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Women in the dark about certain cancers

Pharmacy Magazine, clock5 Min

Women in the dark about certain cancers

Pharmacy Magazine, clock5 Min

In OTC

Women are in the dark about gynaecological cancers, but pharmacists can save lives by highlighting risks and symptoms.

While women are usually more in tune with health matters than men, poor understanding of certain gynaecological cancers is endangering thousands of women’s lives.

As women are regular pharmacy visitors, pharmacists clearly have a role to play in raising awareness of the risk factors and signs and symptoms of these cancers, as well as encouraging uptake of screening and vaccination where necessary.

This feature will focus on ovarian cancer, which is commonly believed to have no symptoms, and cervical cancer, the risk of which many women underestimate.

Ovarian cancer

Over 7,000 women in the UK are diagnosed with ovarian cancer each year, while over 4,200 die from the disease, making it the country’s second commonest gynaecological cancer and its biggest gynaecological cancer killer.

According to the charity Ovacome, the poor survival rates are due to the fact that ovarian cancer is usually not diagnosed until an advanced stage, because the initial symptoms are hard to detect. A recent survey by Ovacome found that over 90 per cent of women with ovarian cancer did not know the symptoms of the disease prior to diagnosis.

“Women’s bodies are designed to contain large masses in the abdomen, which is one of the reasons why ovarian cancer is difficult to pick up,” explains Ovacome founder and chief executive Louise Bayne. “The ovaries are tucked away inside the pelvis, but tumours in the reproductive organs can quickly impact on other abdominal areas. Ovarian cancer is often known as a silent disease but our message is that it is not silent; it whispers, so listen.”

The charity uses the simple acronym ‘BEAT’ to help women identify the symptoms and seek advice from their GP promptly:

  • Bloating that doesn’t come and go
  • Eating difficulties
  • Abdominal and pelvic pain
  • Talking to your doctor.

Raising awareness

Thanks to various campaigns and initiatives, including the Government’s ongoing ‘Be Clear on Cancer’ campaign and Ovarian Cancer Awareness Month in March, awareness of the symptoms is growing among both women and healthcare professionals.

However, due to the nature of the symptoms, ovarian cancer is often misdiagnosed as irritable bowel syndrome (IBS). Louise Bayne believes that pharmacists have an important role in picking up these cases, by referring to their GP those women repeatedly purchasing products for IBS without seeing an improvement in their symptoms.

Pharmacists and their staff can raise awareness of ovarian cancer symptoms, she says, by supporting the campaigns and signposting concerned women towards the Ovacome website and helpline (0845 371 0554). The website includes a new BEAT symptom tracker that allows women to keep a daily record of their symptoms, which they can print out and show to their GP. Factsheets and posters are also available for pharmacies via the site.

Risk factors and screening

Cancer can occur in the ovary at any age, although the commonest type (epithelial) is seen most often after the age of 45 years old. The cause is unknown but 10 per cent of ovarian cancers are associated with BRAC 1&2 genetic alterations.

“Women with a strong family history of ovarian and/or breast cancer are at increased risk; they should contact our helpline to discuss their risk level and options,” says Louise Bayne. “Certain factors are known to have a small-scale effect on reducing the risk of ovarian cancer, including taking combined oral contraceptives, having children and breastfeeding, but ovarian cancer is not considered a lifestyle disease.”

Mind the gap...

Pharmacists could help improve the health and wellbeing of their female customers with some simple dietary advice. Fibre and iron are two key nutrients, the intakes of which are often below average.

Fibre facts

Fibre has a key role to play in maintaining the health of the digestive tract, controlling blood cholesterol and blood glucose levels, and managing digestive discomfort such as bloating and constipation. Despite these benefits, the majority of people do not have an adequate fibre intake, according to the British Dietetic Association (BDA).

Replacing refined cereals, breads and pasta with wholegrain versions is a good way of boosting fibre intake. Evidence suggests that wheat bran is particularly effective at relieving digestive discomfort as it contains more fibre per gram than other grains or fruit and vegetables.

Iron info

Data from the latest National Diet and Nutrition Survey (NDNS) found that 21 per cent of women have daily iron intakes below the minimum recommended level for health, while nearly a third of girls and 17 per cent of women have low iron stores. Women have a daily iron requirement of 14.8mg, and deficiency can lead to anaemia, fatigue, hair loss and increased susceptibility to infections.

“Minerals play a critical role in everyday health and wellbeing, so it is quite concerning when a considerable proportion of the population has intakes below the lower reference nutrient intake – the minimum for normal health,” says Dr Carrie Ruxton, dietitian and member of the Meat Advisory Panel. “As red meat is rich in minerals, one way for people to ensure they do receive adequate amounts of minerals is to include lean red meat in their diet.”

 

Early stage ovarian cancer can be detected through blood tests for the CA 125 protein, which is elevated in women with the cancer, or by trans-vaginal ultrasound scans; however both methods can produce false negative and false positive results. The UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) is researching the impact of routine screening on survival rates, with the findings expected in 2015.

In the meantime pharmacists, alongside other healthcare professionals, should try to dispel the widespread myth that cervical cancer screening can detect ovarian cancers.

Cervical cancer

Every year in the UK, around 3,000 women are diagnosed with cervical cancer and 1,000 women die from the disease. Cervical cancer is the commonest cancer in women aged 35 years and under, with 99.7 per cent of cervical cancers caused by persistent infection with certain strains of the human papillomavirus (HPV), which can cause changes to the cervical cells. HPV is transmitted via genital contact as well as sexual intercourse, so condoms offer limited protection against it.

“Anyone who is sexually active is at risk of HPV and 80 per cent of us will be exposed to the virus at some point in our lives, although in most cases the immune system fights it off and there are no symptoms,” explains Robert Music, chief executive of Jo’s Cervical Cancer Trust.

Women who smoke are at a slightly increased risk of persistent HPV infections, as smoking weakens the immune system while, conversely, a healthy lifestyle may reduce the risk.

There are rarely any symptoms with cervical abnormalities or early stage cervical cancer, although some women report abnormal bleeding; post-menopausal bleeding if not taking HRT; unusual vaginal discharge; pain or discomfort during sex; or lower back pain.

SEM of cervical carcinoma

Screening rates

Thanks to the introduction of the HPV vaccination programme, as well as the national cervical cancer screening programme, cervical cancer is largely preventable, and if detected early survival rates are high. However the latest Government statistics (2011) show that there has been an increase in cervical cancer diagnoses, while routine screening uptake has been falling steadily in recent years and currently stands at 78 per cent.

One in three women aged 25-29 years didn’t attend cervical screening last year

 According to Robert Music, drops in screening rates have been particularly prominent in the first and last age groups to be invited for routine cervical screening. One in three women aged 25-29 years didn’t attend cervical screening last year, while screening rates among 60-64 year-olds are at a 16-year low.

Women face various barriers to screening, including embarrassment, fear, inconvenience or lack of understanding, and barriers may vary between different age and ethnic groups.

“Increasing sexual activity among older women could expose them to HPV but we are concerned that these women may not realise they are at risk,” says Robert Music. “Our research has also shown that women from black or minority ethnic backgrounds have a lower understanding of screening’s relevance compared with white women. We need targeted awareness campaigns for different age and ethnic

 

Problems down below...

Women often delay seeking advice or put up unnecessarily with intimate health problems due to embarrassment or a belief that nothing can be done. Pharmacists and their staff have an important role to play in advising female customers on effective OTC products, self-help measures and when to consult a GP.

Bladder weakness

Over 9 million women in the UK have some form of bladder weakness problem, according to the Bladder and Bowel Foundation (B&BF). Stress urinary incontinence (SUI), the commonest type of bladder weakness in women, occurs when the pelvic floor muscles become weakened due to obesity, pregnancy and childbirth or the menopause.

Bladder weakness can be easily managed with continence pads and liners, which are more effective at absorbing urine than sanitary products. Women should also be encouraged to see their GP who may refer them to a physiotherapist to learn pelvic floor exercises.

Cystitis

Almost all women will have cystitis at least once in their lifetime, while one in five women suffer from recurrent bouts, according to NHS Choices. Cystitis can occur at any age but is commoner in women who are pregnant, sexually active or post-menopausal. The infection usually clears up within a few days and can be self-managed with fluids and analgesics, while some women find that urine alkalising agents, such as sodium bicarbonate or potassium citrate, help relieve pain when urinating. Severe cases may require antibiotics.

Thrush

Thrush is caused by an overgrowth of the yeast candida albicans, and is associated with itching, irritation and a white, thick discharge. Women are advised to visit their GP for a diagnosis the first time they experience thrush and can then visit their pharmacy for subsequent bouts once they can recognise the symptoms. Various effective OTC treatments are available, including oral antifungal products containing fluconazole or itraconazole, and pessaries and creams containing clotrimazole.

Bacterial vaginosis

Bacterial vaginosis (BV) occurs due to an imbalance in bacteria in the vagina and can cause an abnormal discharge, which is usually thin and grey, with an unpleasant ‘fishy’ odour, although it does not normally cause irritation. A survey of 2,000 women commissioned by Balance Activ revealed that 61 per cent of women have never heard of BV, while two in three misdiagnose it as thrush, despite the fact that it is twice as common. BV can either be treated with antibiotics or through the use of vaginal gels, which restore the pH balance of the vagina.

Vaginal atrophy

In the UK, 3 million women are affected by vaginal dryness (vaginal atrophy) brought on by the menopause. Specialist gels and pessaries containing hyaluronic acid are available OTC to relieve dryness and discomfort, although many women suffer in silence.

Painful periods

Period pain (dysmenorrhoea) affects up to three-quarters of women and usually has no underlying cause. It can normally be self-treated with OTC NSAIDs, such as ibuprofen, or in more severe cases, naproxen. Heated pads or hot water bottles are also effective and can be used in conjunction with NSAIDs. In addition, combined oral contraceptives can reduce the severity of period pains.

 

HPV vaccination

Introduced in 2008, the national HPV immunisation programme routinely offers the HPV vaccine to all girls aged 12-13 years in school, while it is also available free to girls up until their eighteenth birthday in other settings. The vaccine offers 98 per cent protection from cervical abnormalities associated with HPV 16 and 18 (the strains responsible for 70 per cent of all cervical cancers) in women who have all three doses and have not yet been infected with HPV.

To date, the vaccination programme has reached the target of immunising at least 80 per cent of eligible girls each year. Research indicates that if this uptake is maintained, cervical cancer cases in women under 30 will fall by two-thirds by 2025.

Recent research from Public Health England has shown that infection rates with HPV 16 and 18 have already fallen from one in five sexually active young women to one in 15 since the programme was introduced. Extending the vaccine to boys is unlikely to have much impact on cervical cancer rates as uptake among girls is so high, says Robert Music, although it may help reduce incidence of other HPV-related cancers, including penile cancer and cancers of the mouth, head and neck.

 

Hair today?

Hair loss or thinning in women remains a taboo topic, although it affects an estimated 40 per cent of women aged between 30 and 60 years of age, and can cause a great deal of distress. A recent independent survey, commissioned by hair loss supplement Nourkrin for the National Hair Aware Campaign, found that 46 per cent of women suffer in silence with hair loss and don’t know where to seek advice.

All types of hair loss involve a disrupted hair growth cycle. The two commonest types of hair loss in women are telogen effluvium and female pattern baldness (androgenetic alopecia). The former is usually temporary and occurs a few months after a shock to the system, such as extreme stress; childbirth; sudden weight loss; surgery; or as a reaction to medication. The latter is a hereditary condition, in which the hair follicles become sensitive to normal levels of testosterone, usually after the menopause, and causes gradual thinning to the front and crown area of the scalp. Dietary deficiencies and hormonal disorders can also lead to hair loss.

Women should be careful to avoid products claiming to offer ‘miracle cures’ and should be advised to visit their GP initially to determine the underlying cause of their hair loss. There are OTC products available that may help to maintain hair and even promote regrowth, including a drug-free supplement containing marilex, which helps to normalise the hair growth cycle, and a lotion containing minoxidil, which increases the supply of blood and nutrients to the hair follicles.

For further support and information, pharmacists can refer concerned women to the National Hair Aware campaign website.

Pharmacy education

Community pharmacists could use their public health role to encourage uptake of cervical screening and HPV vaccination, Robert Music says, as well as dispelling myths about HPV and raising awareness of cancer symptoms.

“Thousands of women visit pharmacies every day so pharmacists have a good opportunity to talk to them about screening and cancer symptoms,” he says. “The HPV vaccine only protects against two-thirds of cervical cancer cases, so women who have been vaccinated may need reminding that they still need to attend screening.

“One study found that women were more likely to see their GP about cold/flu symptoms than about abnormal bleeding. The message is that it’s highly unlikely to be cancer but it’s important to get it checked out.”

Jo’s Cervical Cancer Trust offers materials to pharmacies and runs two campaigns each year – Cervical Screening Awareness Week (June 8-14, 2014) and Cervical Cancer Prevention Week, which ran in January.

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