Primary prevention of gynecologic cancers.
A shift from treatment to prevention of the three major gynecologic cancers is overdue. The traditional approach to cervical, endometrial, and ovarian cancers has been secondary or tertiary prevention--early detection and treatment or mitigation of damage, respectively. We reviewed the literature on these cancers to identify strategies for primary prevention. Cervical cancer behaves as a sexually transmitted disease. As with other such diseases, barrier and spermicidal contraceptives lower the risk of cervical cancer; the risk reduction approximates 50%. Combination oral contraceptives help prevent both endometrial and epithelial ovarian cancers. The risk of endometrial cancer among former oral contraceptive users is reduced by about 50% and that of ovarian cancer by about 30% to 60%. Weight control confers strong protection against endometrial cancer. Breast-feeding and tubal sterilization also appear to protect against ovarian cancer. Although women have a range of practical, effective measures available to reduce their risk of these cancers, few are aware of them. Without this information, women cannot make fully informed decisions about their health.
Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco.
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Economy
D016889:Endometrial Neoplasms / Q000517:prevention & control; D005260:Female; D005833:Genital Neoplasms, Female / Q000517:prevention & control*; D006801:Humans; D010051:Ovarian Neoplasms / Q000517:prevention & control; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control