Besides physical damage, cancer induces tremendous psychological harm for patients. And when the patients are women, the devastation tends to reach further due to their central role in the family and society, said Dr. Jeremie Arash Rafii Tabrizi, assistant professor of genetic medicine in obstetrics and gynecology at WCMC-Q, who recently delivered a lecture on Women and Cancer as a part of the college’s Medicine and U lecture series.
Gynecologic cancers—cancers that affect women only—are defined by the uncontrolled growth and spread of abnormal cells originating in the female reproductive organs: the cervix, ovaries, uterus, fallopian tubes, vagina, and vulva.
“Every woman is at risk for developing a gynecologic cancer, Dr. Rafii Tabrizi said, “This year, over 78,000 women in the United States will be diagnosed, and over 28,000 will die from gynecologic cancer—and the numbers, percentage-wise, are similar in the Middle East.”
Many factors cause gynecologic cancers—all falling under the classifications of environmental or hereditary/genetic. Medical research has revealed that some classes of genes, called oncogenes and tumor suppressor genes, promote the growth of cancer. Most gynecological tumors appear at a relatively young age, and the most frequent are cervical, endometrial and ovarian cancers.
Gynecologic cancers are treated by using one or more of the following methods: surgery, radiation therapy or chemotherapy. The choice of therapy depends on the type and stage of the cancer. Treatment is long and often associated with complications.
“As we start understanding these diseases, we can screen and encourage regular self-examinations that can result in the detection of certain types of gynecologic cancers at earlier stages,” Dr. Rafii Tabrizi said. “At earlier stages, treatment is more likely to be successful and a complete cure is a possibility.”
Almost all cervical cancers and some cancers of the vagina and vulva are caused by a virus known as Human Papillomavirus (HPV), Dr Rafii Tabrizi explained. Understanding this fact alone helps researchers zero in on targets for prevention.
Cervical cancer is cancer that begins in the cervix, which is the lowermost part of the uterus. It usually affects women between the ages of 30 and 55. Worldwide it is estimated that there are 473,000 cases of cervical cancer, and 253,500 deaths per year. It is the only gynecologic cancer that can be detected with regular screening, which includes a Pap test. And a new vaccine to prevent cervical cancer was approved by the FDA in June 2006.
“For the first time ever, we have a tool to prevent cancer,” Dr Arash said.
Ovarian cancer is the seventh most common cancer among women, yet, because it is difficult to detect and so often diagnosed at late stages, it has a very high mortality rate, Dr. Rafii Tabrizi said. Approximately one quarter of ovarian cancer deaths occur in women between 35 and 54 years of age. The risk of ovarian cancer increases with age, increasingl markedly around the time of menopause.
A more detectable type of gynecologic cancer, endometrial cancer, often begins in the lining of the uterus, or endometrium. This cancer emerges when the endometrium grows out of control and invades the muscle of the uterus and, if unchecked, other places in the body. Risk factors include obesity, hypertension, diabetes, estrogen use without progesterone taken at the same time, tamoxifen use and late menopause. Most endometrial cancers are found in the early stages when women report symptoms of abnormal bleeding to their doctor and have a biopsy that shows the cancer.
“Exercising regularly, eating a healthy diet and maintaining a healthy weight all can lower a woman's risk of getting uterine cancer,” Dr. Rafii Tabrizi advised.
An emerging health threat for women around the world, cancer among women accounts for hundreds of thousands of deaths each year and leaves families without wives, mothers, and daughters. Beside the medical aspects of these cancers, Dr. Rafii Tabrizi emphasized their particular impact on society.
He discussed consequences regarding the occurrence of these cancers on a personal and societal level, including the trauma patients face—often years after treatment—and how families cope.
“The perception of cancer is different in each society,” Dr. Rafii Tabrizi said. “In the Middle East in particular, the diagnosis of any cancer is associated with a high level of anxiety—and it is often viewed as having a shameful disease.” The loss of fertility related to cancer treatment also can have a significant impact on women and their families, he said.
In the Middle East, the woman’s role is central within the family; therefore, any long chronic disease can threaten the family equilibrium, Dr. Rafii Tabrizi said. This can have significant impact on children, their life and their focus on education.
“Doctors have to take in account the social and cultural aspect when approaching cancer in woman in the Middle East,” he said. “As the level of care is increasing and patients are offered more sophisticated treatments, we want to share this as efficiently and broadly as possible throughout the region.”
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