Among British Columbian women, breast cancer continues to be the most diagnosed cancer with about one in nine women diagnosed. This is an estimated more than 3,100 women will be diagnosed with breast cancer in 2011. Over 600 women will die from breast cancer this year second only to lung cancer.

The good news is, we are seeing progress. In a recent paper published in the journal The Lancet, when compared to 12 jurisdictions in six countries with comparable wealth and healthcare structures, British Columbia had the best five-year survival outcomes for breast cancer.

Signs and Symptoms
If you notice any of these signs, you should see your doctor for a breast examination:

• A mass or a lump or a thickening or a change in your breast that is new or stays over time. 80% - 90% of breast lumps are not cancer.
• If a lump in your breast increases in the size, or your entire breast changes in size (gets visibly smaller or larger). Painful lumps are less likely to be due to cancer.
• Your nipple begins to draw-in.
• There is dimpling or puckering of the skin of the breast.
• There is a change in the contour (shape) of your breast.
• You have bloody or watery nipple discharge.
• Redness, scaling or inflammation of the nipple.
• Your breast becomes red, swollen or hot.
• A lump under your arm / in your armpit.

Screening
Screening for cancer is looking for an early cancer when there are no symptoms or reason to believe there may be cancer present. This is different from diagnosis, which is looking for a suspected cancer found on a screening mammogram or a physical examination.

On top of your regular self-exams, B.C. women may be eligible for regular screening mammograms.

• Mammograms are x-rays of the breasts. A screening mammogram looks for an unsuspected, hidden cancer in women who are healthy and who have never had breast cancer.
• The Screening Mammography Program in British Columbia (SMPBC) encourages healthy women to have regular screening mammograms. The goal of this program is to detect cancers at the smallest and earliest stages possible to increase the odds of curing them with treatment. Further information about the Screening Mammography Program of BC is available on their webpages or by calling the central office in Vancouver at (604) 877-6200 or 1-800-663-3333, local 6200.
• You can make an appointment for a free screening mammogram in B.C. once every 1-2 years without a doctor’s referral if you are a woman aged 40 - 79.
• To make an appointment for a screening mammogram call:

Lower Mainland: (604) 877-6187

B.C. Toll-free: 1-800-663-9203

 
Risk Factors
No one thing causes breast cancer, but there are a few common factors that seem to increase risk of developing it:

• Risk increases with age the risk of breast cancer doubles between ages 45 and 65.
• A previous diagnosis of breast cancer increases the risk of additional breast cancers.
• A family history of breast cancer, particularly breast cancer in a woman's mother, sister, or daughter increases the woman’s risk.
• Defects or mutations in certain genes, especially BRCA1 and BRCA2 genes that can be passed to our children and can increase their risk of getting breast cancer. However, probably less than 5 per cent of women with breast cancer have these genes.
• Women with a family history of cancer of the cervix, uterus or colon have a slightly increased risk.
• Length of exposure to estrogen (early menstruation).
• Late menopause.
• Having taken hormone replacement therapy for more than five years.
• Never having given birth.
• Giving birth for the first time over the age of 30.
• Dense breast tissue.
• An increased number of non-cancerous cells in the breast.
• Radiation treatment to the chest area before age 30.
• Obesity, alcohol consumption and the use of birth control pills may also slightly increase risk.

Treatment
Breast cancer treatment and care today is so customized that a specialized treatment plan is tailored to the needs of the individual patient. Breast cancer treatment may include:

• A lumpectomy removes the tumour while conserving most of the breast.
• A mastectomy removes the entire breast and sometimes the lymph nodes.
• Radiation is used to treat many stages of breast cancer and frequently used after a lumpectomy.
• Biological therapy helps the body's immune system fight cancer.
• Herceptin is used to treat human epidermal growth factor positive (HER2) tumours.

This year, an estimated 300 British Columbian women will be diagnosed with ovarian cancer and approximately 230 B.C. women will die from it.

Ovarian cancer has traditionally been very hard to diagnose at an early-stage as warning signs often present themselves as similar to common pains felt by women bloating, nausea, back pain. By the time symptoms are obvious, the disease is already at an advanced stage.

The good news is, we are seeing progress. In a recent paper published in the journal The Lancet, when compared to 12 jurisdictions in six countries with comparable wealth and healthcare structures, British Columbia had the best one- and five-year survival outcomes for ovarian cancer.

Signs and Symptoms
Ovarian cancer is difficult to find in its early stages. It usually has vague, non-specific symptoms, such as:

• Abdominal discomfort or pain.
• Lower abdominal swelling or bloating.
• Indigestion, gas, nausea, constipation, diarrhea.
• Unusual bleeding (heavy periods or bleeding after menopause).
• Frequent and urgent need to urinate.
• Loss of appetite.
• Feeling full even after a light meal.
• Pain in lower back or legs.
• Pain during sex.

Screening

• There are currently no screening methods that have been proven to be effective.
• Pap smears are not effective for ovarian cancer screening. They test the cervix, not the ovaries.
• There have been trials which tested screening methods based on; physical examination, ultrasound imaging, and a biomarker called CA 125. These methods of screening proved unreliable. They produced a high rate of false positives, which means many healthy women would be wrongly diagnosed with ovarian cancer and have unnecessary surgery.

Risk Factors
No one thing causes ovarian cancer, but there are a few common factors that seem to increase risk of developing it:

• Personal or family history of ovarian, breast, colon, uterine or pancreatic cancers
• Use of hormone replacement therapy (especially estrogen-only therapy).
• Being over the age of 50.
• Some hereditary risk factors such as the BRCA1 or BRCA2 gene or being of European (Ashkenazi) Jewish descent.
• Previous history of breast cancer.
• Early menstruation (before age 12) and late menopause (after age 50).
• Never having been pregnant.
• Other possible risk factors being studied include the use of fertility drugs, certain types of diet, smoking, the use of talcum powder on the genitals, and a combination of early menstruation and late menopause.

Treatment
Ovarian cancer treatment and care today is tailored to the needs of the individual patient. Ovarian cancer treatment may include:

• Surgery (including removal of ovaries, fallopian tubes or uterus)
• Chemotherapy
• Radiation

An estimated over 150 British Columbian women will be diagnosed with cervical cancer in 2011, with an estimated 44 women dying from the disease.

Signs and Symptoms
Women with abnormal cells in the cervix and early stage cervical cancer often do not experience any symptoms. However, if any of these signs or symptoms are detected, a doctor should be seen as soon as possible:

• Abnormal vaginal bleeding, bleeding between regular menstrual periods or bleeding after sex.
• Pain during intercourse.
• Longer and heavier menstrual periods, bleeding after menopause, more discharge from vagina than normal.
• Lower back or pelvic pain.

Screening
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Pre-cancerous and cancerous cells in the cervix are often identified through routine physical exams that include a Pap test.

The Pap test is the current method used for cervical cancer screening. It is named after its inventor Dr. Georgios Papanicolaou. The test detects pre-cancerous changes in the cervix and cervical cancer before symptoms appear.

Regular screening with a Pap test can find abnormal cervical cells early, when treatment can prevent cervical cancer from developing.

Cervical cancer is one of the easiest cancers to prevent by identifying and curing it in the early stages. When abnormal cells are identified before cancer develops, the cure rate is 100 per cent. For cancer limited to the surface tissue of the cervix, the cure rate is 80 to 90 per cent.

See the BC Cancer Agency’s Cervical Cancer Screening program for information on:

Risk Factors
No one thing causes cervical cancer, but there are a few common factors that seem to increase risk of developing it:

• All women who have ever been sexually active (touching or intercourse) are at risk of cervical cancer.
• Almost all cervical cancers are caused by certain types of the Human Papillomavirus (HPV). There are more than 100 types of HPV and about 40 can infect the genital area. About 15 types of genital HPV can cause cervical cancer.
• HPV is one of the most common sexually transmitted infections (STIs). Most adults have HPV some time in their lives and it usually goes away within 24 months without any problem.
• Early sexual activity.
• Having many sexual partners or a sexual partner who has had many partners.
• Smoking cigarettes.
• Having a weak immune system.

Treatment
Cervical cancer treatment and care today is tailored to the needs of the individual patient. Cervical cancer treatment may include:

• Surgery
• Radiation therapy
• Chemotherapy
• Immunotherapy
• Vaccine therapy

An estimated over 665 British Columbian women will be diagnosed with uterine cancer in 2011, with an estimated 97 dying from the disease.

Signs and Symptoms

• Odd vaginal bleeding or discharge
• Pain during intercourse
• Pelvic or back pain
• Change in bladder and bowel habits
• Weight loss

Screening
Although a routine Pap test occasionally detects patients with this disease, it will miss many of them because the pap smear scrape does not reach the uterine cavity. Most cases are not found through this test. Diagnostic tests include ultrasound, endoscopy, biopsy and blood tests.

Risk Factors

• Being between the ages of 45-70
• Being Caucasian
• Receiving hormone replacement therapy consisting of estrogen without progesterone
• Prior pelvic radiation
• Unusual menstrual history
• Late menopause
• Early first menstruation
• Diabetes
• Infertility
• Use of the drug Tamoxifen

Treatment
Uterine cancer treatment and care today is tailored to the needs of the individual patient. Uterine cancer treatment may include:

• Hysterectomy (removal of the uterus) with bilateral salpingo-oophorectomy (removal of ovaries and Fallopian tubes)
• Pelvic exenteration
• Removal of lymph nodes
• Radiation
• Hormonal therapy
• Chemotherapy

Vaginal cancer is extremely rare. The vagina is the primary site in less than one per cent of all gynacologic cancers.

Sign and Symptoms :
There are often no symptoms of vaginal cancer until it is an advanced stage. However, if symptoms, which may include the following, are detected a doctor should be seen as soon as possible:

• Vaginal bleeding (after intercourse or menopause)
• A noticeable mass in the vagina
• Abnormal vaginal discharge
• Pain during intercourse
• Pain when urinating
• Constipation
• Constant pelvic pain

Screenings
Most cases of vaginal cancer can be found through routine pelvic examination and Pap screening.

It is suggested that a woman get pap tests and pelvic exams every or every other year. These screenings should begin after becoming sexually active or at the age of 21, whichever comes first.

Risk Factors
Most women who develop this disease have no risk factors. The following risk factors have been found to slightly elevate your chances of getting vaginal cancer:

• Being 50 years of age or older
• A persistent human papillomavirus (HPV) infection
• Cervical or vulvar cancer
• Smoking
• Vaginal adenosis

Treatment
Treatment can be either local or systemic—meaning controlling or destroying cancer cells in one area (local) or throughout the body (systemic). These are the main vaginal cancer treatments:

• Surgery
• Radiation
• Chemotherapy

Vulva cancer is a very rare type of cancer.

Signs and Symptoms

Vulvar burning or itching that doesn’t improve

Bleeding that is not related to menstruation (your period)

Pain

Discharge

A lump or ulcer

Leukoplakia

A change in vulvar skin color or feel

Urination pain

Enlarge groin glands

A new mole, or existing mole that now has an irregular color or borders

Screenings
Vulvar cancer may be found during a normal routine visit, even without symptoms.

If your doctor has reason to believe you may have vulvar cancer, the following are ways that this type of cancer may be detected: a pelvic exam, pap test, human papillomavirus (HPV) test, colposcopy of the vulva and/or biopsy.

Risk Factors
You may have no risk factors and still get vulvar cancer. Or, you may have one or more the following risk factors and not have it. Doctors are not sure what causes vulvar cancer, but here are some possible risk factors:

• Primarily affects women in their 60s and 70s
• HPV infection
• History of chronic vulvar pruritus (itching)
• History of abnormal pap smears
• Smoking
• Vulvar intraepithelial neoplasia (VIN)
• Lichen scierosus
• HIV

Treatment
The type of treatment for vulvar cancer depends on each patient. Surgery and radiation are the most common forms of treatment, sometimes chemotherapy is performed as well.