Get Well Wednesday: National Minority Cancer Awareness Week

It is National Minority Cancer Awareness Week and Dr. Carol Brown wants you to know exactly what your risk factors are and when its time to see a doctor. She is a board-certified gynecologic oncologist which means her specialty is diagnosing and treating cancers that affects a woman’s reproductive organs.

For more than 25 years, she has used her skills as a surgeon to provide high-quality and compassionate care to women with ovarian, uterine, cervical, and vulvar cancer at Memorial Sloan Kettering Cancer Center, and this year, Dr. Brown serves as the 50^th president of the Society of Gynecologic Oncology.

WHY DOES IT SEEM LIKE CANCER EFFECTS MINORITY COMMUNITIES AT A HIGHER RATE THAN WHITE COMMUNITIES?

People of color, including Asians, Hispanic/Latinos, American Indians and Blacks are affected by some cancers at higher rates than other groups. Blacks in the U.S. have the highest death rate of any racial/ethnic group for lung, colon, breast, prostate and uterine cancer.

The causes of these inequalities are complex, but through research we are learning that biologic differences in the cancer itself may explain many cancer disparities experienced by Blacks and other diverse populations. Socioeconomic factors, especially poverty, also contribute to cancer disparities through barriers to high-quality cancer prevention, early detection, and treatment information and services.

WHAT’S ONE THING MOST PEOPLE DON’T KNOW ABOUT CANCER IN GENERAL?

The risk of being diagnosed with cancer increases with age because most cancers require many years to develop. According to data from the American Cancer Society, about 1 in 2 Black men and 1 in 3 Black women will be diagnosed with cancer in their lifetime.

The lifetime probability of dying from cancer is about 1 in 4 for Black men and 1 in 5 for black women. The one thing that most people don’t know about cancer is, that today, unlike in the past, most cancers can be cured with the right diagnosis and treatment, and even more cancers can be prevented by pursuing a lifestyle minimizes their risk.

The World Cancer Research Fund has estimated that about 20% of cancers that occur in the US are due to poor nutrition (including excess alcohol consumption), physical inactivity, and excess weight, and thus could be prevented.

BLACK WOMEN ARE DYING FROM CERVICAL CANCER AT A RATE 77% HIGHER THAN PREVIOUSLY THOUGHT, BUT THIS IS PREVENTABLE. WHY? HOW IS THIS PREVENTABLE?

The rate at which Black women in the U.S. are dying from cervical cancer is comparable to that of women in many poor nations. What makes these findings especially disturbing, is that the majority of cervical cancer is caused by a virus called Human Papilloma Virus(HPV).

Between primary prevention- which means getting ourselves and our children, boys and girls, vaccinated with the HPV vaccine so that we never get the virus- and secondary prevention-which means getting your PAP smears on a regular basis so that cervical pre-cancer can be detected early and treated- cervical cancer is an almost completely preventable disease. Many studies have shown that the most common reason Black women and any women in the U.S. die from cervical cancer is that they have not had recommended screening with PAP smears.

AT WHAT AGE SHOULD WOMEN STOP GETTING PAP SMEARS?

Many cervical cancer screening guidelines say that women over 65 who have had regular

screening with negative results don’t need to have PAP smears. But based recent research that shows almost 20% of cervical cancer in the US occurs in women over age 65 and the research that death rates for cervical cancer are highest for Black women over 65, I recommend women continue to get regular cervical cancer screening past age 65 and for at least as long as they are sexually active.

WHAT’S THE BEST WAY FOR WOMEN TO DETECT CANCERS AFFECTING THEIR REPRODUCTIVE ORGANS BEFORE IT’S TOO LATE?

The best way for women to detect GYN cancer in an early stage is to get vaccinated against HPV to prevent cervical, vulvar, and vaginal cancer; to get regular screening tests, either PAP smears or HPV testing for these same cancers with your OB-GYN or primary health care provider; and most importantly to know the signs and symptoms of gynecologic cancer so that cancers of the uterus and ovary, for which there are no screening tests available, can be found in the earliest possible and curable stage.

Many of the signs of uterine and ovarian cancer are commonly experienced by most women at some point in their lives. But when things like pelvic pain, bloating, bleeding or discharge happen for a long period of time and you have no other explanation; see your doctor and ask about your risks for ovarian and uterine cancer and whether your symptoms could be a sign of these diseases.

Knowing your family history can be especially important for reducing your risk and even preventing uterine and ovarian cancer- for both of these there are known mutations in cancer-causing genes that can be passed down from one generation to the next.

There are medical and surgical options for both uterine and ovarian cancer that can help women who are at increased risk because of their family history from every getting the disease. For more information about GYN cancers and clinical trials please check out these great videos put together by my colleagues at the Society of Gynecologic Oncology at https://www.sgo.org/patients-caregivers-survivors/clinical-trials/.

WHY ARE CLINICAL TRIALS FOR CANCER IMPORTANT?
Here’s what we know: Clinical research in underserved populations equals cancer health equity. Put simply, clinical trials are a crucial step to finding new and promising ways to improve treatment for cancer. Most medical advances have come as a result of clinical trials.

Participating in cancer clinical trials is the best way to level the playing field for Black people and all underserved groups affected by cancer. We’re not just talking about the best in terms of care, but access to the best in new therapies, access to new drugs and interventions before they are widely available. If the treatment is a success, you are among the first to benefit.

WHAT IS THE PROCESS FOR CLINICAL TRIALS?

Before the clinical trial

All people affected by cancer should ask their doctor about clinical trials and whether there are any available for their particular disease and stage of treatment. If you are interested in a specific clinical trial, your doctor will explain to you the purpose of the trial and how it affects you, including the main risks and benefits of taking part through a process called informed consent. It’s important to know that participating in a clinical trial is voluntary and if you decide not to participate, it will not affect the care your doctor will give you.

During the clinical trial

Once you are on a clinical trial, the researchers running the trial will want to carry out regular tests, including physical exams and sometimes imaging tests, on you to find out how your treatment is working. At the same time, they will be on the lookout for any side effects – so you may be asked questions about any new symptoms you experience while you are receiving treatment on the clinical trial.

Doctors will also look at the wider effects of a treatment on your life as a whole – in other words, your ‘quality of life’. So, they may ask you if you’re able to take part in your usual day-to-day activities, or if you need any extra help around the home or to look after your family.

After the clinical trial: How will trial results be used?

After you finish treatment on a clinical trial, your doctors may still see you and follow you for symptoms on a regular basis for a long period of time to understand all the effects the treatment has had on you and your cancer. For some cancer clinical trials where you are receiving a specific treatment, your participation may give your doctor results that can be used to help find the best available treatment for your particular situation.

Results of cancer clinical trials are also used by your doctor and researchers to help cancer patients in general and to find new and more effective, less toxic ways of treating cancer. Results of the clinical trial you participated in should be made available to you by the researchers if you want them.

WHO SHOULD PARTICIPATE IN CLINICAL TRAILS?
More than twenty years after Congress required that research funded by the National Institutes of Health (NIH) include minorities, and women, less than 2% of all adults with cancer in the U.S. participate in a clinical trial. For minority and underserved people who suffer severe disparities in cancer incidence and death rates, participation in clinical trials is critical. Participation in clinical trials can help us understand how gender, racial, ethnic, and socioeconomic differences can affect the way cancer progresses and how well patients respond to treatments, as well as aid in the development of new treatments and ways to prevent cancer.

Dr. Brown answers your Text Tom questions on the next page:

Do U still need to have a Pap smear if you’ve had a hysterectomy?

If your cervix was removed at the time of your surgery, and your uterus was removed for any reason other than cervical cancer or pre-cancer, you don’t need to have Pap smears moving forward. It’s important to ask your doctor to make sure your cervix was removed at the time of your hysterectomy- if it was let in place, you still need to get regular screening with Pap smears or HPV tests.

Dr. Brown, why can’t adults get the vaccines like the kids for HPV?

HPV vaccine is not currently recommended in the U.S. for men or women older than 26 years old. This is because most people are exposed to HPV for the first time during their late teens and early 20’s and the vaccine is most effective when given before you are exposed to HPV.

But there is no known harm to getting the HPV vaccine at an older age. In Australia, the vaccine is recommended for women up to age 45. You should discuss with your doctor whether getting HPV vaccine after age 26 is a good idea for you, but if you and your doctor decide to proceed, you may have to pay for the vaccine yourself instead of it being covered by insurance.

Can a Pap smear detect antigens associated with ovarian cancer?

Pap smears were not designed to screen for anything other than cervical cancer. But with recent liquid based methods of collecting the cells from the cervix during the Pap smear, there are other possible uses for the liquid cervical sample, including diagnosing sexually transmitted diseases and detecting cells from other cancers of the reproductive organs. Using liquid Pap smears to diagnose other cancers is not a reality yet, but research is ongoing to see if this could be helpful in the future. As of now, we still don’t have an effective screening test for ovarian or uterine cancer.

Is it true that cancer can’t grow when your body’s pH is balanced? I read this, so I’ve been drinking essential water because it has the highest pH.

A cancer cell’s ability to grow does depend to some extent on the on the local environment of the organ where the cancer started. Different cancer producing organs can have very different pH levels and it would be hard to change any part of your body’s pH through diet. But the right diet can be one of the most effective ways you can prevent cancers of the uterus, breast and colon – following a low-fat diet with lots of fresh fruits and vegetables has been shown to decrease your risk of getting many types of cancer.

Dr. Brown, if I haven’t had a cycle in 14 months then all of a sudden, I have a light cycle, is that normal with menopause or do I need to have an ultrasound to check it out?

You didn’t mention how old you are, but at any age, not having a menstrual cycle for more than 12 months and then bleeding again needs to be investigated by your doctor or health care provider. For younger women, losing your cycle for so long is usually caused by changes in hormones (including pregnancy). But if you are over 35 with this issue, your doctor will likely also perform an ultrasound and maybe even a biopsy of the lining of your uterus to make sure there is no structural cause of the bleeding like fibroids or even uterine cancer. Cancer would be more likely if you are at or beyond the age of menopause.

How often should women 58 and older get a Pap smear?

Most organizations recommend Pap smears every three years for women between the ages of 30 and 65, and if simultaneous HPV testing is done along with the Pap, screening can be done every five years. Due to recent evidence suggesting that the highest mortality for Black women with cervical cancer happens after age 65, and that 20% of cervical cancers in the US occur in women over 65, I recommend women consider getting Pap smears past age 65 for as long as they are sexually active.

Is there a treatment/cure if you have the have cancerous virus?

As with most viruses, there is no effective treatment or “cure” for HPV infection. When people are “treated” for HPV related changes on their cervix, the treatment is directed at the tissue that has been transformed by the HPV into a pre-cancerous state- you are not treating the virus itself.

Low level pre-cancer cells don’t need treatment as they will most likely never turn into real cancer. Methods to treat high level pre-cancer of the cervix include cutting out the affected tissue with a minor surgery called a cone biopsy or using a laser or other method to vaporize and destroy the high level pre-cancer cells. There are clinical trials looking at new HPV vaccines that help the immune system destroy the virus, and hopefully there will be an immune type therapy for HPV related cancers available in the future.

My son has already had the HPV vaccination. I’m in my 50’s and never had the vaccination can I still get the vaccination?

At age 50 years old, you have almost certainly already been exposed to the HPV virus and getting the HPV vaccine at this point will not likely be effective. If you feel you are still at risk of getting reinfected with HPV, talk with your doctor about your situation and together you can make the best decision for you.

I have a history of fibroids and would like to find an African American female GYN that specializes in the treatment of fibroids. Can you recommend a directory or site to find a physician?

Although I can’t give you specific names, go to the website of the American College of Obstetricians and Gynecologists at https://www.acog.org/About-ACOG/Find-an-Ob-Gyn for help with locating a specialist for fibroids. To help find a gyn cancer surgeon, try the Society of Gynecologic Oncology at https://www.sgo.org/seek-a-specialist/ . And to learn more about fibroids especially as they affect women of color, please check out BlackHealthMatters.com at http://www.blackhealthmatters.com/tag/fibroids/ .

I had a hysterectomy. Now I have a complex cyst on the ovary that’s left. Is that cancer or if that’s just extra left over?

The ovaries are not always removed when you have a hysterectomy, especially if you hadn’t gone through menopause at the time of your surgery. Most ovarian cysts are not cancer, but you should see your doctor and discuss what is the next best step for your situation to make sure.

I had a total hysterectomy 8 years ago and I bleed a little after sex. Is this normal?

Bleeding after sex is one of those symptoms that should be evaluated by your OB/GYN or other health care provider to be able to determine the cause and make sure there is nothing more serious, like cancer, going on.

Is it true that men are also getting head and neck cancer from performing oral sex on someone who has HPV?

Oral sex is a risk factor for head and neck cancer; and the number of head and neck cancers in men related to HPV has increased significantly in the last ten years, along with the increased practice of oral sex. Preventing HPV-related head and neck cancer is one of reasons that getting boys vaccinated against HPV is so important.

I’ve had my cervix frozen in that Cairo freeze for cancer cells. I have HPV now and have to go back for yearly Paps. I’m a little worried about getting cancer and it coming back and having the cells again? Is this common? My family also has a great history of cancer and my mother has had cervical cancer and is now battling cancer again should I be worried

The most important thing for you to do is to continue to go for your regular screening tests and exams with your doctor. Most cervical cancer is caught in the precancerous phase and destroyed before ever becoming a real threat if you are getting regular evaluations.

My daughter had an abscess on her pelvic area recently. It grew the size of a baseball. The doctors said it’s not cancerous but it has grown back, should we be concerned? Also, should we have this abscess tested?

You should consult with your daughter’s doctor about what are the next best steps for her situation.

What are the side effects of the HPV vaccine?

The only documented side effects of the HPV vaccine are those rare ones related to the infection itself including infrequent irritation at the injection site. HPV vaccines have been researched and used by so many people, that there is large amount of data about side effects that prove the vaccines’ safety. You can see what side effects are associated and how often they occur for yourself at https://wonder.cdc.gov/vaers.html

I was told by my doctor that annual Pap smears and breast exams/mammograms are no longer required. They are now saying every 3 years. Is this true? Is this safe?

A 3-year interval between Pap smears for most women ages 21-65 years old is one of the cervical cancer screening options recommended by most physicians and scientific organizations based on the results of large clinical trials in women with average risk of getting cervical cancer. You should discuss with your doctor whether you have any risk factors that mean you should get screened for cervical cancer more often than every three years. For a discussion about screening intervals for mammograms please see:

http://www.blackhealthmatters.com/health-conditions-hub/breast-cancer/breast-cancer-screening-guidelines-revised/

What are the signs and symptoms of lung cancer?

Although lung cancer is more common in people who have a history of smoking or exposure to second-hand smoke, about 20% of lung cancer in women is not smoking-related. Screening for lung cancer with a CT scan is recommended for people aged 55-74 years old with a smoking history equal to a pack a day for 30 years, but CT scan screening is not recommended for non-smokers.

According to the American Cancer Society, symptoms of lung cancer include a persistent cough, coughing up blood, chest pain or hoarseness. You should see your doctor to discuss your individual risk for lung cancer and whether you should be screened with a CT scan. https://www.cancer.org/cancer/non-small-cell-lung-cancer/detection-diagnosis-staging/signs-symptoms.html