Below is a brief outline of cancer screenings: what they are, what to expect, and who’s overdue for an appointment.
GYNECOLOGICAL CANCER SCREENING
Gynecological cancers include breast cancer, colon cancer, and cervical cancer, which are screened via pap smear/HPV testing, mammography, and colonoscopy, respectively.
Pap smears, HPV testing, mammography, and colonoscopy are all effective gynecological cancer screening methods, because they meet the basic criteria for testing, which include:
- Natural history of the disease known
- Cost effectiveness
- High sensitivity (a positive result in the person with the disease)
- High specificity (negative result in individuals without the disease)
- Reproducible results
- Screening results in increased survival by early detection
- Well known epidemiology (i.e. population to which test applied)
- Minimal risk
OVARIAN CANCER SCREENING
Currently there are no routine screening tests for the general population, yet many are at risk, including:
- Women over the age of 50
- Those with family histories of the disease
- Those with personal histories of breast cancer
- Women who have never given birth
- Women experiencing infertility
Upwards of 20% of cases are due to genetic mutation, most of these due to BRCA 1 & 2 mutations (screening methods for these mutations are described below).
Detection methods for ovarian cancer have evolved over the years, beginning with the simple (but inconsistent) pelvic examination in the 1800’s. Since then, the following advancements have made diagnosis easier for gynecologists around the world.
- Transvaginal ultrasound: introduced in the early 1990’s by Goldstein, Lebovic, and others
- MRI: The CA 125 was Introduced 1981 by Bast, Knapp, et. al. It has an accuracy of 99% of measurements for those under the age of 35, and 99.7% for those under the age of 65. MRI’s can be elevated in many benign conditions (menstruation, ovulation, early pregnancy, endometriosis, fibroids, adenomyosis, benign ovarian tumors, hydrosalpinx, pelvic inflammatory disease, liver disease, cirrhosis, pancreatitis, pericarditis, colitis, gastroenteritis, peritonitis, autoimmune disease, etc) and other malignant conditions (endometrial cancer, cervical cancer, breast cancer, lung cancer, pancreatic cancer, colon cancer, non-hodgkins lymphoma, etc).
Clearly, there is still a strong need for screening tests and new methods of detection, especially
since Ovarian cancer has a high mortality rate due to late detection (26,700 new cases vs. 14,800 deaths in USA, with no significant improvement in death rates last over the last 20 years). Ovarian cancer poses a lifetime risk ~1/70.
Currently, prevention is the only truly successful strategy, with a hope for successful proteinomics in the future.
OTHER GYNECOLOGICAL CANCER SCREENINGS
- Cervical Cancer: pap smear and HPV testing:
- Breast Cancer: SBE, clinical exam, mammography, sonography, MRI
- Endometrial Cancer: endometrial sampling, D & C, hysteroscopy in individuals at risk
- COLON CANCER: stool testing for occult blood, colonoscopy, virtual colonoscopy
HBOC (BRCA 1 & 2 GENES) TESTING
HBOC testing is the molecular basis for cancer described in the early 1970’s.
The target population for testing includes:
- Classic criteria: Testing when the probability of carrying a genetic mutation exceeds 10% for a positive test (according to the American Society of Clinical Oncology 1996)
- Those descending from Ashkenazi Jewish ancestry
- Birth control pills
- Tubal ligation
- Prophylactic surgery
PRACTICAL ASPECTS IN A MEDICAL PRACTICE
The modern cancer screening practice in gynecology incorporates pap smear, HPV testing, mammography, colonoscopy, transvaginal ultrasound, BRCA testing, etc. Patient education is also critical.