The Doc­tor Is In

Pro­tect your uterus.

Prevention (USA) - - CONTENTS - BY LAU­REN STRE­ICHER, M.D.

Breast and ovar­ian can­cers take cen­ter stage in the news, but uter­ine can­cer is ac­tu­ally the most com­mon gy­ne­co­logic one. In fact, over­all it’s the fourth most com­mon can­cer in women, re­sult­ing in hys­terec­tomy and of­ten ra­di­a­tion and chemo­ther­apy. And alarm­ingly, over the last 15 years, while rates of colon, lung, and other can­cers have de­creased, uter­ine can­cer rates have in­creased by 12%.

There are a num­ber of rea­sons for this, but the big­gest cul­prit is obe­sity (40% of women in the U.S. are now obese). Obese women are two to four times more likely to de­velop uter­ine can­cer than those at a healthy weight. Fat cells make es­tro­gen, and an over­load of es­tro­gen can re­sult in an ab­nor­mal buildup in the lin­ing of the uterus. That, in turn, can lead to the de­vel­op­ment of ab­nor­mal cells.

But it’s not just fat cells that can cause a hor­monal im­bal­ance.

Nor­mally, ovu­la­tion trig­gers the pro­duc­tion of pro­ges­terone, which pre­vents the uter­ine lin­ing from get­ting too thick. If a woman isn’t ovu­lat­ing (for ex­am­ple, if she is per­i­menopausal or has poly­cys­tic ovar­ian syn­drome), the lin­ing of the uterus gets blasted with es­tro­gen, but there’s no pro­ges­terone to bal­ance it out.

Uter­ine can­cer is highly cur­able if de­tected early. Fiveyear sur­vival rates for women di­ag­nosed when the can­cer is Stage I are over 90%. But Black women and those in other non-Cau­casian racial/eth­nic groups who have this can­cer are ap­prox­i­mately twice as likely to die from it, be­cause it tends to be de­tected in them at a later, less treat­able stage.

An im­por­tant thing to watch for: any ab­nor­mal bleeding. Ninety per­cent of women with uter­ine can­cer re­port that they’ve had that symp­tom. In a pre­menopausal or per­i­menopausal woman, this

means any­thing that varies from a nor­mal monthly flow, whether it’s heavy bleeding, spot­ting, or ir­reg­u­lar cy­cles. And any bleeding in a post­menopausal woman should be eval­u­ated. The over­whelm­ing ma­jor­ity of ab­nor­mal bleeding is not an in­di­ca­tion of can­cer, but it still needs to be checked out as soon as pos­si­ble.

The num­ber one thing you can do to re­duce your risk: Get to a healthy weight. Ex­er­cise (any type of move­ment) also helps, as do these tac­tics:

CHOOSE AN IUD

Those that con­tain pro­gestin sig­nif­i­cantly de­crease the risk of uter­ine pre­can­cers and can­cers.

USE HOR­MONAL BIRTH CON­TROL

Us­ing birth con­trol pills and other hor­monal con­tra­cep­tives for at least one year de­creases the risk of uter­ine can­cer by a whop­ping 50% to 80%. This pro­tec­tion may last up to 30 years af­ter you stop.

PICK YOUR PRO­GESTIN

If you’re tak­ing oral or trans­der­mal es­tro­gen for re­lief of hot flashes (and you have a uterus), it’s cru­cial to take an ap­pro­pri­ate pro­gestin. (This isn’t nec­es­sary if you’re us­ing a lo­cal vagi­nal es­tro­gen.)

CON­SIDER YOUR GENES

If you have mul­ti­ple fam­ily mem­bers with colon can­cer and/or uter­ine can­cer, talk to your doc­tor about ge­netic test­ing. Your fam­ily may carry a Lynch mu­ta­tion, with which there’s a 20% to 51% risk of de­vel­op­ing uter­ine can­cer.

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