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- Cervical cancer:
- HPV (human papilloma virus): For cervical cancer, the most important risk factor is infection with HPV (human papilloma virus). HPV is a group of more than 100 types of viruses that may cause genital warts or cancers of the cervix. If the viruses cause cervical cancer, they are known as high risk HPVs. HPV is contracted during sexual intercourse. Having unprotected sex increases the risk of acquiring an HPV infection, and this occurs more often in the younger population. Women who have many sexual partners (or who have sex with men who have had many partners) have a greater chance of getting HPV and thereby developing cervical cancer.
- Smoking: Women who smoke are twice as likely as to contract cervical cancer. Tobacco smoke can produce chemicals that may damage DNA in cells of the cervix, which makes the cancer more likely to occur.
- HIV infection (human immunodeficiency virus): HIV is the virus that causes AIDS, and may also be a risk factor for cervical cancer. Being HIV positive makes a woman's immune system less able to fight both HPV and early cancers.
- Many sexual partners: The larger the number of sexual partners, the greater the chances of acquiring HPV and possibly cervical cancer.
- Early sexual activity: Having sex before the age of 18 may increase the risk of HPV infection. Immature cells are found in younger aged women, and seem to be more susceptible to the precancerous changes that HPV can cause.
- Chlamydia
infection: Chlamydia is a form of bacteria that can infect women's sex organs and spread during sexual intercourse. Many women are unaware that they have it unless samples are taken at the time of their Pap test. Some studies suggest that women who have this infection (or have had it in the past) are at greater risk for cervical cancer. While further studies are needed to determine if this is true, there are good reasons to avoid this infection or to have it treated. Long-term infections can cause other serious problems.
- Dietary choices: Diet can play a role in its development as well. Diets low in fruits and vegetables are linked to an increased risk of cancers including cervical cancer. Women who are overweight have been reported to be at a higher risk.
- Birth control pills: The long-term use of birth control pills increases the risk of cervical cancer. Some studies have shown a higher risk after five or more years of use.
- Multiple pregnancies: Women who have had more than one full-term pregnancy have an increased risk of cervical cancer. The cause is not well understood, but has been proven to be true in large studies.
- Low income: Women who are poor are at greater risk for contracting cancer of the cervix. This may be due to their inability to afford good healthcare, such as Pap tests.
- DES (diethylstilbestrol): This drug is a hormone that was used between 1940 and 1971 for women who were in danger of miscarriages. Daughters of women who took this drug have been reported to have a slightly higher risk of vaginal and cervical cancer.
- Family history: Studies suggest that women whose family members have had cervical cancer are at an increased risk of getting the disease themselves. This may be because they are less able to fight HPV or a number of other factors could be involved.
- Age: Because full-blown cervical cancer typically takes years to develop, women between the ages of 35 and 50 years are the ones who are most frequently diagnosed. However, women older than 50 or who are postmenopausal are not protected from cervical cancer. Women aged 65 years and older account for 25% of cervical cancer cases and 41% of deaths.
- Endometrial cancer:
- When the balance of the hormones estrogen and progesterone shifts toward more estrogen (which stimulates growth of the endometrium), a woman's risk of developing endometrial cancer increases. Factors that increase levels of estrogen in the body include:
- Long-term menstruation: Individuals who begin menstruating at an early age, such as before age 12, and continue to have periods into their 50s, are at greater risk of endometrial cancer than a woman who has menstruated for fewer years. The more years the individual has had periods, the more exposure the endometrium has to estrogen.
- Never being pregnant: Pregnancy seems to protect against endometrial cancer. The body produces more estrogen during pregnancy, but also produces more progesterone. Increased progesterone production offsets the effects of the rise in estrogen levels. Women with excess exposure to estrogen that is not balanced by progesterone tend to be at an increased risk of endometrial cancer.
- Irregular ovulation: Ovulation, the monthly release of an egg from an ovary in menstruating women, is regulated by estrogen. Irregular ovulation or failure to ovulate can increase the individual's lifetime exposure to estrogen. Ovulation irregularities have many causes, including obesity and a condition known as polycystic ovary syndrome (PCOS). PCOS is a condition in which hormonal imbalances prevent ovulation and menstruation. Treating obesity and PCOS can help restore monthly ovulation and menstruation cycle, decreasing the risk of endometrial cancer.
- Obesity: Fat tissue can alter estrogen levels. Being obese can increase levels of estrogen in the body by altering the metabolism of estrogen, putting the individual at a higher risk of endometrial cancer and other cancers. A high-fat diet and lack of exercise can also add to the risk by promoting obesity. Fatty foods (especially trans fats found in snacks and fried foods) may also directly affect estrogen metabolism, further increasing a woman's risk of endometrial cancer. Obesity may lead to diabetes and metabolic syndrome (including high cholesterol levels, blood sugar regulation problems, and inflammation).
- Estrogen-only replacement therapy (ERT): Replacing estrogen alone after menopause by using estrogen drug therapy may increase the risk of developing endometrial cancer. Taking synthetic progestin, a form of the hormone progesterone, with estrogen (combination hormone replacement therapy or HRT) causes the lining of the uterus to shed and may actually lower the risk of endometrial cancer. Shedding is important because if the uterine lining becomes too thick and the endometrial glands too crowded, endometrial hyperplasia may occur allowing for the development of cellular atypia and then possibly cancer. However, the combination of estrogen and progestin therapy may increase the risk of developing other health conditions, such as cardiovascular disease, breast cancer, and ovarian cancer.
- Ovarian tumors:
Tumors in the ovaries may themselves be a source of estrogen, increasing estrogen levels.
- Age: Most endometrial cancers develop over many years. Therefore, the older the individual, the greater their risk of developing gynecological cancers. Approximately 95% of endometrial cancer occurs in women older than 40.
- History of breast cancer or ovarian cancer: A history of breast cancer or ovarian cancer can also increase the risk of endometrial cancer.
- Tamoxifen therapy: One in every 500 women whose breast cancer was treated with tamoxifen (Nolvadex ®) will develop endometrial cancer. Although tamoxifen acts mostly as an estrogen blocker, it does have some estrogen-like effects and can cause the uterine lining to grow. If the individual is being treated with tamoxifen, a doctor will recommend an annual pelvic examination and ask the individual to report any unusual vaginal bleeding.
- Race: Caucasian women are more likely to develop endometrial cancer, but African American women are much more likely to die of the disease. Although the reasons are not known for this increase in death rates among African American women, socioeconomic, biologic, and cultural factors increase their risks of death.
- Hereditary nonpolyposis colorectal cancer (HNPCC): Hereditary nonpolyposis colorectal cancer
(HNPCC) is an
inherited disease caused by an abnormality in a gene important for DNA repair. Women with HNPCC also have a significantly higher risk of endometrial cancer as well as colon and other cancers.
- Ovarian cancer:
- Women who started menstruating at an early age (before age 12), have no children, had their first child after age 30, and/or experienced menopause after age 50 are at high risk of developing ovarian cancer. Women with a history of breast cancer also are at high risk for developing ovarian cancer. Menopause also increases the risk of developing ovarian cancer, especially if hormonal replacement therapy (HRT) is being used.
- Inherited gene mutations: The most significant risk factor for ovarian cancer is having an inherited mutation in one of two genes called breast cancer gene 1 (BRCA1) and breast cancer gene 2 (BRCA2). These genes were originally identified in families with multiple cases of breast cancer, but they are also responsible for about five to 10% of ovarian cancers. An individual is at particularly high risk of carrying these types of mutations if they're of Ashkenazi Jewish descent. Another known genetic link involves an inherited syndrome called hereditary nonpolyposis colorectal cancer (HNPCC). Individuals in HNPCC families are at an increased risk of cancers of the uterine lining (endometrium), colon, ovary, stomach, and small intestine. Risk of ovarian cancer associated with HNPCC is lower than is that of ovarian cancer associated with BRCA mutations. Other hereditary risk factors include basal cell nevus syndrome, Lynch II Syndrome (also known as hereditary nonpolyposis colorectal cancer), multiple endocrine neoplasia I, and Peutz-Jeghers Syndrome.
- Family history: Ovarian cancer may occur in more than one family member, although it can occur in individuals who have no family members with the disease. If the individual has one first-degree relative (a mother, daughter or sister) with ovarian cancer, the risk of developing the disease is five percent over a lifetime.
- Age: Ovarian cancer most often develops after menopause. The risk of developing ovarian cancer increases with age through a woman's late 70s. Although most cases of ovarian cancer are diagnosed in postmenopausal women, the disease may also occur in premenopausal women.
- Childbearing status: Women who have had at least one pregnancy appear to have a lower risk of developing ovarian cancer, unless the pregnancy was not carried to term.
- Infertility: Studies indicate that infertility may increase the risk of ovarian cancer, even without the use of fertility drugs. The risk appears to be highest for women with unexplained infertility and for women with infertility who never conceive. In some studies, researchers have found that prolonged use of the fertility drug clomiphene citrate (Clomid ®), especially without achieving pregnancy, may increase the risk for developing ovarian tumors.
- Ovarian cysts: Cyst formation is a normal part of ovulation in premenopausal women. However, cysts that form after menopause have a greater chance of being cancerous. The likelihood of cancer increases with the size of the growth and with age. Polycystic ovary syndrome (PCOS) is a disorder where many fluid-filled cysts (sacs) are present and male hormones (androgens) are excessively high. PCOS can increase the risk of developing ovarian cancer.
- Hormone replacement therapy (HRT): Some research suggests that long-term use of HRT (10 years or more) increases the risk of ovarian cancer. In a study of more than 200,000 women, researchers from the American Cancer Society found that using estrogen replacement therapy (estrogen without progestin) for 10 or more years increases the risk of death from ovarian cancer. While the chances of developing ovarian cancer doubles with prolonged estrogen use, the risk still appears to be small, estimated at approximately two percent over a lifetime. However, the study did not include data from women who used combination hormone replacement therapy (estrogen and progesterone), which is the most common regimen prescribed today. While researchers are not certain why estrogen therapy increases the risk of ovarian cancer, they do know that estrogen causes ovarian cells to produce at faster than normal rates.
- Obesity in early adulthood: Studies have suggested that women who are obese at age 18 are at increased risk of developing ovarian cancer before menopause. Obesity may also be linked to more aggressive ovarian cancers, which can result in a shorter time to disease relapse and a decrease in the overall survival rate.
- Talcum powder: Some studies have shown a slight increase in the risk of ovarian cancer among women who used talcum powder (baby powder) on the genital area. Asbestos in the powder may explain the link, but these products have been free of asbestos for more than 20 years.
- Smoking and alcohol use: Some studies have found smoking and alcohol use may increase the risk for developing one type of ovarian cancer, called mucinous ovarian cancer.
- Vaginal cancer:
- Risk factors for developing vaginal cancer include: being aged 60 or older and being exposed to diethylstilbestrol (DES) while in the mother's womb. In the 1950s, the hormonal drug DES was given to some pregnant women to prevent miscarriage. Women who were exposed to DES before birth have an increased risk of developing vaginal cancer. Some of these women develop a rare form of cancer called clear cell adenocarcinoma. Having human papilloma virus (HPV) infection and having a history of abnormal cells in the cervix or cervical cancer may also increase the risk of developing vaginal cancer.
- Vulvar cancer:
- Diabetes:
Diabetes may be a risk factor for vulvar cancer. The reasons are not clear.
- Age: Advancing age increases the risk for developing
squamous cell carcinoma, the most common type of vulvar cancer. Many women diagnosed with this cancer are in their 70s or older.
- Human papillomavirus (HPV):
Human papillomaviruses can cause genital warts or precancer of the cervix without visible warts. HPV may also increase the risk for vulvar cancer.
- Smoking: Smoking increases the risk for vulvar cancer. If the individual smokes and also has genital warts or human papillomavirus (HPV) infection in the genital tract, the risk is even greater for vulvar cancer.
- Vulvar intraepithelial neoplasia (VIN):
Vulvar intraepithelial neoplasia (VIN) is a
precancerous condition that causes a change in the cells on the surface of the vulva. VIN may or may not be visible, but having it may increase the individual's risk for the most common type of vulvar cancer, squamous cell carcinoma.
- Lichen sclerosis: Lichen sclerosis, a condition that makes the vulvar skin itchy and thin, slightly increases the risk of developing vulvar cancer.
- Melanoma: If a parent or sibling has had melanoma or atypical moles, an individual may have a higher risk of getting a melanoma of the vulva. Melanoma is a rare kind of vulvar cancer but one that can be quite aggressive. There is no known hereditary risk for other types of vulvar cancer. Any new mole, freckle, or dark spot on the vulva should be checked by a doctor.
- Chronic vulvar infections or irritations: Chronic infections or irritations of the skin of the vulva may also be a risk factor for vulvar cancer. Improving hygiene or managing infections will help to decrease the risk.
- Human immunodeficiency virus (HIV): Human immunodeficiency virus increases the individual's risk for vulvar cancer due to a decrease in immunity.
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