Exploring Prevalent Disparities in Gynecological Cancers

Minimizing Gynecological Cancer Risk

While pap smears or tests cannot detect endometrial or ovarian cancers, they can help providers detect precancerous or cancerous cells in the cervix or vulva that may result in cervical or vulvar cancers.

Post-menopausal women are advised to seek help from a licensed healthcare provider if they experience vaginal bleeding, as it is not a natural experience for women of this age.

Additional factors that may reduce cancer risk include maintaining a healthy weight, eating a nutritious and balanced diet, regular exercise, and avoiding tobacco. Often these habits can prevent a multitude of cancers beyond gynecological cancers.

Unfortunately, social determinants of health and varying access to resources, such as affordable, nutritious foods, may result in cancer health disparities, impacting cancer incidence and survival rates.

Cervical Cancer

Cervical cancer refers to cancer in the cervix, which is the connection between the vagina and the upper portion of the uterus.

The National Cancer Institute (NCI) notes that bleeding after sex, between periods, or after menopause is a symptom of cervical cancer. Although early-stage cervical cancer does not often present with symptoms, these characteristics, in addition to heavy or extended periods, watery, odorous, bloody discharge, pelvic pain, and pain during sex, are the most likely symptoms.

Advanced-stage cervical cancer may present with symptoms such as painful bowel movements, rectal bleeding, hematuria, dysuria, backache, swollen legs, abdominal pain, and fatigue.

Anyone with a cervix is susceptible to cervical cancer; however, the risk significantly increases in individuals older than 30.

Multiple risk factors may increase a patient’s risk of gynecological cancer. One of the most significant risk factors for gynecological cancers is human papillomavirus (HPV), a common sexually transmitted infection.

Additionally, aging can impact the risk of gynecological cancers. For example, the average uterine cancer diagnosis occurs at 63 years old.

Genetic factors can also influence the risk of developing female reproductive cancers. For example, the risk of ovarian cancer is 10% greater in patients with a family history of ovarian cancer. Genetic testing can provide insight into a women’s health and cancer risk.

In 2020, 11,542 new cervical cancer cases were reported in the US, with 7 new cases per 100,000 women. Simultaneously, 4,272 cervical cancer-related deaths occurred, for a rate of 2 deaths per 100,000 women.

Statistics among non-Hispanic White women, the rates of cervical cancer were comparable to overall rates in the United States, with 7 incidences and 2 deaths per 100,000 women. Comparatively, African American women are statistically more likely to die of cervical cancer in the US, at a rate of 3 deaths per 100,000 women, despite having a similar cancer prevalence of 7 new cases per 100,000 women, pointing to additional racial and ethnic disparities.

Hispanic women have a higher risk of cervical cancer diagnosis and death at 8 new cases and 3 deaths per 100,000 females.

A 2022 article published in Cancer, an American Cancer Society (ACS) journal, explored the gaps and opportunities in screening, preventing, and treating cervical cancers.

The University of California Los Angeles (UCLA) Health recommends multiple strategies to reduce cervical cancer risk, including HPV vaccination, pap testing and HPV testing, safe sexual habits, and avoiding tobacco.

Annual checkups for individuals with female reproductive organs of reproductive age at an obstetrics/gynecology (OB/GYN) physician typically include a pap smear, which is a routine cervical cancer screening.

Data has continually proved that early diagnosis and prompt treatment promote higher cancer survival rates; however, racial disparities, variations in socioeconomic status and treatment costs, and other societal factors can impact access to care.

A 2023 study published in JAMA Network Open, using data from the Surveillance, Epidemiology, and End Results program on cervical cancer, revealed that early-stage cervical cancer was diagnosed more often in women with private health insurance or Medicare (57.8%). Meanwhile, uninsured or Medicaid beneficiaries were less likely to be diagnosed at an early stage (41.1%).

Additionally, the study revealed racial disparities in cervical cancer diagnosis. Black women are 18% more likely to get an advanced-stage cancer diagnosis, which correlates with worse survival and poorer cancer outcomes, despite having similar cancer incidence rates.

Ovarian Cancer

Despite the name, ovarian cancer can originate in the ovaries, fallopian tubes, or peritoneum.

According to the Cancer Treatment Centers of America, only 20% of ovarian cancers are diagnosed at an early stage because early symptoms are uncommon. These symptoms often are similar to common stomach or digestive issues.

Because of the difficulty differentiating between common illnesses and ovarian cancer, many cases go unnoticed until later stages when patients prevent with bloating, pelvic or abdominal pain, weight loss, lack of appetite, dysuria, fatigue, or menstrual changes.

Age, personal or family history, genetic mutations, a personal history of endometriosis, infertility issues, and hormone replacement therapy may contribute to an increased risk of ovarian cancer.

Based on 2020 Centers for Disease Control and Prevention (CDC) data, roughly 18,518 new ovarian cancer cases are diagnosed in the US annually, for a rate of 9 new cases per 100,000 individuals. However, the ovarian cancer death rate is also significant, with 13,438 ovarian cancer-related deaths or 6 deaths per 100,00 women.

The rates of ovarian cancer are the highest among American Indian and Alaska Native individuals, at 10.1 new incidences per 100,000 women each year. Comparatively, the incidence among White, Asian and Pacific Islanders, Hispanic, and Black women are 9.4, 8.5, 8.4, and 7.8 new incidences per 100,00 women annually.

Despite having the lowest incidence of ovarian cancer, Black women have the second-highest ovarian cancer-related death rates, 5.4 deaths per 100,000 women — just after White patients with an ovarian cancer-related death rate of 6.3 deaths per 100,000 women.

American Indian and Alaska Native patients experience 5.2 deaths per 100,000 women yearly. The rates for Asian/Pacific Islander and Hispanic individuals are 4.4 and 4.6 deaths per 100,000 women, respectively.

Ovarian cancer risk is also managed by understanding the family history of cancer. Additionally, researchers hypothesize that oral contraceptive use before menopause can minimize risk.

Data from the Memorial Sloan Kettering Cancer Center implies that women who have more full-term pregnancies, take oral contraceptives, or undergo tubal ligation may have a reduced cancer risk.

According to the CDC, individuals with ovarian cancer whom gynecologic oncologists treat have better health outcomes. This information informed CDC initiatives to increase the number of women with ovarian cancer treated by gynecologic oncologists.

Uterine Cancer

Uterine cancer, sometimes called endometrial cancer, forms in the endometrial lining of the uterus. This type of cancer is more common in women who are experiencing or have experienced menopause.

Endometrial cancer patients may present with unusual vaginal discharge, dysuria, pain with sex, pelvic pain, and unintentional weight loss. Uterine sarcoma, a type of endometrial cancer, may be characterized by a vaginal lump or growth and abdominal pain.

Each year, in the US, there are 26 new uterine cancer cases per 100,000 women and 5 uterine cancer-related deaths per 100,000 women.

The CDC’s cancer statistics reveal that new uterine cancer diagnoses are highest in non-Hispanic Black patients, with 27.1 new cases per 100,000 women. The incidence for White, American Indian/Alaska Native, Hispanic, and Asian/Pacific Islander is 25.6, 25.0, 23.4, and 20.0 new cases per 100,000 women.

The uterine cancer mortality rate among Black patients is significantly higher than any other racial or ethnic group, at 9.3 deaths per 100,000 women. This is nearly double the second-highest rate of 4.7 deaths per 100,000 White women.

Hispanic, Asian/Pacific Islander, and American Indian/Alaska Native women have death rates of 4.4, 3.8, and 3.1 deaths per 100,000 women.

Uterine cancer risk can be minimized by understanding a patient’s family history of cancer and screening patients accordingly. Additionally, maintaining a healthy body weight can reduce risk.

A 2022 article in Obstetrics and Gynecology with input from clinicians at the Society for Academic Specialists in General Obstetrics and Gynecology and the Society of Gynecologic Oncology identified disparities in cancer intervention. For example, Black and Hispanic women with uterine cancer are less likely to receive surgical care, including minimally invasive surgery, and have lymph node sampling or dissection.

Vaginal and Vulvar Cancer

Vaginal cancer starts in the vagina, otherwise known as the birth canal, which connects the lower part of the uterus to the outside of the body. Vulvar cancer begins in the external female genitalia, including the labia.

Vaginal and vulvar cancers are rare, accounting for roughly 7% of all gynecological cancers. According to the CDC, only 0.6 per 100,000 women are diagnosed with vaginal cancer yearly. Meanwhile, only 2.5 per 100,000 women are diagnosed with vulvar cancer yearly.

The annual mortality rate for vaginal cancer is 0.2 deaths per 100,000 women. For vulvar cancer, the rate is 0.6 deaths per 100,000 women.

At 0.8 new cases per 100,000 women yearly, Black women are the most likely to be diagnosed with vaginal cancer. White, Hispanic, and Asian/Pacific Islander women have lower rates at 0.6, 0.5, and 0.3 cases per 100,000 women. The incidence rate for American Indian and Alaska Native women is so low that it cannot be quantified.

Similarly, the vaginal cancer-related death rates are too low to be quantified for Asian/Pacific Islander and American Indian/Alaska Native women. Black and White women have similar vaginal cancer mortality rates of 0.2 deaths per 100,00 women.

White women have the highest incidence and mortality rates for vulvar cancer at 2.9 new cases and 0.7 deaths per 100,000 women annually.

American Indian/Alaska Native women have 2.4 new vulvar cancer diagnoses per 100,000 women annually; however, their death rates are too low to be quantified. Hispanic and Black women have comparable incidence rates at 1.7 new cases per 100,000 women. They also have similar death rates at 0.4 deaths per 100,00 women. Asian/Pacific Islander women have 0.8 new vulvar cancer cases per 100,000 women and 0.2 vulvar cancer-related deaths per 100,000 women.

Vulvar cancer risk can be managed using HPV vaccination, avoiding tobacco, and monitoring the vulva for external changes.

The continuing disparities in gynecological cancers point to inequities in the healthcare system. As researchers continue to evaluate disease trends and conduct clinical trials, they must include a diverse patient population and conduct long-term follow-ups to evaluate how societal factors may impact disease outcomes.