Uterine Cancer: What to Know About Symptoms and Treatment - The New York Times

A new study raised alarms about chemical hair straighteners being linked to the disease, but doctors say there are telltale symptoms to watch for.

A new national study has suggested that chemical hair straighteners could pose a small risk for uterine cancer. Rates of the disease are still relatively low, said Dr. Alexandra White, head of the environment and cancer epidemiology group of the National Institute of Environmental Health Sciences and the lead author on the study. The research also did not definitively show that hair straighteners cause cancer. But the findings are cause for concern, she said.

Rates of uterine cancer have been increasing in the United States, particularly for Black and Hispanic women. The number of cases diagnosed each year rose to 65,950 this year, compared to 39,000 15 years ago. Black women are also more likely to have more aggressive cases of the cancer, Dr. White said, and the study showed they were disproportionately more likely to use hair straighteners.

If you have used chemical hair straighteners, you do not need to seek out medical attention or consult your doctor unless you have symptoms for uterine cancer, said Dr. Otis Brawley, an oncologist at Johns Hopkins University. But women should regularly see a gynecologist, and be aware of the risk factors and early signs of the disease.

What is uterine cancer?

When we talk about uterine cancer, most of the time, we’re talking about endometrial cancer, which starts in cells that form the lining of the uterus, said Dr. Emily Hinchcliff, a gynecologic oncologist at Northwestern Medicine. The other, much rarer, type of uterine cancer is uterine sarcoma, which develops in the muscles supporting the uterus.

The National Cancer Institute estimates that around 3.1 percent of women in the U.S. will be diagnosed with uterine cancer at some point in their lives. But endometrial cancer is largely treatable, especially if you catch it early, said Dr. Roberto Vargas, a gynecologic oncologist at Cleveland Clinic.

Dr. Brawley also noted that cases of uterine cancer are rare in pre-menopausal women. “This is a disease of women in their 50s and 60s,” he said.

What are the risk factors for uterine cancer?

Anyone with a uterus is at risk for developing uterine cancer, but your risk rises as you age, with women over 50 particularly at risk. Environmental exposures may also factor into someone’s risk, as the researchers on the hair straightener study noted. Several chemicals found in straighteners, including parabens, bisphenol-A, metals and formaldehyde, which are also used in many other personal care products, could potentially explain the increased risk to women who used straighteners.

Medical conditions related to hormonal imbalances can also elevate risk. Polycystic ovary syndrome, or PCOS, has been linked to an increased risk of uterine cancer — because women with PCOS tend to skip periods, which leads to a buildup of tissue in the uterus that can develop into endometrial cancer.

Certain types of ovarian tumors can also raise the risk, as some can secrete estrogen, Dr. Vargas said. Excessive estrogen can overly stimulate hormone receptors, causing cancer cells to multiply and spread. Women who have taken tamoxifen, an estrogen modulator that is used to treat breast cancer, are also at an elevated risk.

And because excess fatty tissue can produce additional estrogen, obese women are dramatically more likely to develop endometrial cancer, Dr. Brawley said. Those who take estrogen without progesterone are also at an increased risk for developing the cancer, he added. To manage that risk, when doctors prescribe estrogen to manage hot flashes, they should also prescribe progesterone, he said.

Diabetes and high blood pressure are also risk factors, said Dr. Ginger Gardner, a gynecologic oncologist at Memorial Sloan Kettering Cancer Center. And, as with many other forms of cancer, family history can play a role, she added. Women whose family members have been diagnosed with uterine cancer should be particularly vigilant about monitoring for symptoms.

What are the early symptoms to watch for?

Abnormal bleeding is the most common symptom of uterine cancer, Dr. Brawley said, especially for women who have gone through menopause. Dr. Gardner said if you experience vaginal bleeding after not getting a period for a year or more, even light pink or brown spotting or staining when you wipe, you should talk to your gynecologist.

For younger women, a change in bleeding pattern — including bleeding between periods and heavy bleeding in general — can be a symptom of uterine cancer, she added.

Dr. Andrea Jackson, an obstetrician and gynecologist at the University of California, San Francisco who specializes in providing care for Black patients, said that patients often overlook those changes in bleeding patterns. Anecdotally, she said her Black patients, in particular, often don’t see it as a cause for concern, partly because many have concurrent conditions like fibroids, which can also cause spotting.

Skipping periods can also be a sign of concern, she said. If you skip a period for any amount of time and are not menopausal or on hormonal contraception, you should speak with a gynecologist.

Other early symptoms of uterine cancer include pelvic pain or pressure. Patients might experience bloating or changes in their bowel habits, which could look like constipation or diarrhea, Dr. Hinchcliff said. The Centers for Disease Control and Prevention recommends seeing your doctor if symptoms persist for two weeks or longer.

How is uterine cancer screened and treated?

There are no regular screenings for uterine cancer, and pap smears cannot detect it. That’s why it’s essential to monitor symptoms and any changes in your cycle, Dr. Jackson said. Progesterone IUDs and birth control pills can help protect against uterine cancer if someone is at higher risk, she added.

For patients who do present with symptoms, “a diagnosis of endometrial cancer is pretty straightforward,” Dr. Gardner said. A doctor will perform a pelvic exam and an endometrial biopsy, or they might conduct a dilation and curettage procedure, which removes tissue from the uterus; if a biopsy is uncomfortable for a patient, a doctor might opt for a transvaginal ultrasound, Dr. Jackson said, which allows them to examine the reproductive organs.

If endometrial cancer is caught early, doctors typically conduct a hysterectomy, Dr. Jackson said. For later stage uterine cancer, some patients may need chemotherapy and radiation. Outcomes vary based on how aggressive the cancer is, but for a standard case, “this is a very treatable form of cancer,” Dr. Brawley said.

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