• Infection with Human Papilloma Virus (presenting as genital warts)
• Early initiation of sex (<20 years)
• Multiple sexual partners
• Smoking

• Vaginal bleeding after sexual intercourse (Post coital bleeding)
• Vaginal discharge – profuse, offensive and blood stained
• Vaginal bleeding between periods (Intermenstrual bleeding)

Cervical screening is not a test for cancer. It is a method of preventing cancer by detecting and treating early abnormalities which if left untreated can lead to cancer of the cervix.

This is carried out by regular PAP smears. During a PAP test, the doctor scrapes a small sample of cells from the surface of cervix, to look for cell changes. If the test shows abnormal cells, the doctor may do other tests to look for precancerous or cancer cells on your cervix.

Your doctor may also do a PAP test and take a sample of tissue (Biopsy), if you have symptoms of cervical cancer, like bleeding after sex.

When the PAP smear reveals abnormal results a colposcopy exam in performed. It is a microscope which magnifies the cervix 5-20 times. This is when a cervical biopsy (sample of cervical tissue) is taken.

Three treatment methods are commonly used to treat cervical cancer:

• Surgery
• Chemotherapy
• Radiation therapy

More than 95% of the time HPV 16/18 is associated with cervical cancers.

• Age more than 50 years
• Family history of breast, ovarian, colonic cancer
• Early menarche and late menopause
• Women who have not borne a child or first pregnancy > 30 years
• Obesity

Ovarian cancer does not usually cause symptoms at first.

The most common symptoms are

• The feeling of a lump in the abdomen
• Gas and pain or swelling in the belly
• Increased abdominal girth
• Loss of weight
• Increased urinary frequency or dribbling or incontinence
• Lower abdominal pain
• Backache

But these symptoms are so non specific that they are more likely to be blamed on a number of other causes. Most of the time, the cancer has already spread by the time it is found.

• Sometimes the doctor may feel a lump in the ovary during a routine vaginal examination. Often a lump may be seen during an ultrasound. Most lumps are not cancerous.

  The only way to know for sure that a woman has ovarian cancer is with biopsies taken during surgery.

  There is a blood test called CA-125 (cancer antigen 125) that is sometimes done to look for cancer in women at high risk. This is not a specific test though a level >200 is highly suggestive.

• Surgery is the main treatment option. The doctor will remove any tumors that he or she can see. This usually means taking out one or both ovaries (oopherectomy). It may also mean taking out the fallopian tubes and uterus (hysterectomy). After surgery, most women have several months of chemotherapy, which means taking drugs that kill cancer cells.

  This cancer often comes back after treatment. So you will need regular checkups for the rest of your life. If your cancer does come back, treatment may help you feel better and live longer.

• Age more than 50 years
• Family history of breast,ovarian,colonic cancer
• Early menarche and late menopause
• Women who have not borne a child or first pregnancy > 30 years
• Obesity

• Vaginal bleeding after menopause
• Vaginal discharge – blood stained
• Vaginal bleeding between periods - Inter menstrual bleeding

Investigations of abnormal vaginal bleeding:
Initially an ultrasound scan will be done to determine the thickness of the endometrial lining. Endometrial cancer is diagnosed by using a microscope to examine a sample of endometrial tissue if the scan shows a thickened endometrium. The tissue can be obtained by an office endometrial biopsy (pipelle) or a day surgical procedure (dilatation and curettage).

Surgery

• For early stages of cancer, potentially curative surgery would include a total abdominal hysterectomy (removal of the womb) and bilateral salpingo oophorectomy (removal of the tubes and ovaries).

Radiation

• Can be used before the surgery to shrink tumours and make them more amenable to surgery.
• Can be used after surgery to try to reduce the risk of recurrence in patients with very advanced tumours.

Chemotherapy

• May be recommended for advanced disease or for certain rare subtypes or for cancers that have spread to distant sites.

A risk factor is anything that increases your risk of developing breast cancer.

There are some risk factors that you are in control of. A simple change in your lifestyle will reduce your risk of acquiring breast cancer. These risk factors are:

• Being overweight after menopause: Before menopause oestrogen is mainly produced by the ovaries. Fat tissue is the body’s main source of oestrogen after menopause therefore, if you are obese your fat tissue will produce more oestrogen. Higher oestrogen levels can increase the breast cancer risk.
• Diet  – High fat diet, refined carbohydrate intake eg: buns, bread etc and intake of increased animal food eg: meat all increase the risk of breast cancer.
• Alcohol consumption. Studies have shown that breast cancer risk increases with the amount of alcohol a woman drinks. Alcohol can limit your liver’s ability to control blood levels of the hormone estrogen, which in turn can increase risk.
• Smoking. Smoking is associated with a small increase in the risk of breast cancer.
• Exposure to estrogen. Because the female hormone oestrogen stimulates breast cell growth, exposure to estrogen over long periods of time, without any break, can increase the risk of breast cancer. Some of these risk factors are under your control, such as:
  • Taking the combined hormone replacement therapy (estrogen and progesterone; HRT) for several years or more, or taking estrogen alone for more than 10 years
  • Recent oral contraceptive use. Using oral contraceptives (birth control pills) appears to slightly increase a woman’s risk for breast cancer, but only for a limited period of time. Women who stopped using oral contraceptives more than 10 years ago do not appear to have any increased breast cancer risk.
• Women who never had children are at an increased risk of breast cancer. The older a woman is when she has her first child, the greater her chance of breast cancer.
• Women who did not breast feed their child are at increased risk of developing breast cancer.

Risk factors that are not under your control are:

• Age: The chance of getting breast cancer increases as a woman gets older. Breast cancer is uncommon before menopause.
• Personal history of breast: cancer: A woman who had breast cancer in one breast has an increased risk of developing cancer in her other breast.
• Family history of breast cancer: A woman’s risk of breast cancer is higher if her mother, sister, or daughter had breast cancer. The risk is higher if her family member got breast cancer before the age of 40 years.
  Gene changes: Changes in certain genes increases the risk of breast cancer. These genes include BRCA1, BRCA2 and others. Genetic testing is sometimes done to detect these changes in at risk individuals.
• Reproductive and menstrual history: Because the female hormone estrogen stimulates breast cell growth, exposure to estrogen over long periods of time, without any break, can increase the risk of breast cancer.
  • Women who had their first menstrual period before age 12 are at an increased risk of breast cancer.
  • Women who went through menopause after age 55 are at an increased risk of breast cancer.

Initially, breast cancer may not cause any symptoms. Often, an abnormal area turns up on a screening mammogram (x-ray of the breast) or ultrasound scan, which leads to further testing.
Any of the following unusual changes in the breast can be a symptom of breast cancer:

• a lump in one or both breasts
• swelling of all or part of the breast
• skin irritation or dimpling
• breast pain
• nipple pain or the nipple turning inward
• redness, scaliness, or thickening of the nipple or breast skin
• a nipple discharge other than breast milk
• a lump in the underarm area

These changes also can be signs of less serious conditions that are not cancerous, such as an infection or a cyst. It’s important to get any breast changes checked out promptly by a doctor.

The purpose of screening  is to find breast cancer early, before any symptoms can develop and the cancer usually is easier to treat. When caught early, localized breast cancers can be treated without resorting to breast removal (mastectomy).

Screening tests such as mammograms or ultrasound scanning (if <40 years of age) of the breast are done to people who appear to be healthy and are not suspected of having breast cancer. Women also need to practice breast self-examination and  get regular breast examinations by an experienced health care professional.

• Mammograms :  It is an x-ray photograph of the breast. Screening mammograms are ideally done every year to check the breasts for any early signs of breast cancer from age 40 or earlier if they are at increased risk. A mammogram is safe and reasonably accurate. They help save lives by detecting breast cancer as early as possible. Modern-day mammography only involves a tiny amount of radiation — even less than a standard chest x-ray. Mammography is a fast procedure (about 20 minutes), and discomfort is minimal for most women.


• Ultrasound scanning of the breast: Ultrasound is an imaging test that sends high-frequency sound waves through your breast and converts them into images on a screen. There is no radiation involved. Ultrasound scanning is used as a screening tool in women <40 years of age as mammograms can be difficult to interpret in young women because their breasts tend to be dense and full of milk glands. (Older women’s breasts tend to be more fatty and are easier to evaluate.)
   
• Self breast examination
  Try to get in the habit of doing a breast self-examination once a month.  Examine yourself several days after your period ends, when your breasts are least likely to be swollen and tender.

1. Look at your breast standings in the mirror with shoulders straight and arms on the hips.
   Look for:-any change in size, shape, of breasts including nipple and area around nipple. If you see any change of swelling, rash, redness or soreness or if nipples are pushed inwards (inverted) go and see a doctor.


2. Raise arms above head and look for the same including inversion of breast skin (dimpling) or buldging or puckering. If there is any go and see a doctor.


3. Now examine your breast 1st sitting or standing with shoulders straight and arms on the hip.
   Left breast should be examined with right hand (fingers of the hand keeping flat and together) and the right with the left hand similarly.
   Begin at the nipple, moving in larger and larger circles until you reach the outer edge of the breast. (the pattern should cover the whole breast)
   Then place the hand behind your head and tighten and do the same to each breast alternatively.
   You must next place the hand in the armpit (axillae) and check for same. Then gently squeeze each nipple between the fingers and thumb and check for nipple.

In recent years, there’s been many advances in treatment against breast cancer. Today there’s a variety of treatment choices that include surgery, radiation, hormonal (anti-estrogen) therapy, and/or chemotherapy.

Breast cancer is diagnosed using the ‘triple assessment’:

• Clinical examination by a doctor
• Imaging (using ultrasound scanning or mammography)
• Biopsy (examining a sample of tissue from the suspected cancer)

After a breast cancer diagnosis, you and your doctors will put together a treatment plan specific to your situation, based on your pathology report.

• Usually surgery is first.
• If chemotherapy is going to be part of your care, it is often given second.
• Radiation therapy  usually follows surgery and chemotherapy (when chemotherapy is given).
• A hormonal therapy  (like tamoxifen or an aromatase inhibitor) is often started after the other treatments have been given if the cancer is hormone-receptor positive.