Women’s Health Barbara J. Nelson MD MPH

What is Cancer? Cancer occurs when cells in a part of a body start to grow out of control. There are many types of cancer, but all start because of out-of-control growth of abnormal cells. Cancer cells can also invade adjacent tissues.

What is Cancer? Cells become cancer cells because of damage to DNA. (In normal cells, DNA damage is repaired.) DNA damage can be inherited, but most DNA damage occurs due to mistakes in normal cell production or is caused by something in the environment (like cigarette smoking, obesity, toxicity, etc.)

What is Cancer? Cancer cells can travel to other parts of the body, where they can grow and and form new tumors that replace normal tissues; this is called metastasis No matter where the cancer has spread, it is named for the original site: i.e. breast cancer spread to the liver is still called breast cancer, not liver cancer.

How is Cancer treated? Surgery: preventative, diagnostic, staging, curative, debulking, palliative, supportive, reconstructive. Chemotherapy: drugs target rapidly dividing cells. Radiation Therapy: localized ionizing radiation to cure or shrink tumors. Immunotherapy, Photodynamic therapy, Gene therapy, Antiangiogenesis therapy, Bone Marrow/Stem cell transplants

Cancer in Women

Lung cancer a different disease in men and women 1 in 5 female lung cancer patients never have touched a cigarette Women more vulnerable to the harmful effects of tobacco smoke

Gynecologic Cancers Uterine (37,465 US cases in 2005) Ovarian (19,842 cases in 2005) Cervical (11,999 cases in 2005) Vulvar and Vaginal (4,765 cases in 2005)

Uterine Cancer Occurs mostly in menopausal women Characterized by abnormal bleeding Risk factors: obesity, unopposed estrogen, history of Tamoxifen, age >50. Diagnostic tools include ultrasound and endometrial biopsy.

Ovarian Cancer 90 percent of cases are in women over 40, most cases occur in women over 55. Risk factors: family history, nulliparous, infertility, endometriosis. Only accounts for 3 percent of all cancer in women, but causes more deaths than any other gynecologic cancers. Diagnosis: CA-125, ultrasound, pelvic exams.

Vulvar and Vaginal Cancer Relatively rare, only 1-2 percent of gyn cancers Most are caused by HPV. Risk factors: HPV infection, smoking, immune suppression.

Cervical Cancer Occurs most frequently in women over 30 Mainly caused by the human papillomavirus Diagnosis: Pap smears, HPV testing Prevention: HPV vaccine, smoking cessation, condom use, limit number of sexual partners.

Human Papillomavirus

What is HPV? Human papillomavirus is the name of a group of viruses that infect skin (eg, warts on hands and feet) and mucous membranes (lining of the mouth, vagina.) About 30 types of HPV affect the genital area. “High-risk” types cause cervical cell abnormalities that can lead to cancer “Low-risk” types cause genital warts

HPV affects women and men Anyone who has genital contact with an infected person can get HPV. Transmission can take place by oral-to-genital, hand-to-genital, and genital-to-genital contact. Most people do not know they have HPV, and can pass the virus without knowing it. It is estimated that most people get HPV within their first 2-3 years of becoming sexually active. By age 50, at least 80% of women have acquired genital HPV.

Most new HPV cases occur in adolescents and young adults Study results indicate that women are at risk of acquiring an HPV infection from as few as 1 sex partner; risky sexual behavior is not necessary. Of the approximately 6 million new cases of genital HPV in the United States every year, it is estimated that 74% occur in 15- to 24-year-olds.

Pap tests help prevent cervical cancer Routine cervical cancer screening detects abnormal cervical cells before they turn into cancer. Detecting and treating abnormal cells early almost always prevent cervical cancer from developing. It is recommended that women have regular Pap tests about 3 years after they begin to have sexual intercourse, but no later than age 21. Between 60% and 80% of women diagnosed with cervical cancer had not had a Pap test within 5 years of their diagnosis.

Gardasil Vaccine (HPV types 6,11,16, 18) Recommended for girls years old, and women aged 13-26, also adolescent boys. GARDASIL is administered in 3 separate intramuscular injections 6-month period with the first dose at an elected date, the second dose 2 months after the first dose, and the third dose 6 months after the first dose.

Top 10 Female Causes of Death Heart Disease 27.2% Cancer 22% Stroke 7.5% COPD 5.2% Alzheimer’s 3.9% Injuries 3.3% Diabetes 3.1% Influenza, pneumonia 2.7% Kidney disease 1.8% Septicemia 1.5%

Heart Disease Don’t smoke or use tobacco products Eat a diets rich in vegetables, fruits, whole grains, fiber, fish. Decreased saturated fat and sodium. Treat high cholesterol, high blood pressure Physical activity, manage stress Maintain healthy weight Alcohol only in moderation

Cancer Don’t smoke or use tobacco products Daily exercise, maintain healthy weight Diet: fruits, vegetables. Avoid high fat Limit sun exposure, use sunscreen Alcohol only in moderation Visit a doctor for regular cancer screening

According to the American Cancer Society, approximately ONE-THIRD of the 564,830 cancer deaths in the US in 2006 were related to POOR NUTRITION, INACTIVITY, and OBSESITY

Stroke Don’t smoke Treat high cholesterol, high blood pressure Limit saturated fat, avoid trans fat Daily physical activity, maintain healthy weight If you have diabetes, keep blood sugar in control

COPD Don’t smoke Avoid exposure to secondhand smoke Minimize exposure to chemicals and air pollution

Alzheimer’s disease Take care of your heart: high blood pressure, heart disease, stroke, diabetes, high cholesterol increase risk. Avoid head injuries Daily physical activity, maintain a healthy weight Avoid tobacco, alcohol in moderation. Stay socially active and maintain mental fitness.

Injuries Wear your seat belt Follow the speed limit Don’t drive under the influence Don’t drive while sleepy

Type 2 Diabetes Lose excess pounds if you are overweight Eat a health diet rich in fruits, vegetables, and low-fat foods Include physical activity in your daily routine

Obesity Trends* Among U.S. Adults BRFSS, 1985 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

Obesity Trends* Among U.S. Adults BRFSS, 1986 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

Obesity Trends* Among U.S. Adults BRFSS, 1987 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

Obesity Trends* Among U.S. Adults BRFSS, 1988 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

Obesity Trends* Among U.S. Adults BRFSS, 1989 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

Obesity Trends* Among U.S. Adults BRFSS, 1990 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

Obesity Trends* Among U.S. Adults BRFSS, 1991 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

Obesity Trends* Among U.S. Adults BRFSS, 1992 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

Obesity Trends* Among U.S. Adults BRFSS, 1993 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

Obesity Trends* Among U.S. Adults BRFSS, 1994 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

Obesity Trends* Among U.S. Adults BRFSS, 1995 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

Obesity Trends* Among U.S. Adults BRFSS, 1996 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

Obesity Trends* Among U.S. Adults BRFSS, 1997 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

Obesity Trends* Among U.S. Adults BRFSS, 1998 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

Obesity Trends* Among U.S. Adults BRFSS, 1999 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

Obesity Trends* Among U.S. Adults BRFSS, 2000 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

Obesity Trends* Among U.S. Adults BRFSS, 2001 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) Obesity Trends* Among U.S. Adults BRFSS, 2002 No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

Obesity Trends* Among U.S. Adults BRFSS, 2003 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

Obesity Trends* Among U.S. Adults BRFSS, 2004 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

Obesity Trends* Among U.S. Adults BRFSS, 2005 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Obesity Trends* Among U.S. Adults BRFSS, 2006 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Obesity Trends* Among U.S. Adults BRFSS, 2007 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Obesity Trends* Among U.S. Adults BRFSS, 2008 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Obesity Trends* Among U.S. Adults BRFSS, 2009 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Obesity Trends* Among U.S. Adults BRFSS, 2010 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%