HIV positive Women who do not get regular Pap smears It is important to talk to your gynecologist about your risk factors.

8 WHAT ARE THE SCREENING RECOMMENDATIONS FOR UTERINE (ENDOMETRIUM) CANCER? There is no routine screening test for uterine cancer. A biopsy of the lining of the uterus (endometrium) may be done in your gynecologist s office. If uterine cancer is suspected, a transvaginal ultrasound may be helpful in detecting an abnormal uterine lining in high-risk women. WHAT ARE THE SIGNS OF UTERINE CANCER? Possible signs of uterine cancer include: Abnormal bloating Abnormal spotting or discharge Abnormal vaginal bleeding (i.e., between periods or after menopause) Pelvic fullness or cramping Unexplained weight loss or gain Uterine cancer is the most common gynecologic cancer in women. A woman s risk increases after the age of 40. WHAT ARE THE RISK FACTORS FOR UTERINE CANCER? Risk factors include: Diabetes Estrogen replacement therapy (without progestins) High blood pressure Infertility Late menopause Long or irregular menstrual cycles Never having children Obesity Tamoxifen use

9 ARE THERE OTHER RECOMMENDATIONS I SHOULD FOLLOW TO MAINTAIN GOOD HEALTH? To help maintain good health, follow these guidelines: Don t smoke Exercise to elevate your heart rate for 30 minutes at least four days a week Get an internist examination at least every three years to screen for other cancers, such as thyroid, colon, lymph node and melanoma Maintain a healthy weight with a low-fat, high-fiber diet Reduce alcohol intake to no more than seven ounces of beer or wine per day Regularly get your cholesterol checked Talk to your physician about a bone density scan to screen for osteoporosis Visit the Women s Cancer Network website ( and complete a survey that will calculate your cancer risks IS THERE ANYTHING ELSE I NEED TO KNOW? You should learn the early warning signs of cancer. Be aware of your body, and take control of your health. If you ever have questions or suspect that something is not normal, do not be afraid to discuss the issue or any health concern with your doctor. You need to take an active role in your health.

10 WHAT IS BRCA? All cancers are genetic, but only a small percentage is related to genetics that are inherited from a person s mother or father. Recently scientists have discovered two genes known as BRCA1 (breast cancer gene 1) and BRCA2 (breast cancer gene 2). All men and women have BRCA1 and BRCA2 genes. These genes normally help to prevent cancer by telling DNA to instruct cells not to grow abnormally. However, some individuals inherit a mutation in BRCA1 or BRCA2 from their mother or father. This inherited mutation may result in the DNA allowing cells to grow abnormally. SHOULD I HAVE GENETIC TESTING TO SEE IF I HAVE AN ABNORMAL BRCA1 OR BRCA2 GENE? Most cases of breast and ovarian cancer are not hereditary. How do you determine if you or the women in your family are at high risk for breast or ovarian cancer? As a first step, you should develop a cancer family tree that outlines you and your relatives and who has cancer. Take the opportunity at your next family gathering to begin researching your family s cancer history. Next, discuss your cancer family tree with your physician to decide whether or not you should be referred for genetic counseling and testing. Using less than a tablespoon of your blood, genetic testing can determine whether there is an error or mutation in your BRCA1 or BRCA2 genes. Genetic testing is generally recommended only for women with a higher than average likelihood of being BRCA1 or BRCA2 carriers. If you have been diagnosed with breast cancer at an early age or with ovarian cancer at any age, you may want to consider BRCA testing.

11 Although genetic testing is done with a simple blood test, what you and your doctor will do with the results may not be clear. Before you consider testing, talk to your gynecologist about your mother and father s family histories to determine if you should see a genetic counselor. HOW CAN I LEARN MORE ABOUT WOMEN S HEALTH AND WOMEN S CANCERS? Cedars-Sinai Medical Center has established the Women s Cancer Research Institute (WCRI) at the Samuel Oschin Comprehensive Cancer Institute to empower women with valuable information to protect them against cancer. The WCRI is committed to eliminating cancer through research, education, early detection and prevention. Physicians and scientists at the WCRI are doing basic science research and clinical trials to learn what causes cancer and how it can be prevented, diagnosed and treated. The results of this research will have wide-reaching implications for all women. The WCRI urges you to know your body and take control of your health. Visit the Women s Cancer Network s website at for a free confidential assessment of your risk for developing gynecologic or breast cancer. Cedars-Sinai s WCRI is also available to you as a local resource. For more information about women s cancers, please contact us at: Women s Cancer Research Institute at the Samuel Oschin Comprehensive Cancer Institute Cedars-Sinai Medical Center 8700 Beverly Blvd. Los Angeles, CA Phone: (310)

12 8700 Beverly Blvd. Los Angeles, CA Phone: (310) LEADING THE QUEST FOR HEALTH 2006 Cedars-Sinai Health System (07/06) Form # CB0049 This brochure was created with appreciation to Jerry Linkin and sons in memory of Barbara Linkin.

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