Each year, thousands of women worldwide are diagnosed with “below the belt” or gynaecological cancers: cervical, ovarian, uterine, vaginal and vulvar. Few opt to share their stories, suffering in silence as they wage a difficult and a very personal battle.
Gynaecologic oncologist Dr Vikash Chatrani says this silence is driving the unnecessary spread of these potentially deadly diseases. And he challenged women to take charge of their health, as he delivered his presentation Cancers Below The Belt ahead of the start of Gynaecological Cancer Awareness Month, celebrated in September worldwide.
“These five cancers account for nearly 20 per cent of the nearly 5.1 million estimated new cancer cases, and contribute to nearly three million cancer deaths worldwide. So even though they only contribute to a small fraction, they end up causing 60 per cent of the mortality associated with cancer worldwide; and it shows the gravity of the situation.
“The thing with gynaecological cancers is that the inability to have good screening tests to pick them up early ends up with women presenting advanced cases of the disease and having more complex pathways for their care.”
Dr Chatrani points out that all women are at risk of developing gynaecological cancers, though he says the risk generally increases with age. But this does not rule out the young.
“I have treated a patient with cervical cancer at age nine and a patient with vulvar cancer as old as age 95.”
Dr Chatrani says there is no real way to prevent below the belt cancers, even as he stressed that the “best cancer cure option is prevention”.
“If we can prevent the disease, rather than curing it or treating its symptoms . . . . I think that’s the best bet at winning the fight against cancer; and prevention involves taking a visit to your doctor.”
He however noted that there were things women could do to lower their chances of getting gynaecological cancers and identify them early. First, know the symptoms of each disease, pay attention to your body, get regular pap smears, and live a healthy lifestyle.
“Make sure that your weight is good for you, so that you don’t develop diabetes or high cholesterol. Avoid smoking, and practise safe sex.
“Know your family history. All gynaecological cancers do not have a family history; cervical cancer doesn’t have a family history, but ovarian cancer does. They have found genetic modifications that can increase your risk of ovarian cancer.”
Dr Chatrani strongly advises regular pap smears, which pick up abnormalities of the cervix before they lead to cancer and therefore allow doctors to treat and prevent cancer. Of the five below the belt cancers, cervical cancer is number one in Barbados and the Caribbean, but Dr Chatrani insists there’s no reason why women have to die from cervical cancer.
“If you have free access to health care, you should be able to screen for these diseases early, pick them up and prevent cancer. Cervical cancer is a cancer that can be prevented.”
Every year about 40 people are diagnosed with cervical cancer, and Dr Chatrani revealed that it cost $1.7 million to provide them with treatment. According to Dr Chatrani, there are common symptoms women can look for, including abnormal bleeding or discharge for more than two weeks; pelvic pain or pressure; abdominal pain; back pain and bloating.
But he believes the rising incidence of the disease can be contained if women get the HPV vaccine which has been treated with much scepticism and strongly criticised in some cases. He advised women to think of the HPV vaccine as the cancer vaccine, as he pointed to expert findings that showed the HPV virus was responsible for over 95 per cent of cervical cancer cases.
“Some of you may be saying, ‘Why should I care about the HPV? Not me. I have had a single partner my entire life’. It has nothing to do with the number of partners. They have actually shown that over 80 per cent of the population would have acquired HPV at one point in their life.
“But you have an immune system. Your body has the ability to get rid of the virus; so all HPV infections do not cause cancer. There are over 140 different types of HPV, 40 of them located below the belt, and out of these 40 only some are high-risk . . . but you won’t know unless you get checked by your doctor.”
Dr Chatrani strongly debunked myths about the side effects of the vaccine, pointing out that over 46 million people had received the vaccine.
“The cost to vaccinate 5,000 girls is $150 000. It makes more sense to start vaccinating now, because the effects down the line will be more beneficial . . . . Don’t think of it as an HPV vaccine; think of it as a cancer vaccine. What we are trying to prevent at the end of day is cervical cancer.”
With respect to the other four gynaecological cancers –– ovarian, uterine, vaginal and vulvar –– Dr Chatrani advises women to pay attention to bloating, pelvic and abdominal pain, in case of ovarian cancer; and bleeding after menopause, in case of uterine cancer.
He noted that vaginal cancer was rare, but could be picked up by a doctor during examination, while vulvar cancer usually presented itself in the elderly.
“My youngest patient with vulvar cancer was probably 69; my eldest was 95. Usually you have itching and a persistent lump . . . . If it doesn’t go away after a couple of weeks, go to the doctor. It may be an early sign.”