Alfred Guirguis, DO, a gynecologic oncologist at Rush University Medical Center, recently took part in a Rush On Call Q&A about women’s health on our Facebook page. Here are his answers to questions about the HPV vaccine, cervical cancer, ovarian cancer, progesterone and minimally invasive hysterectomies.
Can you explain the HPV vaccine? Should young girls/women get it, and what does it do?
The HPV vaccine is approximately 99 percent effective at preventing of cervical cancer when given to females between the ages of 9 and 26 who have not already been exposed to the HPV high-risk virus.
If a family member had cervical cancer, is it likely to happen in other females in the family?
Cervical cancer is not a hereditary disease.
Is it really necessary for post-menopausal women taking estrogen to supplement it with progesterone?
Absolutely, as long as you have a uterus. If you have had a hysterectomy, then progesterone is not prescribed. You need to know, however, that HRT (hormone replacement therapy) is no longer routinely prescribed since 2002 and the completion of the WHI (Women’s Health Initiative) study that did show a small but significant increase in breast cancer, heart attacks and strokes. There is, however, a decrease in colon cancer and osteoporosis.
Also, taking unopposed estrogen puts you at high risk for endometrial cancer, assuming that you still have a uterus.
How common are hysterectomies? Are there any minimally invasive options for hysterectomies?
Overall there are three basic ways to perform a hysterectomy. The traditional approach is to have an incision on your abdomen/pelvis that is big enough to complete the surgery. The second approach is a vaginal hysterectomy which is an excellent alternative if certain criteria are met, including the size of the uterus, the number of previous pelvic surgeries, if the patient ever had a vaginal delivery. Therefore this approach is not for everyone.
The last is minimally invasive/laparoscopically/robotically. With the advances in technology, most cancer staging surgeries including radical hysterectomies, pelvic and para-aortic lymph node dissections can be done robotically with much better recovery times, decreased pain and blood loss, and excellent oncologic outcomes. (See related post)
What is the prognosis for ovarian cancer these days?
Ovarian cancer has historically been a deadly disease but with the advancement of more aggressive surgical techniques and better delivery of chemotherapy, the median survival of patients with advanced stage III ovarian cancer is over 60 months after their original diagnosis.
Is there any danger of prolonged use of birth control pills?
For a small percentage of patients, the use of OCP’s can increase your risks of DVT (clots in your veins). However, OCPs have been shown to decrease your risks of ovarian cancer by 50 percent if used for approximately five years of more. The long-term risk of breast cancer is unknown at this time.