Medically reviewed by Dr Raina Loh, MMed (Family Medicine), Singapore
Gynaecological and breast cancers pose significant health challenges worldwide, including in Singapore. These cancers affect thousands of women in the country and require increased attention, awareness and resources. Gynaecological cancers encompass a range of cancers affecting the female reproductive system, including uterine (womb), vaginal, vulvar, cervical, and ovarian cancers. Breast cancer is the most common cancer among Singaporean women. The incidence has been rising over the years, partly due to increased awareness and detection.
Why Are Certain Cancers More Common in Women Than Men?
While some cancers are gender-specific due to the absence of such organs in the opposite sex, cancer incidence can be attributed to regulation at the genetic/molecular level and sex hormones such as estrogen. For example, breast cancer is more common in women primarily because of the higher estrogen levels that are present in women.
Females have higher levels of estrogen than males, especially during reproductive years. Prolonged exposure to estrogen increases the risk of breast cancer. Men, on the other hand, have lower levels of estrogen, which contributes to their lower risk of developing breast cancer. Other factors such as genetic factors can also increase the risk of developing breast cancer. The most well-known genetic mutation associated with breast cancer is BRCA1 and BRCA2. These mutations increase the risk of breast cancer, and the incidence of these mutations is higher in females. It is important to note that while breast cancer is less common in men, it can still occur. Males should be aware of any changes in their breast tissue and seek medical attention if they notice any such abnormalities.
What Are The Female Specific Cancers?
- Cervical Cancer
Cervical cancer is cancer that starts in the lower, narrow end of the uterus, also known as the cervix. Cervical cancer is almost always caused by the human papillomavirus (HPV). HPV infection is very common, and many women will have it at some point in their lives. In the majority of women, the immune system clears it naturally. Persistent infection of HPV can result in cellular changes and consequently, cancer. While cervical cancer is the 10th most common cancer in women in Singapore, it is also a highly preventable cancer because it can be detected in the precancerous stages using reliable and affordable cervical cancer screening tests. Furthermore, there are now vaccines to prevent HPV infection. - Ovarian Cancer
The ovaries are small organs that make female hormones and eggs. They are located in the pelvis on each side of the womb. There are different types of ovarian cancers, depending on the type of cells that are affected. Ovarian cancer can manifest from the surface epithelium of the ovary, in the egg-producing cells and/or the hormone producing tissue that holds the ovary together. Ovarian cancer is the 5th most common cancer in women in Singapore. - Uterine Cancer
Cancer that starts in the uterus or the womb is called uterine cancer. The most common type of uterine cancer is called endometrial cancer because it forms in the lining of your uterus, also known as the endometrium. All women who have a uterus are at risk of this cancer, and it is the most common gynecological cancer in Singapore. - Vaginal/vulvar Cancer
The vagina is a tube-like channel between the bottom of the uterus and the outside of the body. The vulva is the outer part of the female genitalia and includes the lips around the opening of the vagina (labia), the tissue at the opening of the vagina (clitoris) and the mucus-producing glands on either side of the vaginal opening (Bartholin’s Glands). Cancer that forms in the vagina and the vulva are called vaginal and vulvar cancer respectively. However, these two cancers are very rare in women compared to the other gynecological cancers. - Breast Cancer
Breast cancer is an abnormal growth of tissue in the breast. The tumour develops when cells in the breast divide without control and produce extra tissue. It can be benign (non-cancerous) or malignant (cancerous). Cancerous cells can spread within the breast, to lymph nodes (glands) in the armpit, and to other parts of the body. It is Singapore’s top cancer for women.
Risk Factors for Gynecological Cancers and Breast Cancer
There are several risk factors associated with gynecological and breast cancers. Here are some of the common risk factors for these types of cancers:
1. Age
2. Family history and genetic factors
3. Human papillomavirus (HPV) or human immunodeficiency virus (HIV) infection
4. Reproductive factors: certain reproductive factors can affect the risk of some of these cancers. These include early onset of menstruation, late menopause, never giving birth, or using hormone replacement therapy for an extended period
5. Lifestyle factors: Certain lifestyle choices can impact cancer risk. These include smoking, lack of physical activity, and a poor diet.
6. Personal history of cancer: Women who have had gynecological or breast cancer in one breast are at an increased risk of developing cancer in the other breast or in the reproductive organs
Detecting and Preventing Gynecological Cancer and Breast Cancer
Treatment for cancers at an early stage usually improves the success rates of recovery. Hence, it is crucial to be aware of the symptoms of these cancers or to go for regular screenings so that you can detect cancer, if any, at the early stages.
A monthly physical self-examination for any odd lumps at the breasts may help to detect early breast cancer. Frequent self-exams can also help you to be familiar with how your breasts look and feel so that you can alert your healthcare professional if there are any changes. Mammograms can also detect the presence of cancerous lumps even before they can be felt with the hand. It is recommended to go for a mammogram once a year (if you are 40-49 years old) or once every two years (if you are 50 and above).
Ovarian cancer typically does not present any symptoms in its early stages. However, it is advisable that you seek medical attention if you notice anything unusual as the symptoms for ovarian cancer may be mistaken for other common illnesses. On the other hand, while uterine cancer is the most common gynecological cancer, it is also easily detected since early or precancerous changes in the endometrial lining will result in bleeding that most women will consider as abnormal and thus seek medical advice. Therefore, most women tend to discover the presence of uterine cancer before it has a chance to spread outside of the uterus.
Cervical cancer is also considered one of the most preventable cancers because immunising against common strains of HPV can greatly reduce the chances of cervical cancer. Current HPV vaccines offer protection against 70%-90% of HPV strains. Moreover, cervical cancer is easily detected through Pap smear and HPV DNA tests. They are simple procedures where the doctor/nurse gently brushes cells from the narrow neck of the cervix. Do take note that you do not need to have a cervical cancer screening if you have never had sexual intercourse before.
Conclusion
While the risk of cancer is something that is daunting and is a significant cause of concern, it is important that we do what we can to reduce the risk of such cancers. That includes maintaining a healthy diet, exercising regularly and going for regular screenings. In Singapore, the Screen for Life (SFL) programme is a government initiative that subsidises the costs of Pap/HPV smears and Mammograms for eligible patients.
Here at Keystone Clinic & Surgery, our doctors are able to carry out consultations relating to women’s health. Each of our locations currently has a female doctor in case you prefer consulting about women’s health with a female doctor. Our clinics are all equipped to conduct Pap/HPV tests and we are also able to refer you for a mammogram with our partners if necessary. By working together, we hope to continue to make significant strides in reducing the burden of these cancers and improving the overall well-being of our female patients.
References
Centres for Disease Control and Prevention. Basic Information About Gynecologic Cancers. 2022. https://www.cdc.gov/cancer/gynecologic/basic_info/
Centres for Disease Control and Prevention. Basic Information About Vaginal and Vulvar Cancers. 2022. https://www.cdc.gov/cancer/vagvulv/basic_info/
Kim, Hae-In et al. “Sex Differences in Cancer: Epidemiology, Genetics and Therapy.” Biomolecules & therapeutics vol. 26,4 (2018): 335-342. doi:10.4062/biomolther.2018.103
K. W. Ong Breast & General Surgery. What is the Difference between Male and Female Breast Cancer? 2023. https://www.kwongbreastclinic.com.sg/what-is-the-difference-between-male-and-female-breast-cancer/
National Cancer Centre Singapore. Women VS Cancer. 2023. https://www.nccs.com.sg/giving/Pages/Women-VS-Cancer.aspx
National University Cancer Institute Singapore. Womb Cancer (Endometrial Cancer / Uterine Cancer). Accessed 2023, May 30.
https://www.ncis.com.sg/Cancer-Information/About-Cancer/Pages/Endometrial-Cancer-Uterine-Cancer.aspx
National University Hospital. Vulvar Cancer. Accessed 2023, May 30. https://www.nuh.com.sg/Health-Information/Diseases-Conditions/Pages/Vulvar-Cancer.aspx
Singapore Cancer Society. Cervical Cancer. Accessed 2023, May 30.
https://www.singaporecancersociety.org.sg/learn-about-cancer/types-of-cancer/cervical-cancer.html
Singapore Cancer Society. Ovarian Cancer. Accessed 2023, May 30. https://www.singaporecancersociety.org.sg/learn-about-cancer/types-of-cancer/ovarian-cancer.html
Wong C.I. Male vs Female Breast Cancer: What is the Difference? Parkway Cancer Centre. 2022. https://www.parkwaycancercentre.com/sg/news-events/news-articles/news-articles-details/male-vs-female-breast-cancer-what-is-the-difference