Excess Pounds Boost Risk of Cervical Cancer

September Is Gynecologic Cancer Awareness Month

Being overweight doubles the risk of cervical cancer, according to a new study reported in the medical journal Cancer.

"Our study is not the first to look at obesity [and cervical cancer]," says Dr. James V. Lacey Jr, an epidemiologist at the National Cancer Institute (NCI) and the lead author of the study.

"But by controlling for human papilloma virus [a sexually transmitted virus that causes genital warts and is considered the primary risk factor for cervical cancer], we got a better picture of what role obesity might also play," Dr. Lacey says.

"It showed us that when taking into account the role of HPV, obesity might be an important co-factor for cervical adenocarcinoma," Dr. Lacey says.

Exactly how excess weight may increase the risk of cervical cancer is not known. But some experts believe that excess fat tissue can influence levels of estrogen and other sex hormones, and that, in turn, can increase susceptibility to cancers.

Other risk factors for cervical cancer include intercourse before age 18, multiple sex partners, or a partner with many previous partners.

Body Mass Index Measured

Cervical adenocarcinomas account for about 10 percent to 15 percent of all cervical cancers, Dr. Lacey says.

The American Cancer Society (ACS) estimates that in 2003, about 12,200 cases of invasive cervical cancer will be diagnosed in the United States. Some researchers estimate that noninvasive cervical cancer (carcinoma in situ) is about four times more common than invasive cervical cancer.

About 4,100 women will die from cervical cancer in the US during 2003, the ACS states. Cervical cancer was once one of the most common causes of cancer death for American women.

Between 1955 and 1992, the number of cervical cancer deaths in the US declined by 74 percent. The main reason for this change is the increased use of the Pap test, which is a screening procedure that permits diagnosis of preinvasive and early invasive cancer.The death rate continues to decline by about 2 percent a year.

September is national Gynecologic Cancer Awareness Month, an observance supported by the Gynecologic Cancer Foundation.

In the study, Dr. Lacey and his team evaluated 124 women with adenocarcinoma, 139 with squamous cell cancer, and 307 healthy controls, ranging in age from 18 to 69. The women gave their height and weight, and researchers measured their waist-to-hip ratio, another measure of obesity.

Women with a Body Mass Index (BMI) above 30, which is considered obese, were 2.1 times more likely to have adenocarcinoma, compared with women who had BMIs in the healthy range, under 25. Less consistent results were found for squamous cell cancers, Dr. Lacey says.

A woman who is 5 feet, 3 inches tall and weighs 135 pounds has a BMI of 24; if a woman weighs 170, her BMI is 30.

The link to cervical cancer was found "not just for obese women, but also for overweight women," Dr. Lacey says.

Experts Say New Study Confirms Link

The new study strengthens the argument for the role of hormones in the development of some cancers, says Dr. Margaret M. Madeleine, an epidemiologist at the Fred Hutchinson Cancer Research Center in Seattle.

Dr. Jonathan Berek, of the University of California Los Angeles Jonsson Cancer Center, agrees, calling the new research "a good study."

A high BMI is already a known risk factor for endometrial cancers, so it is feasible that the same may hold true for cervical cancers, Dr. Berek says.

Exactly how excess pounds can boost the risk isn't certain. But it might be that the higher levels of circulating estrogen in a heavy woman's body stimulate normal cells to become malignant cells, he says.

Always consult your physician for a diagnosis.

Online Resources

American Society for Reproductive Medicine (ASRM)

Centers for Disease Control and Prevention (CDC)

Gynecologic Cancer Foundation

HealthierUS.Gov

National Institutes of Health (NIH)

National Women's Health Information Center

Office of Research on Women's Health

• infection

• inflammation

• abnormal cells

• cancer

Most invasive cancers of the cervix can be detected early if women have Pap tests and pelvic examinations regularly.

As with many types of cancer, cancer of the cervix is more likely to be successfully treated if it is detected early.

The Pap test is useful for detecting not only cancerous cells, but also other cervical and vaginal abnormalities including dysplasia (precancerous cells) and inflammation. Inflammation may be caused by:

• yeast infections

• trichomoniasis infections

• bacteria

• viruses

• medications or other chemicals

• hormones

• pregnancy

• miscarriage (or abortion

According to the National Cancer Institute (NCI), cervical cancer screening should begin approximately three years after a woman begins having sexual intercourse, but no later than at 21 years old.

Experts recommend waiting approximately three years following the initiation of sexual activity because transient HPV infections and cervical cell changes that are not significant are common and it takes years for a significant abnormality or cancer to develop.

Cervical cancer is extremely rare in women under the age of 25.

Women should have a Pap test at least once every three years.

Women 65 to 70 years of age who have had at least three normal Pap tests and no abnormal Pap tests in the last 10 years may decide, upon consultation with their healthcare provider, to stop cervical cancer screening.

Women who have had a total hysterectomy (removal of the uterus and cervix) do not need to undergo cervical cancer screening, unless the surgery was done as a treatment for cervical precancer or cancer.

Women should seek expert medical advice about when they should begin screening, how often they should be screened, and when they can discontinue cervical screenings, especially if they are at higher than average risk of cervical cancer due to factors such as HIV infection.

Always consult your physician for more information.