Health awareness is vital as it will help you to recognise if you are at risk of cancer, to know how to protect yourself and also to spot the symptoms early so treatment can be successful.

Do this quiz and find out how much you actually know about gynaecological cancer.

Instructions:

Read each statement and decide if you think it is true or false. You can then see if you are right or wrong and why

1. The combined oral contraceptive pill causes ovarian cancer (True/False)

2. Bleeding after sex may be a symptom of cervical cancer (True/False)

3. All gynaecological cancers are hereditary (True/False)

4. The right lifestyle choices can reduce your chances of getting cancer (True/False)

5. You can only get cervical cancer if you have sex with a man (True/False)

6. A smear is a cancer test (True/False)

7. Hormone replacement therapy increases the chance of getting womb and ovarian cancer (True/False)

8. Gynaecological cancers cannot be cured (True/False)

9. Removing the fallopian tubes if you are having a hysterectomy can reduce your chances of getting ovarian cancer (True/False)

10. Smears can detect all gynaecological cancer (True/False)

ANSWERS

Question 1 The combined oral contraceptive pill causes ovarian cancer

Answer: False

The Pill as it is commonly known has several health benefits. It is a reliable form of contraception and, in addition, it makes periods regular and lighter, protecting women against anaemia.

Some women are concerned about taking the pill because they may have heard that it increases the risk of gynaecological cancers. This should not be the case. The pill protects women against ovarian cancer and the longer you take the pill for, the lower your risk of ovarian cancer. Women who take the pill for 5 years have half the risk of developing ovarian cancer compared with women who have never taken the pill.

The pill also protects against cancer of the lining of the womb (Endometrial cancer). There is evidence that this protection lasts for up 15 years after you stop taking the pill.

Question 2 Bleeding after sex may be a symptom of cervical cancer

Answer: True

Bleeding after sex is a common symptom. In most cases it will be due to benign (non-cancerous) conditions such as infection with Chlamydia or cervical ectropion. Bleeding after sex can however be a symptom of cervical cancer and you must never ignore it. Other symptoms of cervical cancer include:

• Bleeding in between periods
• Bleeding after the menopause
• A very smelly discharge that does not go away.

You should seek help immediately if you have any of these symptoms.

Question 3: All gynaecological cancers are hereditary

Answer: False

Most gynaecological cancers occur by chance, to which lifestyle and environmental factors may contribute. Only a small minority of gynaecological cancers are hereditary and these occur when a woman inherits a faulty gene from one of her parents.

The commonest of these are the BRCA gene mutations – BRCA1 and BRCA2. A fault in these genes impairs the body’s ability to repair abnormalities in cells that may lead to cancer. A parent who has a BRCA gene mutation has a 50% chance of passing the gene to his or her offspring.

Women with a BRCA gene mutation have a much higher risk of developing breast and ovarian cancer than the general population. They also tend to develop these cancers at a younger age.

A BRCA1 mutation is associated with:

• 60-90% chance of breast cancer
• 40-60% chance of ovarian cancer

A BRCA2 mutation is associated with:

• 45-85% chance of breast cancer
• 10-30% chance of ovarian cancer

If you have family members who have a BRCA gene mutation, or think you might, you should seek medical advice about testing for the genetic abnormality.

There is no indication that the other gynaecological cancers: cervical or vulval are associated with a hereditary pattern.

Question 4: The right lifestyle choices can reduce your chances of getting cancer

Answer: True

No one can guarantee that you will avoid cancer but certain lifestyle choices can help to reduce the risk of some gynaecological cancers. Here are some things to think about:

Diet and exercise:

• Endometrial cancer is the commonest gynaecological cancer in the UK. It is directly associated with obesity and the number of women affected by this cancer continues to increase as the rates of obesity rise. This is because fat produces a female hormone, oestrogen which has a direct effect on the lining of the womb and can cause changes which can lead to cancer.

You can reduce your chances of getting endometrial cancer by eating a healthy diet, taking regular exercise and maintaining the right body weight for your height.

Smoking:

• Everyone knows that smoking causes lung cancer but fewer people know that it also causes cervical cancer. Cervical cancer is caused by an infection called the high risk human papilloma virus. This virus is more likely to persist in the cervix if you smoke as it has a direct effect on the immune system of the cervix and can also cause vulval cancer.

Avoiding smoking significantly reduces your chances of getting an abnormal smear and of developing cervical cancer.

Vulval Skin Conditions:

• A lot of women suffer from itching of the vulva (the skin on the outside of the genital tract). This is more common in older women and some women tend to ignore it or not go to the doctor because they are too embarrassed. Some of the skin conditions that cause the itch can lead to cancer if undetected and untreated such as Lichen Sclerosis. If the diagnosis is made then the condition can be managed by steroid creams which make you more comfortable and also reduce your risk of getting cancer.

If you have an itch, do go and see your doctor so you can be referred to a specialist to get proper treatment. Do not ignore it or self-medicate.

Family History:

• A small minority of gynaecological cancers are caused by an inherited predisposition. If you inherit a faulty gene then your chances of getting endometrial or ovarian cancer can increase to 50%. If you are known to belong to a high risk group then you may be eligible for monitoring or risk reducing surgery that will modify your chances of getting these cancers.

If you have a family history of breast, bowel, womb or ovarian cancer you must speak to your doctor to find out if you’re eligible for genetic testing.

Question 5: You can only get cervical cancer if you have sex with a man

Answer: False

The High Risk Human Papilloma Virus (HRHPV) is the virus that causes cervical cancer.

The commonest HRHPV (HPV16 and HPV18) are responsible for 75% of cervical cancer cases with 80% (4 out of 5) of us developing the infection at some stage. The HRHPV is passed on by sex or genital contact. Everyone who has ever had sex, whether in a heterosexual or same sex relationship, is at risk of infection with the HRHPV virus, even if you are not currently sexually active.

In most cases, the body’s immune system will get rid of the virus within a year or two. In some women, for reasons we do not fully understand, the virus infection persists. It is this persistent infection that leads to the cell abnormalities that can cause cervical cancer.

We cannot treat HRHPV infection but we can treat the cell changes it causes to reduce the risk of cervical cancer. The best way to protect yourself against cervical cancer is to go for regular screening smear tests.

Question 6: A smear is not a cancer test

Answer: True

A smear is not a cancer test – it is a test to protect women from getting cancer

Women who live in England and Wales are invited for cervical screening smear tests on the NHS from the age of 25 and are asked to attend every three years till the age of 50. If the tests have been normal, the frequency of screening is reduced to every five years from the age of 50 till the age of 65, when women are discharged from the screening programme.

Sometimes people refer to this test as a cancer test as they assume that the test is to detect cancer of the cervix. This is incorrect. The test protects against cancer of the cervix. This is because, before cancer develops, the cells that line the cervix can undergo changes, known as pre-cancerous changes which, if undetected and untreated, can develop into cervical cancer.

The changes can be detected on a smear. If you have an abnormal smear, you will be referred for colposcopy. If the abnormality is confirmed, you will be offered treatment which, in most cases, is a simple outpatient procedure. Nineteen out of 20 women will only need one treatment so it is highly successful

It is estimated that cervical screening saves 5000 lives a year.

Question 7: Hormone replacement therapy (HRT) increases the chance of getting womb and ovarian cancer

Answer: True

Hormone replacement therapy (HRT) may be given to women after the menopause to help them deal with some of the symptoms such as hot flushes and mood changes. While HRT may improve the quality of life for menopausal women, there is good evidence that it can increase the risk of ovarian and womb cancer.

HRT replaces oestrogen and progesterone, the hormones of the female reproductive system. Most forms of HRT contain both these hormones (combined HRT) but in certain circumstances, women may be given oestrogen only HRT.

Using either oestrogen-only or combined HRT increases a woman’s risk of ovarian cancer. In 2015 new research found that there is an increased risk of ovarian cancer even for women who are taking HRT for under 5 years.

HRT also increases the risk of womb cancer. This risk is mainly related to oestrogen only HRT but combined HRT may also be associated with an increased risk.

If you are worried about taking HRT, do not just discontinue it – seek medical advice

Question 8: Gynaecological cancers cannot be cured

Answer: False

All gynaecological cancers can be completely cured if diagnosed early. It is important therefore that women are aware of the signs and symptoms of gynaecological cancers and that they do not ignore these. You must see your doctor urgently if you develop any of the below symptoms:

• Bleeding after the menopause: This is always abnormal and may indicate womb or cervical cancer
• Bleeding after sex or between periods: Never ignore this as it may indicate cervical cancer
• A persistent smelly discharge: Vaginal discharge should never be smelly and this symptom may indicate cervical cancer
  Vulval itching, bleeding or soreness: This always needs to be investigated as it may indicate vulval cancer
• Abdominal bloating, swelling, discomfort or change in bowel habit: This may indicate ovarian cancer.

Question 9: Removing the fallopian tubes if you are having a hysterectomy can reduce your chances of getting ovarian cancer

Answer: True

Ovarian cancer is a difficult disease to treat. This is because it does not have obvious symptoms in the early stages and as a consequence, three out of four women will have advanced disease at diagnosis.

Approximately 4000 women die of ovarian cancer in the UK every year and only one in three women diagnosed with ovarian cancer will be alive in 10 years. Thus it is worth making a big effort to try to avoid developing the disease in the first instance. Removing the ovaries and Fallopian tubes reduces the risk of developing ovarian cancer.

Research suggests that some common types of ovarian cancer actually start in the Fallopian tubes. Removing the tubes and leaving the ovaries behind at least until the menopause, reduces the risk of ovarian cancer without leading to problems associated with a premature menopause.

Question 10: Smears can detect all gynaecological cancer

Answer: False

The Cervical Screening System is designed to protect women against cervical cancer. This is because a smear test can detect abnormal cells from the cervix that are not cancerous but if undetected and untreated, can develop into cancer over time. The cells give no symptoms, so you would not be aware you had abnormal cells if you didn’t attend a cervical screening test. The changes are fully treatable, usually by a simple outpatient procedure and treatment prevents progression to cancer. Cervical screening saves approximately 5,000 lives a year.

However cervical screening is just that – a test to protect women against cervical cancer. It does not screen for other cancers and having a normal smear does not indicate that you are protected from other gynaecological cancers such as ovarian, womb or vulval cancer.

Congratulations on taking this test.

If you scored 70% or more, then you are truly well informed.

If you scored less than 70% then you have just learned a lot that you did not know before.