From the Guidelines
The female reproductive system is at risk for various types of cancer, including endometrial, ovarian, and cervical cancer, with ovarian cancer being the most lethal, and thus, it is crucial to prioritize early detection and prevention strategies to improve morbidity, mortality, and quality of life. According to the American Cancer Society's 2022 guideline for cancer survivors 1, gynecologic cancers, which include cancers of the cervix, ovary, uterus, vagina, and vulva, are estimated to result in 115,130 new cases and significant mortality in the United States. The most common gynecologic malignancy is endometrial cancer, with an estimated 65,950 new cases and 12,550 deaths in 2022, highlighting the need for awareness and screening for this type of cancer. Key statistics include:
- Endometrial cancer has a 95% survival rate if diagnosed with localized disease 1
- Ovarian cancer has an overall 5-year survival rate of 49%, but this increases to 93% for women diagnosed with localized disease 1
- Invasive cervical cancer is estimated to result in approximately 4280 deaths in 2022 1 Understanding these statistics and the role of nutrition and physical activity in gynecologic cancer prognosis, which is largely unknown 1, can inform strategies for reducing the risk and improving outcomes for women with these cancers. Given the high mortality rates associated with these cancers, particularly ovarian cancer, early detection and prevention are critical for improving morbidity, mortality, and quality of life. Therefore, it is essential to prioritize regular screening, healthy lifestyle choices, and awareness of the risks and symptoms of these cancers to reduce their impact on women's health.
From the Research
Overview of the Female Reproductive System
- The female reproductive system is composed of internal organs and the vulva, with disorders associated with these organs requiring management and treatment by health professionals 2.
- Menstrual irregularities are a common issue in women, with polycystic ovary syndrome (PCOS) being a hormonal disorder characterized by menstrual irregularities, high androgen levels, and ovarian cysts 3.
Menstrual Irregularities and Associated Risks
- Menstrual irregularities have been linked to an increased risk of cervical cancer, with a study finding that patients with a diagnosis of menstrual irregularity had a statistically significant higher odds of association for being diagnosed with cervical cancer 4.
- The clomiphene citrate challenge test (CCCT) is used to evaluate ovarian reserve in women with menstrual irregularities and/or infertility, with results showing that women with normal CCCT results had higher mean plasma levels of anti-Müllerian hormone (AMH) compared to those with abnormal results 5.
Ovulation Induction Therapies
- Clomiphene citrate and letrozole are two ovulation induction therapies used in women with PCOS, with a study comparing the efficacy and safety of a stair step protocol of letrozole versus clomiphene citrate in women with PCOS 3.
- Letrozole was found to have a higher ovulation rate and shorter time to ovulation compared to clomiphene citrate, although the difference in ovulation rate was not statistically significant 3.
Cancer Risk and Ovulation-Stimulating Drugs
- The long-term effects of ovulation-stimulating drugs on cancer risk are not fully understood, with some studies suggesting possible risk increases for ovarian, breast, and endometrial cancers 6.
- Clomiphene usage has been linked to an increased risk of endometrial cancer, with further follow-up necessary to fully resolve the effects of exposures such as gonadotrophins used in conjunction with IVF 6.