There are a few reasons that I ultimately chose OB/Gyn as my medical specialty, with an important piece being that both sides of my family have been impacted by cancers of reproductive organs. During medical school, the topic was unavoidable to me as my maternal grandmother was diagnosed with and ultimately passed due to complications of endometrial cancer (cancer within the uterus). Unlike other gynecologic cancers, which can have vague, absent, or unnoticed symptoms, endometrial cancer generally provides a big red flag symptom - abnormal (usually postmenopausal) bleeding. Most patients are diagnosed early and treated relatively easily. My grandmother, who had only ever really seen a doctor in the context of her pregnancies about 50 years before, wasn't sure if what she was experiencing was abnormal. She never had a driver's license and didn't like to rely on others driving her around. She was always busy caring for everyone else - babysitting what seemed like every person in town throughout their childhoods; growing vegetables (including the most delicious peas) in her amazing garden; baking unmatched fresh buns from scratch; playing the organ and directing the choir at her church; sewing, knitting, and crocheting clothes, blankets, and Christmas ornaments for everyone all the time; staying up with us playing cards late into the night (and somehow still being up earlier than everyone else in the morning); singing us to sleep; encouraging everyone in everything they did; and spreading kindness everywhere she went. All of these factors meant that she didn't seek care until she was essentially forced to in the setting of heart and lung symptoms, some potentially related to the cancer and some not. The condition of her heart made surgical intervention a risky choice and ultimately was a large factor in her management plan. The cancer was simply discovered at the wrong time. She passed about 9 months after her diagnosis, on the day after her 75th birthday.
Her story makes me think a lot about the importance of information and resources. How was a busy homemaker born in the 1930s and living in very rural North Dakota without consistent transportation supposed to know anything about her gynecologic health? The cards were stacked against her.
Fortunately, we live in a world now where most of us have boundless information at our fingertips and where it's becoming more supported and accepted to talk about reproductive and gynecologic health issues. Unfortunately, there's also a lot of bad information out there, and access to healthcare is not easy for everyone.
During this Gynecologic Cancer Awareness month - a month dedicated to increasing public and professional knowledge regarding vulvar, vaginal, cervical, uterine, and ovarian cancers - here are my recommendations:
- Get the HPV vaccine. This can prevent cervical, vaginal, and vulvar cancers. Countries with robust vaccination programs have essentially eradicated cervical cancer.
- Have cervical cancer screening at recommended intervals. (https://www.erinstevensmd.com/post/we-need-to-talk-about-pap-smears)
- Tell your clinician about ANY vaginal bleeding. This means discussing your periods as well, even if you think they are normal.
- Report weight gain, weight loss, feeling full quickly when eating, loss of appetite, change in bowel habits, change in urinary habits, pelvic pain/pressure, persistent bloating, genital skin changes, unusual vaginal discharge, or anything that is concerning you. These aren't definitively a sign of something bad, but they are important for us to know as we consider your overall circumstances.
- Be aware of your family medical history, and share this with your healthcare practitioner. Some types of cancer can be related, and discussing a full history can help draw connections.
- Ask about genetic screening for cancer syndromes if you have a strong family history of gynecologic cancers. Not every type or case of cancer is genetically driven, so this type of testing is not appropriate for everyone. If it makes sense to test and you end up testing positive, this may change the type of care you should receive going forward.
- Don't rely on celebrities for your health information. Grey's Anatomy's Ellen Pompeo stated on The Ellen Show that every woman should demand a pelvic ultrasound to look for ovarian cancer. This is NOT recommended - it may be falsely reassuring for some and falsely concerning for others.
- Obtain your information from credible sources. These include the American College of Obstetricians and Gynecologists (https://www.acog.org/Patients), the Society for Gynecologic Oncology (https://www.sgo.org/) and its offshoot the Foundation for Women's Cancer (https://www.foundationforwomenscancer.org/gynecologic-cancers/), and the National Comprehensive Cancer Network (https://www.nccn.org/patients/default.aspx).
No one can say for sure if my grandmother's outcome would have changed if she had seen a doctor sooner or told someone what she was experiencing, but that possibility motivates me to be the best physician I can be and increase public health knowledge. Listen to your body, and seek help if it's telling you something that worries you.