DR R.N.SATPATHY

Risk factor- is anything that increases the chance of developing a disease- cancer.

Age related

Sex related

Prolonged exposure to documented risk factors such as.

Tobacco use, diet, infections (STD), Obesity, Diabetes

Environmental Oncogenes

Menopause and perimenopause. Endogenous

HRT and its oncogenic potential

Drug abuse- Clomiphene, Oestrogen

Ethnicity and Genetic

Organ Specific Cancers Average age

CANCER CERVIX PERIMENOPAUSAL 50 YRS

OVARIAN CANCERS PERIMENOPAUSAL 54 YRS

ENDO. CARCINOMA POSTMENOPAUSAL 58 YRS

VULVAL CARCINOMA POSTMENOPAUSAL 70 YRS

VAGINAL CARCINOMA POSTMENOPAUSAL 62 YRS

THE PEAK INCIDENCE OF GYNAECOLOGICAL CANCERS IS NOTICED IN PERI AND POSTMENOPAUSAL WOMEN MAKING THEM AT RISK GROUP FOR DISEASES AND THEIR MANAGEMENT

Cancer Breast Peak- 50s, 2nd Peak 65-69 Yrs

Colorectal Cancer Perimenopausal 50 Yrs

Pancreatic Cancer Perimenopausal 50 Yrs

Bladder Cancer Postmenopausal > 50Yrs

Persons above 60 years suffer from

75% of all multiple myelomas

61% of all leukemias

60% of Non-Hogkin’s Lymphomas

58% of all buccal cavity and pharyngeal cancers

Changing incidence of different cancers in different countries.

UK/US- Increase in Ovarian cancer, less in Ca. Cx.

India- cervical cancer incidence is high, EC on rise.

In developed world incidence of Cancer cervix is falling due to mass screening.

More common in elderly women and will be more apparent in future as aged population are on rise.

The more we live the more we are liable to acquire cancers

Pattern of Gynaecological Cancers

Menopause beyond 55 yrs ( menarche < 12 yrs) Increased risk of

Endometrial Cancer (three fold)

Ovarian cancer

Breast cancer

Bladder cancer

Longer menstrual life- more oestrogen exposure More risk of development of breast and uterine

cancer

Long menstrual life- more number of ovulation Increased Ovarian cancer risk-Obstet Gynecol-2001

Risk of death from uterine & ovarian ca. is increased by 5% with late menopause. -Epidemiology- 2005

Absolute Progesterone lack with relative oestrogen excess.

Endometrial hyperplasia- Spectrum

Oestrogen deficiency

Prolonged and persistent Oestrogen, progesterone and Androgen deficiency

Obesity and adult weight gain- Breast cancer in menopausal women.

Weight loss and maintenance of it from 18yrs till menopause reduces risk of breast cancer.

-Cancer Epi Bio-2005

Excess weight > 200 pounds is a risk factor for EC

Obesity ( extra weight at waist area) is a risk factor for colorectal cancer.

Obese women- Increased oestrogen- more riskHealthy weight- lower risk of breast, colon, renal & EC

- Havard Center for cancer prevention-2004

Drugs commonly used are

HRT- Oestrogen alone or with progesterone

Soy Isoflavone

Tamoxifen

Raloxifene

Clomiphene

HRT reduces risk of colon cancer-Reason? Short term use < 5 yrs risk is relatively low. OCP use > 5yrs lowers risk of colon, uterine and

ovarian cancer, but breast cancer risk increases Debate- Unsolved issues

Duration vs Dose of oestrogen therapy

Duration of oestrogen-progesterone therapy

Type of oestrogen-progestin regimen

Use of more than one type of HRT

The form of oestrogen administration

Soy Isoflavone Protective effect against breast cancer- because of anti

oestrogenic action ???

Tamoxifen Lower the risk of breast cancer

Increased risk of uterine cancer

Raloxifene May lower the risk of breast cancer

Clomiphene Increased risk of Ovarian cancer

Cancer Cervix Reduction of risk factors, safe and responsible sex

VI/ Pap smear from reproductive age till menopause

Breast Cancer BSE, CBE, Mammography, healthy diet more fruit, veg, fiber

Ovarian Cancer Clinical, USG, CA-125 ??, Avoid prolonged use of clomiphene

Endometrial Cancer Weight reduction, Control of Diabetes etc. Restricted HRT

Colorectal Cancer Weight reduction, Maintaining healthy diet ( low in fat and high in

fiber), Removing benign polyp before it becomes malignant .

Menopause itself does not increase the risk of cancer, but menopausal woman is at higher risk of acquiring many cancers.

Associated factors are responsible in these areas. HRT for prolonged use should be avoided ? Diet rich in fiber, vegetables, fruits and low in fat

is preferred to prevent some cancers. Tobacco in any form should be avoided Safe, hygienic and responsible sex with limitation

of family size will see cancer free menopause. Life style modification. As we live, so is our cancer.