Many types of cancer can be cured if they are treated early. Knowing how to prevent them or detect them early can help protect your health.

What Is Cancer?

Healthy cells that make up the body's tissues grow, divide, and replace themselves on a regular basis. Sometimes old cells do not die when they should or may be damaged. Normally, the body repairs or destroys such cells. Sometimes, these cells may grow out of control. This causes growths or tumors to form. Tumors can be benign (not cancer) or malignant (cancer).

Benign tumors do not spread to other parts of the body. They usually are not harmful. If they become a problem—for example, they put pressure on a nearby organ—often they can be removed by surgery.

Malignant tumors can invade and destroy healthy tissues and organs. Cancer cells also can spread to other parts of the body and form new tumors.

The risk of cancer can be inherited in a person's genes. In some cases, cancer can be caused by being exposed to a harmful substance such as a virus, certain chemicals, or radiation. Sometimes more than one cause is involved.

Types of Cancer

There are many types of cancer. The risk factors, warning signs, and treatment may differ based on the type. In women, cancer is most likely to occur in the following areas:

• Lung
• Breast
• Colon and rectum
• Skin
• Ovary
• Uterus
• Cervix
• Vulva and vagina

Screening tests for cancer should be a part of your routine health care. They help find changes in the body that may be early signs of cancer or may lead to cancer (see Table 1).

Warning Signs of Cancer Certain changes in your body may be signs of cancer: A change in bowel or bladder habits A sore that does not heal Unusual bleeding or discharge Thickening or a lump in the breast or other parts of the body Indigestion or difficulty swallowing A change in a wart or mole A nagging cough or hoarseness None of these signs is a sure sign of cancer. They are clues that something could be wrong. If you notice any of these signs, see your doctor right away. Pain is seldom an early sign of cancer. Do not wait for pain if other symptoms do not go away. Getting treatment early increases your chances of successful treatment, whether you have cancer or some other problem. Adapted from the American Cancer Society. Signs and symptoms of cancer. ACS: 2005.

Lung Cancer

Lung cancer is the leading cause of cancer death in both women and men in the United States. Most lung cancer is caused by cigarette smoking. Women who smoke are 12 times more likely to get lung cancer than women who have never smoked. Second-hand smoke—smoke from other people's cigarettes—also increases your risk of lung cancer.

Warning signs of lung cancer often do not appear until the cancer has spread. They may include:

• A cough that does not go away
• Sputum (phlegm) streaked with blood
• Chest pain
• Repeat bouts of pneumonia or bronchitis
• Hoarseness
• Weight loss and loss of appetite
• Shortness of breath
• Fever
• Wheezing

Breast Cancer

Breast cancer is the second leading cause of cancer death among women in the United States. One out of every eight women will get breast cancer in her lifetime. Some risk factors that have been linked to breast cancer are:

• Age (the risk of getting breast cancer increases with age)
• Family history of breast cancer, especially in one's mother or a sister
• Inheriting abnormal genes (BRCA1 or BRCA2)
• Use of hormone therapy
• Being exposed to radiation (for treatment of other cancer)
• Previous history of breast cancer

Breastfeeding, exercise, and keeping a healthy weight may help reduce your risk of breast cancer. Talk to your doctor about what else may work for you.

Table 1. Routine Cancer Screening A screening test looks for signs of disease in people who do not have symptoms. For some types of cancer, screening tests can help detect signs of cancer early enough to treat. Regular physical exams also can serve as useful screening methods. The table shows routine screening tests that all women should have. Based on your risk factors for certain types of cancer, your doctor may recommend additional tests or exams or having them more often.
Type of Cancer	Test or Exam	Who Should Be Screened	When
Breast	Mammography	Women aged 40–49 years Women aged 50 years and older	Every 1–2 years Yearly
Cancer of the cervix	Pap test*	All women 3 years after they became sexually active or by age 21 years	Yearly (If you are 30 years or older and have had three or more normal tests in a row, your doctor may suggest having Pap tests once every 2–3 years.)
Colon and rectal (choose one)	Fecal occult blood test (FOBT) Flexible sigmoidoscopy FOBT plus flexible sigmoidoscopy   Double contrast barium enema Colonoscopy	Women aged 50 years and older Women aged 50 years and older Women aged 50 years and older   Women aged 50 years and older Women aged 50 years and older	Yearly Every 5 Years Yearly FOBT and flexible sigmoidoscopy every 5 years Every 5 years Every 10 years
*May be done with HPV testing in women aged 30 years and older. If the results of both tests are negative, a woman should not be screened again for 3 years.

If detected early, breast cancer can be treated with good results. Be alert to these warning signs:

• A lump, thickening, swelling, or dimpling of the breast
• Irritation of breast skin
• A nipple that is distorted, pulled inward, or scaly
• Nipple discharge or bleeding
• Nipple pain or tenderness

Colon and Rectal Cancer

Colon and rectal cancer—or colorectal cancer—affects the large intestine and rectum. It is the third leading cause of cancer death among women in the United States.

In most cases, colorectal cancer develops slowly over time. This type of cancer often begins as a polyp—a tissue growth in the colon or rectum. You may be at high risk for colorectal cancer if you:

• Have a close relative (mother, father, sister, or brother) younger than 60 years or two or more close relatives of any age who have colorectal cancer or certain types of colon polyps
• Have a personal or family history of certain types of colon problems or cancer of the colon
• Have a personal history of certain types of colon polyps
• Have had bowel disease, such as chronic ulcerative colitis, inflammatory bowel disease, or Crohn's disease

• A change in bowel habits
• Bleeding from the rectum
• Blood in the stool or dark stools
• Stools that are more narrow than usual
• Abdominal discomfort (bloating, cramps, or frequent gas pains)
• A feeling that you need to have a bowel movement (that does not go away after a bowel movement)
• Decreased appetite
• Weakness and feeling tired

Routine screening can help detect colorectal cancer in early stages. Tests used to detect signs of colorectal cancer include:

• Yearly FOBT
• Flexible sigmoidoscopy every 5 years
• Yearly FOBT and flexible sigmoidoscopy every 5 years
• Double contrast barium enema test every 5 years
• Colonoscopy every 10 years

How to Do Breast Self-Exam Self-exams help you get to know how your breasts look and feel. If you know their normal look and feel, you will be better able to find changes that may be a sign of cancer. Most lumps are found by women themselves. The best time to do breast self-exam is right after your period. If you do not have regular periods or sometimes skip a month, do the exam the same day each month. Look for Changes Stand or sit in front of a mirror in good light. Place your arms at your sides. Look for dimpling, puckering, or redness of the breast skin. Also look for discharge from your nipples and changes in breast size or shape. Look for the same signs with your hands pressed tightly on your hips and then with your arms raised high. Feel for Changes Lie flat on your back. Place a folded towel or a pillow under your left shoulder. Place your left hand under or over your head. You also can feel for changes when standing. With your right hand, keeping the fingers flat and together, gently feel your left breast without pressing too hard. Use one of the three methods shown here. Switch your arms and then do the exam on the other breast. Circle. Begin at the top of your breast and move your fingers slowly around the outside in a large circle. When you return to the top, move your hand a little closer to the nipple and make a smaller circle. Do this in smaller and smaller circles until you have examined all of the breast tissue. Lines. Begin in the underarm area. Slowly move your fingers down until they are below your breast. Move your fingers closer toward your nipple and go slowly back up, using the same motion. Use this up-and-down pattern all the way across your breast. Wedge. Begin at the outside edge of your breast. Slowly work your way in toward the nipple, doing one wedge-shaped section at a time. Do this until the entire breast area has been examined. Also . . . With any pattern, be sure to examine the nipples, too. Gently squeeze the nipple and check for any discharge. Examine the upper chest area and below the armpits — these places also have breast tissue. Call your doctor if you notice any lumps or changes in your breasts.

Choosing and Using Sunscreen Sunscreen blocks the sun's harmful rays that could cause cancer. Read the label when choosing sunscreen. "Broad-spectrum" products prevent sunburn of the skin surface as well as the damage of deeper layers of skin. The U.S. Food and Drug Administration recommends using sunscreens with an SPF number 15 or higher. Be sure to use sunscreen the correct way. Put it on all exposed areas of skin 30 minutes before you go outside. Apply it again every 2 hours or after swimming, perspiring, or towel drying. Sunscreen should not be used on babies 6 months and younger.

Skin Cancer

Skin cancer is the most common form of cancer in the United States. Almost one half of the U. S. population who lives to age 65 years will develop some form of it. Many people can take some simple steps to prevent skin cancer.

Fair-skinned people are more likely to get skin cancer, but dark-skinned people also can be at risk. Too much exposure to ultraviolet (UV) light—from the sun or tanning lamps—increases your risk. Your risk also is increased if you have a family history of skin cancer.

The main types of skin cancer are:

• Basal cell
• Squamous cell
• Melanoma

Melanoma starts with small, mole-like growths. The growths get bigger, change color, and get darker. They grow in an irregular—not round—shape and may bleed easily.

Melanoma is the leading cause of death from skin cancer. You are at risk for melanoma if you have a family history of melanoma or have many large and unusually shaped moles.

Warning signs for any type of skin cancer are:

• A change in the size of a mole
• Scaliness, oozing, or bleeding
• A change in color of a mole or other spot on the skin
• Itchiness, tenderness, or pain in or by a bump or mole
• A sore that does not heal

Check any moles regularly to see if the shape, color, or size has changed. Have your doctor examine them at your check-ups. To help prevent skin cancer:

• Avoid being out in the sun between 10 am and 4 pm.
• When you are outdoors, use sunscreen—even if it is not sunny.
• Wear sunglasses and clothing that blocks UV rays and a hat that shades your face, neck, and ears.
• Do not use tanning beds or sun lamps.

The risk of cancer of the ovary is low, but increases with age. This disease causes more deaths than any other type of female reproductive system cancer. Factors that increase a woman's risk of ovarian cancer include:

• Infertility
• High-fat diet
• Personal history of breast or colon cancer
• Endometriosis
• Advancing age (women older than 60 years have the highest risk)
• Abnormal genes (BRCA1 and BRCA2)

Cancer of the ovary often is hard to detect until it is in an advanced stage. There is no good test to screen for cancer of the ovary. Your doctor may be able to feel a cyst on one or both ovaries during your annual pelvic exam. Very few of these cysts will prove to be cancer, but they should be checked by your doctor. The warning signs of this cancer type include:

• Discomfort in the pelvic area
• Indigestion, gas, or bloating that cannot be explained
• Abnormal vaginal bleeding
• Swelling of the abdomen

The risk of cancer of the endometrium (the lining of the uterus) increases after age 55 years and occurs most often in women between the ages of 60 and 75 years. It is rare in women younger than 40 years. Women who have taken oral contraceptives appear to have a lower risk than those who have not.

Factors that increase a woman's risk for this type of cancer include:

• Use of estrogen alone as hormone therapy
• Not giving birth
• Menopause after age 52 years
• Obesity and related conditions, such as high blood pressure
• Diabetes or other disorders, such as thyroid disease or gall bladder disease
• Use of tamoxifen
• Having endometrial hyperplasia
• Having other inherited cancers, such as certain types of colon cancer

Warning signs of endometrial cancer include:

• Bleeding after menopause
• Abnormal bleeding or discharge between periods
• Prolonged and heavy bleeding during periods

• Endometrial biopsy—A small piece of tissue is removed from the lining of the uterus.
• Ultrasound—Sound waves are used to assess the thickness of the uterine lining.
• Dilation and curettage (D&C)—The cervix is opened and tissue is gently scraped or suctioned from inside of the uterus.
• Hysteroscopy—A slender, light-transmitting device is used to view the inside of the uterus.

Cancer of the cervix was once one of the most common causes of cancer death for women in the United States. Today, the death rate is lower, in large part because of the Pap test. The Pap test can help find problems early, before they become cancer. A woman is at increased risk for cervical cancer if she:

Has a human immunodeficiency virus (HIV) infection Has a human papillomavirus (HPV) infection Has a weakened immune system Was exposed to diethylstilbestrol (DES) during her mother's pregnancy

There may be no warning signs of early cervical cancer. Signs of more advanced cervical cancer may include:

• Unusual discharge from the vagina
• Abnormal bleeding
• Bleeding after sex

How to Do a Vulvar Self-Exam   The vulvar self-exam will help you to be aware of any changes in the vulvar area that could signal a problem. You should do this exam at the same time every month. Wash your hands before you begin. Lie or sit up in a comfortable position near a good, strong light with a hand mirror (magnifying mirror may work best). It may help to prop up your back with a pillow, or you can squat or kneel. The key is to find a position in which you can clearly see the vulvar area, perineum, and anus. One way to examine your vulva is to: Gently separate the outer lips of the vulva (labia majora). Look for any changes or signs of a problem, such as redness, swelling, dark or light spots, blisters, or bumps. Next, separate the inner lips (labia minora) and look at the area between them. Also look at the entrance to the vagina. Gently pull back the hood of the clitoris. Examine the area under the hood and the tip of the clitoris. Be sure to inspect the area around the urethra, the perineum, the anus, and the pubic area.

Cancer of the Vulva and Vagina

Cancers of the vulva and vagina are rare. These cancers can occur at any age, but most often in women older than 60 years. Risk factors include smoking and certain vulvar infections, such as HPV. Common warning signs include:

• A sore or lump that does not go away
• Itching
• Abnormal bleeding

Tips to Reduce Your Risk of Cancer

Many cancers are linked to lifestyle factors. Making these changes in your lifestyle will improve your health and some may help prevent cancer. To reduce your risk of cancer:

• Do not smoke.
• Limit your intake of fat (especially saturated fat and trans fat).
• Eat foods with high fiber content.
• Get regular health checkups.
• Exercise every day for at least 30 minutes.
• Limit your time in the sun and use sun block when you go outside.
• Pay attention to changes in your body.
• Limit your number of sexual partners.
• Have recommended exams and tests.
• Limit the amount of alcohol you drink.

Finally...

A healthy lifestyle, screening tests, and regular check-ups can help lower your risk of cancer. Many types of cancer can be cured if they are treated early. Being aware of the types of cancer and how to prevent them or detect them early can help protect your health.

Glossary

Colonoscopy: An exam of the entire colon using a small, lighted instrument.

Cyst: A fluid-filled sac or pouch that can form in the body.

Double Contrast Barium Enema Test: A test during which a special solution and air are injected into the colon and X-ray images are taken to check for abnormalities in the colon.

Endometrial Hyperplasia: A benign condition that occurs when the lining of the uterus grows too much.

Endometriosis: A condition in which tissue similar to that normally lining the uterus is found outside the uterus, usually on the ovaries, fallopian tubes, and other pelvic structures.

Fecal Occult Blood Test (FOBT): A test of a stool sample for blood, which could be a sign of cancer of the colon or rectum.

Genes: DNA "blueprints" that code for specific traits, such as hair and eye color. Fecal Occult Blood Test (FOBT): A test of a stool sample for blood, which could be a sign of cancer of the colon or rectum.

Human Immunodeficiency Virus (HIV): A virus that attacks certain cells of the body's immune system and causes acquired immunodeficiency syndrome (AIDS).

Human Papillomavirus (HPV): The common name for a group of related viruses, some of which cause genital warts and cervical cancer.

Mammography: A procedure in which X-rays of the breast are used to detect breast cancer.

Oral Contraceptives: Birth control pills containing hormones that prevent ovulation and thus pregnancy.

Pap Test: A test in which cells are taken from the cervix and examined under a microscope.

Perineum: The area between the vagina and the rectum.

Saturated Fat: Fat that is waxy or solid at room temperature and comes mostly from animals.

Sigmoidoscopy: A test in which a slender device is placed into the rectum and lower colon to look for cancer.

Tamoxifen: A synthetic estrogen pill used to treat breast cancer.

Trans Fat: Fat that comes from adding hydrogen to vegetable oils to improve their smell, taste, and shelf life.

Urethra: A short, narrow tube that carries urine from the bladder out of the body.

This Patient Education Pamphlet was developed under the direction of the Committee on Patient Education of the American College of Obstetricians and Gynecologists. Designed as an aid to patients, it sets forth current information and opinions on subjects related to women's health. The average readability level of the series, based on the Fry formula, is grade 6–8. The Suitability Assessment of Materials (SAM) instrument rates the pamphlets as "superior." To ensure the information is current and accurate, the pamphlets are reviewed every 18 months. The information in this pamphlet does not dictate an exclusive course of treatment or procedure to be followed and should not be construed as excluding other acceptable methods of practice. Variations taking into account the needs of the individual patient, resources, and limitations unique to the institution or type of practice may be appropriate.

Copyright © November 2006 by the American College of Obstetricians and Gynecologists. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, posted on the Internet, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher.

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