cancer, women, cervix, carcinogen, cancer prevention,

1. DR R.N.SATPATHY

2. Risk factor- is anything that increases the chance
of developing a disease- cancer.

3.  Age related
 Sex related
 Prolonged exposure to documented risk factors
such as.
 Tobacco use, diet, infections (STD), Obesity, Diabetes
 Environmental Oncogenes
 Menopause and perimenopause.
 Endogenous
 HRT and its oncogenic potential
 Drug abuse- Clomiphene, Oestrogen
 Ethnicity and Genetic

4. Organ Specific Cancers Average age
 CANCER CERVIX PERIMENOPAUSAL 50 YRS
 OVARIAN CANCERS PERIMENOPAUSAL 54 YRS
 ENDO. CARCINOMA POSTMENOPAUSAL 58 YRS
 VULVAL CARCINOMA POSTMENOPAUSAL 70 YRS
 VAGINAL CARCINOMA POSTMENOPAUSAL 62 YRS
THE PEAK INCIDENCE OF GYNAECOLOGICAL CANCERS IS NOTICED IN
PERI AND POSTMENOPAUSAL WOMEN MAKING THEM AT RISK GROUP
FOR DISEASES AND THEIR MANAGEMENT

5.  Cancer Breast Peak- 50s, 2nd Peak 65-69
Yrs
 Colorectal Cancer Perimenopausal 50 Yrs
 Pancreatic Cancer Perimenopausal 50 Yrs
 Bladder Cancer Postmenopausal > 50Yrs

6. Persons above 60 years suffer from
 75% of all multiple myelomas
 61% of all leukemias
 60% of Non-Hogkin’s Lymphomas
 58% of all buccal cavity and pharyngeal
cancers

7.  Changing incidence of different cancers in
different countries.
 UK/US- Increase in Ovarian cancer, less in Ca.
Cx.
 India- cervical cancer incidence is high, EC on
rise.
 In developed world incidence of Cancer cervix is
falling due to mass screening.
 More common in elderly women and will be more
apparent in future as aged population are on
rise.
The more we live the more we are liable to acquire
Pattern of Gynaecological Cancers

9.  Menopause beyond 55 yrs ( menarche < 12 yrs)
 Increased risk of
 Endometrial Cancer (three fold)
 Ovarian cancer
 Breast cancer
 Bladder cancer
 Longer menstrual life- more oestrogen exposure
 More risk of development of breast and uterine
cancer
 Long menstrual life- more number of ovulation
 Increased Ovarian cancer risk-Obstet Gynecol-2001
Risk of death from uterine & ovarian ca. is increased by 5%
with late menopause. -Epidemiology- 2005

11.  Absolute Progesterone lack with relative
oestrogen excess.
 Endometrial hyperplasia- Spectrum
 Oestrogen deficiency
 Prolonged and persistent Oestrogen,
progesterone and Androgen deficiency

12.  Obesity and adult weight gain- Breast cancer in
menopausal women.
 Weight loss and maintenance of it from 18yrs till
menopause reduces risk of breast cancer.
-Cancer Epi Bio-2005
 Excess weight > 200 pounds is a risk factor for
EC
 Obesity ( extra weight at waist area) is a risk
factor for colorectal cancer.
 Obese women- Increased oestrogen- more risk
Healthy weight- lower risk of breast, colon, renal & EC
- Havard Center for cancer prevention-2004

14.  Drugs commonly used are
 HRT- Oestrogen alone or with progesterone
 Soy Isoflavone
 Tamoxifen
 Raloxifene
 Clomiphene

15.  HRT reduces risk of colon cancer-Reason?
 Short term use < 5 yrs risk is relatively low.
 OCP use > 5yrs lowers risk of colon, uterine and
ovarian cancer, but breast cancer risk increases
 Debate- Unsolved issues
 Duration vs Dose of oestrogen therapy
 Duration of oestrogen-progesterone therapy
 Type of oestrogen-progestin regimen
 Use of more than one type of HRT
 The form of oestrogen administration

16.  Soy Isoflavone
 Protective effect against breast cancer- because of anti
oestrogenic action ???
 Tamoxifen
 Lower the risk of breast cancer
 Increased risk of uterine cancer
 Raloxifene
 May lower the risk of breast cancer
 Clomiphene
 Increased risk of Ovarian cancer

18.  Cancer Cervix
 Reduction of risk factors, safe and responsible sex
 VI/ Pap smear from reproductive age till menopause
 Breast Cancer
 BSE, CBE, Mammography, healthy diet more fruit, veg, fiber
 Ovarian Cancer
 Clinical, USG, CA-125 ??, Avoid prolonged use of clomiphene
 Endometrial Cancer
 Weight reduction, Control of Diabetes etc. Restricted HRT
 Colorectal Cancer
 Weight reduction, Maintaining healthy diet ( low in fat and high in
fiber), Removing benign polyp before it becomes malignant .

19.  Menopause itself does not increase the risk of
cancer, but menopausal woman is at higher risk
of acquiring many cancers.
 Associated factors are responsible in these areas.
 HRT for prolonged use should be avoided ?
 Diet rich in fiber, vegetables, fruits and low in fat
is preferred to prevent some cancers.
 Tobacco in any form should be avoided
 Safe, hygienic and responsible sex with limitation
of family size will see cancer free menopause.
 Life style modification.
 As we live, so is our cancer.