The risk of cancers increase as women get older. After 75 years of age, 1: 4 women will have cancer. One third of cancers are preventable. One third of cancers are treatable if detected early. The commonest cancer in Malaysia is breast cancer, followed by colorectal, cervical, ovarian and lung cancer
Knowing her risk factors and family history is important as it can help decide on certain tests for early detection. The American Cancer Society recommends the following for early detection.
he peak incidence of breast cancer in Malaysian women is between 50 – 69 years. Screening of women aged 40 and above showed a 14% relative risk reduction of breast cancer mortality through early intervention in women aged 50-59 years.
In Malaysia, screening mammograms are recommended for women who are at high risk such as women with previous breast atypia, breast or ovarian cancer, family history of breast cancer in first or second degree relatives before the age of 50 years.
Due to limited resources, it is not advised for all eligible women. Many women are advised to take advantage of the government subsidized mammograms offered in various centers on a regular basis or to have their mammograms done at private hospitals.
Screening mammograms can be done for any woman after the age of 40 years and then repeated at 2 yearly intervals.
Ultrasound breasts are advised for women below the age of 40 years, and women with dense breasts.
Early intervention after early detection can reduce the risk of breast cancer mortality by 14%.
After 50 years
Tests that find polyps and cancer (American Cancer Society)
- Colonoscopy every 10 years, or
- CT colonography (virtual colonoscopy) every 5 years*, or
- Flexible sigmoidoscopy every 5 years*, or
- Double-contrast barium enema every 5 years*
Tests that mostly find cancer
- Yearly fecal immunochemical test (FIT)**, or
- Yearly guaiac-based fecal occult blood test (gFOBT)**, or
- Stool DNA test (sDNA), every 3 years*
* If the test is positive, a colonoscopy should be done.
** The multiple stool take-home method should be used. One test done by the doctor is not enough. A colonoscopy should be done if the test is positive.
Colon cancer is the 3rd leading cause of death in women in Malaysia. Faecal occult blood testing beginning at 50 years should be done and continued until 75 years every 2 years. This can reduce the risk of dying from colon cancer to 13% from 21%.
Regular pap smears and pelvic ultrasounds can pick up early uterine cancer. In women with a uterus, progestins should always be taken along with estrogen for hormone therapy treatment of the menopause. Always see a doctor if one has post-menopausal bleeding.
Women with history of polycystic ovarian disease, early and late menopause and family history of non polyposis colon cancer have a higher incidence of uterine cancer. Women with breast cancer who is on Tamoxifen should also have regular uterine screening.
Cervical cancer can affect any woman who is or has been sexually active. It occurs in women who have had the human papilloma virus (HPV). This virus is passed during sex. Cervical cancer is also more likely in women who smoke, have HIV or AIDS, have poor nutrition, and who do not get regular Pap tests.
Women who are sexually active should be screened with a pap smear. Pap smears should be ideally done 1- 3 yearly from the age of 20 – 65 years. A woman who has been vaccinated against HPV should still follow the screening recommendations for her age group.
Cervical cancer is the second most common cancer in Malaysia. Around 5 women die from cervical cancer daily. However only 23% of women have their pap smears done yearly. Around 80% of cervical cancers are detected in the late stage.
Ovarian cancer is more likely to occur as women get older. Women who have never had children, who have unexplained infertility, or who had their first child after age 30 may be at increased risk for this cancer. Women who have used estrogen alone as hormone replacement therapy are also at increased risk. Women with a personal or family history of hereditary non-polyposis colon cancer (HNPCC), ovarian cancer, or breast cancer are more likely to have this disease. But women who don’t have any of these conditions can still get ovarian cancer.
A pelvic exam should be part of a woman’s regular health exam. Unfortunately ovarian cancer is usually detected late as it usually does not cause any symptoms until it is advanced. Bloating, and abdominal distension should always be checked out.