Early Detection is Great Cancer Prevention: Women's Issues I

From the desk of the Executive Director, RI Cancer Council, Inc. Arvin S. Glicksman, M.D.
April 2000

Regular screening for some cancers can lead to curative treatments even before the disease has been established. Fifty years ago cancer of the cervix was one of the lead causes of cancer deaths in young women. With the introduction of the Papanicolaou Test (Pap Test) a simple examination and smear of the lining of the cervix was able to detect cancer cells even before a visible, invasive cancer had formed. With yearly Pap smears, the cancer deaths from cervical cancer has plummeted and now, with more sophisticated laboratory support, we can eliminate invasive cancer of the cervix completely. Women who are sexually active should have a Pap smear once a year even after they stop having babies. The annual visit to the gynecologist not only can detect pre-invasive cervical cancer, but any other potentially malignant change around the vulva and vagina would also be detected. Even more important, a pelvic examination at the time of the Pap smear by a gynecologist is the only reliable method we have of detecting early ovarian cancer. At this time, a blood test, CA-125, is still not established as a screening tool for ovarian cancer. Therefore, the annual pelvic exam is our first line of defense in this silent killer which now is the leading cause of death of gynecological cancers. Women with a family history of ovarian cancer and breast cancer are at the highest risk and need to be especially concerned.

Women have been advised to do regular breast self-examination for over a generation, particularly to know the consistency of their breasts so that any alteration could be called to the attention of their physician. In this way, small lumps, sometimes less than an inch in size, could be found. Most of these turn out to be benign cysts but a significant number may be early breast cancer and in these cases, surgery proved to be successful treatment in a large percentage of cases. Thus, it has been established that early breast cancer can be cured, more so than advanced cases, many of which have already spread to the lymph nodes and beyond by the time they are diagnosed.

In the early 1960s, a study was done in New York using a newly introduced x-ray procedure of the breast which demonstrated that very small lesions, not yet palpable, could be detected and those cases had an even better chance for cure. This HIP study was confirmed by a large national study called "The National Breast Demonstration Project." Since the 70's, improved and refined mammography has proven to be one of the most effective cancer detection programs in medicine. Many very early cancers can be detected which require only local excision without significant deformity. Post-operative radiotherapy is frequently but not always required. Improved surgical techniques are now available to sample the lymph nodes in the axilla without the prospect of shoulder problems, swelling of the arm, or other post-operative complications and over the last ten years, the survival rate for breast cancer has continued to improve. For more advanced cases chemotherapy may be required. In many cases the addition of Tamoxifen improves the chances of remaining cancer free not only in the operated breast but in the other breast as well.

Who should have mammograms? All women should start their mammography examinations at age 40 and repeat studies should be performed annually. Women at high risk should start their mammography program before the age of 40. These include women with a family history of breast cancer, particularly mothers, sisters, grandmother. Women over the age of 65 should continue to have mammograms although it may not be as necessary to have one every year, but they should be done at regular intervals for the rest of their lives.

It is important for women to perform breast self-examination regularly as a component of their breast health program. Small, early cancers can be found between the annual mammograms in a substantial number of instances.

A small number of mammograms can miss a cancer and this has been estimated at under 10% of all studies. Even the best and most expert mammography specialist will have a small number of "false negatives." Another aggravation women have to contend with is a slightly larger number of "false positives" where they are asked to come back for a second study or a biopsy is performed which turns out to be perfectly normal. This is aggravating but not life-threatening. Research is underway using MRI techniques rather than x-ray. If these studies prove useful, the prospect of a smaller number of false positives and false negatives can be expected and with the added blessing of a more comfortable examination for women.

For more information and answers to specific questions contact the Rhode Island Cancer Council at maureen@ricancercouncil.org or call us at (401) 728-4800 or toll free 866-879-4100.

IT IS EASIER TO PREVENT CANCER THAN TO TREAT IT.

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