Understanding Gaps in Women’s Health: Gynecological Cancer Research

Risk Assessment 

According to the University of Pennsylvania Medicine (Penn Medicine), multiple factors can increase the risk of gynecological cancer. These factors include comorbid health conditions like diabetes or hypertension, HIV/AIDS, hormone replacement therapy after menopause, human papillomavirus (HPV), obesity, and smoking. 

Other uncontrollable factors include abnormal endometrial growths, advanced age, diethylstilbestrol exposure in the womb, genetic mutations, infertility drug use, menstrual issues, personal or family history of cancer, and polycystic ovary syndrome (PCOS). 

Although these risk factors may vary depending on the type of gynecological cancer, understanding a patient’s risk is invaluable medical information that can facilitate prevention efforts, early screening and diagnosis, and successful treatment. 

Some ways that providers currently assess the risk of ovarian cancer include genetic testing, family history, and personal medical history. Mutations in BRCA1 and BRCA2 genes have been linked to an elevated risk of ovarian cancer. Patients with a personal or family history of ovarian cancer or another gynecological condition are often screened for mutations to assess risk and develop the best treatment plan. 

While risk assessments can provide some patients insight into their ovarian and breast cancer risk, genetic screenings are not a standard protocol. Even when offered or suggested by clinicians, genetic testing can be expensive and may not be covered by insurance. Beyond that, most reproductive cancers are not linked to genetic mutations, implying that other risk factors must be more carefully researched. 

Despite the clinical importance of risk assessment, the underlying mechanisms of these factors that increase gynecologic cancer risk are not fully understood. While some of them, like aging and smoking, are known to contribute to cancer-causing DNA damage, other factors aren’t as well understood. 

For example, an article in the International Journal of Gynecology and Obstetrics discussing the link between obesity and gynecological cancers explained multiple correlations between obesity and gynecological cancers. Research has shown increased body mass index (BMI) is linked to higher cervical adenocarcinoma risk. Despite knowing that obesity can independently increase gynecological cancer risk, little research has explained the link. 

Beyond obesity, the link between PCOS and increased gynecological cancer risk is a widely accepted phenomenon backed by multiple evidence-based scientific studies. Meanwhile, the mechanisms behind this link are poorly understood. In a 2023 review article published in Cureus, researchers maintain that additional studies on the connection between the two conditions that consider other confounding factors are vital to developing effective diagnosis and treatment approaches. 

STI status can be a critical predictor of gynecological cancer risk, as certain sexually transmitted diseases have been linked to female reproductive cancers. Despite recommendations for regular STI screenings, only 28% of women 18–64 have been screened for chlamydia or herpes in the past two years. Even fewer, 25%, have had an HIV screening. Research on effective public health strategies encouraging HIV screenings and STI tests can improve risk assessments. 

Conversely, using oral contraceptives may contribute to a reduced risk of some types of cancer. According to the National Cancer Institute (NCI), a subset of the National Institutes of Health (NIH), observational studies have implied that oral contraceptives may reduce the risk of endometrial, ovarian, and colorectal cancers. However, they may increase the risk of breast and cervical cancer. Regardless of observational research on cancer incidence and prevalence, this type of research cannot definitively assess the impact of using contraceptives on cancer risk.  

In addition to a limited understanding of risk factors, providers need a way to assess risk definitively. As growing fields, artificial intelligence (AI) and machine learning (ML) may present opportunities to develop additional risk assessment tools using new and existing data on disease epidemiology.  

Detection and Diagnosis 

While assessing risk can be an excellent tool for knowing what prevention strategies to apply, and when to screen patients for gynecological cancer, gaps in the detection and diagnosis of gynecological cancer also exist. Globally, oncologists agree that early diagnosis and treatment are the best predictors of cancer survival. However, without the tools to detect or screen for cancer, many gynecological cancers are detected in later stages.  

The only standard screening tool for gynecological cancer is the Pap test, also called a Pap smear, which can detect abnormal cervical cells that are cancerous or precancerous. However, an article by KFF estimates that only 59% of women in the recommended cervical cancer screening group have had a Pap test in the past two years. 

According to a publication in Cancer Medicine evaluated 499 women diagnosed with cervical cancer, nearly half of the patients were not screened during the lookback window. Approximately 31% of the patients assessed in this study had a screening test failure. 

While an HPV test can detect the presence of HPV infections that may result in cervical cancer, it is not necessarily a diagnostic tool. 

Even with screening tools available, many patients are not diagnosed until the disease has reached its late stages. The International Journal of Gynecology and Obstetrics explains that obese patients are twice as likely to have cervical cancer but less likely to be diagnosed at earlier stages. Obese patients have a higher rate of defective screening and missed diagnoses. Even so, clinical research has failed to develop a new way to detect these cancers. 

While there are screening tools for cervical cancers, ovarian cancer has no available diagnostic tools. In a press release from the National Academies of Sciences, Engineering, and Medicine, the organization noted that ovarian cancer may be considered a silent killer because its early symptoms go undetected. 

An estimated two-thirds of ovarian cancer cases are not diagnosed until the condition has advanced, which results in a low five-year survival rate of 30%. 

“While progress has been made in ovarian cancer research over the past few decades, much remains to be learned,” said Jerome F. Strauss III, chair of the committee that carried out the study and wrote the report, and executive vice president for medical affairs and dean of Virginia Commonwealth University School of Medicine, Richmond, in the press announcement.  “The more that is understood about the basic biology of various types of ovarian cancers, such as where they originate in the body, the more rapidly we can move toward advances in prevention, screening, early detection, diagnosis, treatment, and supportive care.” 

Treatment 

Gynecological treatments are littered with gaps that must be addressed with research. For example, the first-line chemotherapy option for cervical cancer is only effective in 48% of cases. Understanding the limitations in gynecological cancer treatments, clinical researchers in the health system must address these treatment gaps. 

In a 2023 European Network for Gynecological Rare Cancer Research meeting, Neil Conlon, PhD, explained that TROP2-directed antibody drug conjugate-based treatments have successfully targeted epithelial ovarian cancer cells in preclinical studies. However, additional research into its human applications is necessary before it can be adopted as a treatment. 

Additionally, immunotherapy options for patients with gynecological cancers have been successful in patients with a BMI in the normal range; however, many successful outcomes do not translate in overweight or obese patients. Future research should assess why immunotherapy is less successful with out-of-range BMIs and how treatments could be adjusted to yield similar successes in these patients. 

Beyond treatment options and efficacy, fertility issues post-treatment is a significant concern. While nearly all cancer treatments result in reduced fertility, infertility is a more substantial threat among gynecological cancer patients. Those wishing to get pregnant after treatment often have to go through expensive egg retrieval and freeing. Additional research must consider fertility-sparing options for gynecological cancer treatments. 

Other Ongoing Gaps and Disparities in Gynecological Cancer 

In addition to biology and pharmacology-related research gaps in gynecological cancer, there are also gaps in societal and public health research for these conditions. Race, ethnicity, socioeconomic status, and other social determinants of health impact the diagnosis and treatment of gynecological cancer.  

For example, the Centers for Disease Control and Prevention (CDC) estimates that Black and non-Hispanic White women have similar cervical cancer incidence rates, with 7 new diagnoses per 100,000 women in 2020. However, Black women have higher cervical cancer death rates at 3 deaths per 100,000 women, compared to 2 deaths per 100,00 women.  

A study published in JAMA Network Open suggests that Black women are 18% more likely to be diagnosed with advanced-stage cervical cancer, which may contribute to cancer survival inequities.  

Understanding existing research gaps and health disparities, it is clear that high-quality, comprehensive gynecological cancer research, diagnosis, and treatment requires a collaborative effort and advocacy from multiple stakeholders, including providers, researchers, and public health experts.