Most women don't know the signs of gynecological cancers, and are especially unaware of symptoms unrelated to the reproductive organs, such as back pain and increased urination, according to a new study.
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There are five main gynecological cancers — cervical, ovarian, uterine, vaginal and vulvar — and screening is recommended only for cervical cancer. Therefore, early detection may depend on women recognizing the symptoms and making a doctor's appointment.
"Our findings illustrate the need to inform women about gynecologic cancer symptoms, and when to seek care," said study researcher Cynthia Gelb, a health communication specialist at the Centers for Disease Control and Prevention.
However, many symptoms of these cancers are common, and are not cause for alarm — they may indicate benign conditions, Gelb said. "The only way to know what is causing them is to see a health care provider."
The study was published online Sept. 3 in the journal Family Practice.
The signs of cancer
There will be nearly 90,000 cases of gynecological cancers diagnosed in the U.S. in 2012, with more than half of those being cervical cancer, according to estimates from the National Cancer Institute. About 30,000 women will die of these five cancers this year; the deadliest of the five is ovarian cancer, which will cause about half of these deaths.
In the study, Gelb and her colleagues conducted focus-group interviews with 132 women ages 40 to 60 in Chicago, Los Angeles, Miami and New York City. Groups had seven to nine participants, and met for about two hours.
Each participant was given a list of eight symptoms of gynecological cancers, although the list was not labeled as such, and the moderator didn't use the word "symptoms" during the discussion. Study participants indicated which symptom would most concern them, and the groups discussed what could cause each of the symptoms.
The symptom that was most concerning to women was unusual vaginal bleeding or discharge, with many saying this is a sign of "something serious," and some recognizing it as a possible sign of cancer.
Many women also said that changes in the skin of the vulva would indicate something serious, though fewer women linked this symptom with cancer, and a few women also indicated that pain or pressure in the pelvic area could be a sign of cancer.
There were five symptoms that very few women identified as possibly being due to cancer: vaginal itching or burning, back or abdominal pain, being tired all the time, having to pass urine very badly or more often than usual, and bloating.
"All of these things and others may not register as being something to see a doctor about," because they are common, and not seen as potential signs of a major problem, Gelb said. "Many people are tired much of the time," women may feel bloated around the time they menstruate, and post-menopausal women commonly have to urinate frequently or more urgently, she said.
One key to recognizing when a common symptom might actually indicate cancer is for women to know what is normal for them, Gelb said.
Women should know how long their periods normally last and how heavy they are, if they normally feel full quickly when eating, and if their back often hurts, she said.
Bleeding that is unusual because of when it occurs, or because it is heavier than usual, is a reason to see a doctor right away, Gelb said. For bloating and other symptoms, it is recommended that women seek care if the symptom has persisted for two weeks.
In the study, some women reported experiencing symptoms for much longer.
"Some women reported living with symptoms that caused discomfort for extended periods, even years, without seeking care," Gelb said. Even in the case of unexplained bleeding, there were many participants who were not aware this could signal gynecologic cancer, and women who had this symptom did not seek care.
Many women in the study also said they searched on the Internet for information about symptoms. Women should be sure to consult reputable websites, Gelb said, such as the CDC's "Inside Knowledge" site, which offers facts about gynecologic cancer and information based on scientific evidence.
"The earlier that gynecologic cancers are found and treated, the more effective treatment can be," Gelb said.
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