Most women assume that ovarian cancer is the most common gynecologic cancer. They are surprised when I tell them that uterine cancer – also known as endometrial cancer – is actually the most common gynecologic malignancy and the fourth most common cancer in women.
The reason uterine cancer is not the first to come to mind is that, unlike ovarian cancer, most uterine cancer is diagnosed in its early stages so relatively few women die from it. The five-year survival rate for women diagnosed when their cancer is still in stage I is 96%. That’s why it is so important to evaluate abnormal bleeding sooner rather than later so that if a cancer is present it will be diagnosed in its earliest, most curable stage.
In a premenopausal or perimenopausal woman, abnormal bleeding is anything that varies from a normal monthly flow. Heavy bleeding, constant spotting or irregular cycles may all indicate a problem. Any bleeding in a postmenopausal woman should be evaluated. The overwhelming majority of abnormal bleeding is not an indication of uterine cancer, but still needs to be checked out.
The only thing better than early detection of uterine cancer is to prevent it from developing in the first place. Since most uterine cancer is caused by an excess of estrogen compared to progestin, this is a potentially preventable cancer. Here are five steps that may dramatically reduce your risk:
1. A Pill a Day…
The use of birth control pills for at least 12 months decreases the risk of uterine cancer by a whopping 50-80 percent. This protection lasts for 15 years after pill use is discontinued.
2. Choose an IUD
You may be familiar with an intrauterine device as a method of contraception, but the progestin in the Mirena ™ IUD also has a number of non-contraceptive benefits. A little known fact is that the Mirena ™ IUD decreases the risk of hyperplasia (an abnormal thickening of the uterine lining), which in many cases is a precursor to uterine cancer.
3. Question Your Kin
If you have multiple family members with colon cancer and/or uterine cancer, genetic testing could be lifesaving, not only for you, but also for your entire family. Carriers of hereditary nonpolyposis colorectal cancer, known as Lynch syndrome, have a 27-71% chance of developing uterine cancer as opposed to the 3% in the general population.
4. Lower Your Weight to Lower Your Risk
Fat cells produce estrogen, so obese women are at an increased risk for uterine and breast cancer. Higher BMI not only increases the rate of developing endometrial cancer, but is associated with an increased death rate as well.
5. Pick Your Progestin
It has been known since the 1970s that taking estrogen therapy without adequate progestin increases the risk of uterine cancer almost tenfold. If you are taking estrogen for relief of menopausal symptoms (and have a uterus), it is crucial to take an appropriate progestin to protect the lining of the uterus. “Bioidentical” progestin creams have not been shown to offer adequate protection in spite of claims by compounding pharmacies. The progestin molecule is too large to be absorbed through the skin, which is why all the FDA-approved progestins are in pill form. (Note: A progestin is not necessary if you are using vaginal estrogen.)