On May 12, the Senate Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies examined efforts to increase awareness of gynecologic cancer.
Director of the National Cancer Institute (NCI) at the National Institutes of Health Andrew von Eschenbach summarized NCI’s activities in the areas of cervical, ovarian, and endometrial or uterine cancer. Explaining that cervical cancer is the most common form of cancer among women worldwide, he stated, “Over 400,000 new cases are diagnosed each year, resulting in about 200,000 deaths. With the continuing education and application of early detection through pelvic examinations and Pap smears, the frequency of cervical cancer has diminished in the United States. However, advanced cervical cancer is still observed and has a poor prognosis.” Dr. von Eschenbach said that the NCI has developed a new vaccine to protect against human papillomavirus, the virus responsible for most cases of cervical cancer. He also noted that the NCI “is working to bring state-of-the-art cervical cancer screening to geographic regions of excess mortality. In one of our most exciting projects, NCI is collaborating with the Centers for Disease Control and Prevention (CDC), the Department of Agriculture, and State health departments to improve screening for cervical cancer among poor, rural women in the Mississippi Delta, who have had some of the highest rates of cervical cancer in the U.S. for the last 50 years.” If the program is successful in Mississippi, the NCI intends to roll out similar programs in Appalachia, along the Mexican-U.S. border, in urban clinics, and in areas serving migrant workers.
Dr. von Eschenbach stated that ovarian cancer “remains the most deadly of the gynecologic cancers,” adding, “Reasons for this continuing poor outcome include the nonspecific and late clinical presentation of ovarian cancer and the lack of reliable and cost efficient methods of early detection.” He explained that the NCI is currently evaluating procedures for early ovarian cancer detection, including CA125 blood tests and trans-vaginal ultrasounds; has established five Specialized Programs of Research Excellence on ovarian cancer; and has begun the Proteomics Ovarian Cancer Recurrence Monitoring Prospective Trail to detect early stages of ovarian cancer. In addition, Dr. von Eschenbach stated that the NCI “is currently sponsoring a national clinical trial aimed at evaluating a novel approach to ovarian cancer screening in women at increased genetic risk of ovarian cancer. While we recognize that more women diagnosed with this disease today are living longer, with a higher quality of life than they were twenty years ago, we also acknowledge that more work is needed to end the suffering and death that too many women still face. For women who have a high risk of ovarian cancer, which includes a family history of breast, ovarian, endometrial, or colon cancer and a known BRCA1 or BRCA2 mutation, we recommend that they receive two yearly exams plus CA125 monitoring as well as a yearly trans-vaginal ultrasound.”
Pointing out that endometrial cancer is the most common gynecologic cancer in the United States but the most treatable, Dr. von Eschenbach stated, “Around 90% of endometrial cancers are diagnosed in the early stages of cancer with an overall 85% survival rate,” adding, “Population studies indicate that endometrial cancer is one where incidence and mortality are most affected by being overweight or obese, as measured by having a high body mass index (BMI). These data suggest that maintaining a normal body weight could prevent about one-half of endometrial cancers.” He explained that the NCI “is able to utilize the latest technology to examine the genetic differences in endometrial cancers from women of normal and high BMI…Through NCI’s Clinical Trials Cooperative Groups, specifically the Gynecology Oncology Group (GOG), NCI has sponsored major anatomic and molecular staging studies of endometrial cancer. Additionally, the GOG has conducted landmark studies evaluating the roles of radiation, hormone therapy, and chemotherapy in women with endometrial cancer.”
Dr. von Eschenbach said that the NCI allocated $212.5 million for gynecologic cancer in FY2004, adding, “This funding supports NCI’s ongoing multi-pronged, multi-disciplinary effort in molecular biology, epidemiology, prevention, treatment, and survivorship issues of gynecologic cancers.” He also noted that the NCI is working to implement the recommendations of the Gynecological Cancer Progress Review Group and is part of a global coalition to implement the Global Initiative on Women’s Cancer (GLOW). “This international partnership will focus on reducing the global burden of gynecological cancer, breast cancer, and tobacco use among women. GLOW will include public and professional education, the development of a needs-assessment database, and technical assistance to countries in the developed and developing world as they work to strengthen cancer control efforts, including prevention, screening, diagnosis, treatment, palliation, and end of life care.”
The subcommittee also heard testimony from actress Fran Drescher, an endometrial cancer survivor, and Sheryl Silver, a freelance writer and gynecologic cancer advocate. Ms. Silver’s sister, Johanna, died from ovarian cancer in 2000 and is the inspiration for the Gynecologic Cancer Education and Awareness Act (H.R. 1245), also known as “Johanna’s Law.” Sponsored by Rep. Darrell Issa (R-CA), the measure would authorize $30 million through FY2008 for programs that are aimed at increasing women and health care providers’ awareness and knowledge of gynecologic cancers. The bill also would authorize $15 million for a national public awareness campaign that would encourage women to discuss their risk of gynecologic cancer with their physician.
