Dr. Aiswarya Sekar

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Preventive Gynecologic Oncology

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Preventive Gynecologic Oncology – Stopping Cancer Before It Starts

Not all gynecologic cancers can be prevented, but many can—and early detection dramatically improves outcomes for those that do develop. Preventive gynecologic oncology focuses on identifying risk factors, screening for early disease, managing precancerous conditions, and reducing cancer risk in high-risk individuals.

Dr. Aiswarya Sekar provides comprehensive preventive oncology services, helping women understand their cancer risks and take proactive steps to protect their health.

The Power of Prevention

Cervical cancer provides the most striking example of cancer prevention success. Through HPV vaccination and screening programs, cervical cancer incidence has declined dramatically in countries with organized prevention efforts. Other gynecologic cancers also offer prevention opportunities through:

  • Genetic testing and risk assessment
  • Management of precancerous conditions
  • Risk-reducing surgery for hereditary cancer syndromes
  • Lifestyle modifications
  • Appropriate use of hormones and other medications

Cervical Cancer Prevention

HPV Vaccination

Human papillomavirus (HPV) causes nearly all cervical cancers plus many vulvar, vaginal, and oropharyngeal cancers. HPV vaccines prevent infection with high-risk HPV types, dramatically reducing cancer risk.

Who Should Be Vaccinated:

  • All adolescents, ideally age 9-14 before sexual activity begins
  • Young adults through age 26 who weren’t previously vaccinated
  • Select adults age 27-45 after discussion with healthcare provider

Vaccine Benefits:

  • Prevents 90% of HPV-related cancers
  • Most effective when given before HPV exposure
  • Safe, well-tolerated, with long-lasting protection

Dr. Aiswarya provides HPV vaccination counseling and coordinates immunization for eligible individuals and their family members.

Cervical Cancer Screening

Regular screening detects precancerous changes before cancer develops, allowing simple treatment to prevent progression.

Screening Guidelines:

Ages 21-29:

  • Pap smear every 3 years
  • HPV testing not routinely recommended

Ages 30-65:

  • HPV and Pap co-testing every 5 years 
  • OR HPV testing alone every 5 years
  • OR Pap smear alone every 3 years

Over Age 65:

  • May discontinue screening if adequate prior screening was negative
  • Continue screening if history of precancerous lesions or inadequate prior screening

Special Situations:

  • Women with HIV: more frequent screening
  • Immunosuppressed women: individualized approach
  • Hysterectomy for benign reasons: usually no screening needed unless cervix remains

Managing Abnormal Screening Results

Abnormal Pap smears or positive HPV tests require further evaluation:

Colposcopy

Magnified examination of cervix identifying areas of abnormal tissue for biopsy. Dr. Aiswarya performs diagnostic colposcopy with targeted biopsies, providing accurate diagnosis and appropriate treatment recommendations.

Treatment of Precancerous Lesions:

  • LEEP (Loop Electrosurgical Excision Procedure) – Removes abnormal cervical tissue using electrified wire loop
  • Cone Biopsy – Removes larger cone-shaped section of cervix
  • Cryotherapy – Freezes and destroys abnormal cells
  • Ablation – Destroys abnormal tissue with heat or laser

These simple procedures, performed in-office or as outpatient surgery, prevent progression to invasive cancer with minimal impact on future pregnancy.

Genetic Testing and Hereditary Cancer Syndromes

Approximately 10-15% of gynecologic cancers occur in women with inherited genetic mutations increasing cancer risk. Identifying these individuals allows:

  • Enhanced screening
  • Risk-reducing interventions
  • Family member testing and risk assessment

BRCA1 and BRCA2 Mutations

BRCA mutations significantly increase risks of:

  • Breast cancer – 45-70% lifetime risk
  • Ovarian cancer – 15-45% lifetime risk
  • Other cancers (pancreatic, prostate, melanoma)

Who Should Consider BRCA Testing:

  • Personal history of ovarian cancer (all patients should be tested)
  • Breast cancer diagnosed before age 50
  • Triple-negative breast cancer
  • Multiple family members with breast or ovarian cancer
  • Ashkenazi Jewish ancestry with personal or family history of breast/ovarian cancer
  • Male breast cancer in family

Risk Management for BRCA Carriers:

Enhanced Screening:

  • Breast MRI and mammography annually starting age 30
  • Clinical breast exams every 6 months

Risk-Reducing Surgery:

  • Bilateral salpingo-oophorectomy (removal of ovaries and fallopian tubes) age 35-40 or when childbearing complete
  • Consideration of prophylactic mastectomy

Risk-reducing removal of ovaries and fallopian tubes decreases ovarian cancer risk by 90% and may also reduce breast cancer risk by 50% in premenopausal women.

Lynch Syndrome

Lynch syndrome mutations affect DNA mismatch repair genes, increasing risks of:

  • Colorectal cancer – 40-80% lifetime risk
  • Endometrial cancer – 25-60% lifetime risk
  • Ovarian cancer – 10-15% lifetime risk
  • Other cancers (stomach, small bowel, urinary tract, brain)

Who Should Consider Lynch Syndrome Testing:

  • Personal history of endometrial or ovarian cancer before age 50
  • Colorectal cancer before age 50
  • Multiple Lynch-associated cancers
  • Family history meeting Amsterdam or revised Bethesda criteria

Risk Management for Lynch Syndrome Carriers:

Enhanced Screening:

  • Colonoscopy every 1-2 years starting age 20-25
  • Annual endometrial biopsy starting age 30-35
  • Consideration of upper endoscopy

Risk-Reducing Surgery:

  • Hysterectomy and bilateral salpingo-oophorectomy when childbearing complete
  • Reduces endometrial and ovarian cancer risk to near zero

Other Hereditary Cancer Syndromes

Less common hereditary syndromes also increase gynecologic cancer risk:

  • Peutz-Jeghers syndrome – Increased ovarian cancer risk
  • Cowden syndrome – Increased endometrial cancer risk
  • Li-Fraumeni syndrome – Increased risk of multiple cancer types

Dr. Aiswarya provides genetic counseling, coordinates testing, interprets results, and develops personalized screening and risk-reduction plans for individuals with hereditary cancer syndromes.

Risk-Reducing Surgery

For women with hereditary cancer syndromes, prophylactic surgery dramatically reduces cancer risk:

Bilateral Salpingo-Oophorectomy (BSO)

Removal of both ovaries and fallopian tubes:

  • Reduces ovarian cancer risk by >90% in BRCA carriers
  • Also reduces breast cancer risk in premenopausal BRCA carriers
  • Recommended age 35-40 for BRCA1, 40-45 for BRCA2
  • Timing individualized based on family history and personal preferences

Dr. Aiswarya performs risk-reducing BSO using minimally invasive techniques, typically as outpatient surgery with rapid recovery.

Considerations:

  • Induces surgical menopause in premenopausal women
  • Hormone therapy may be used short-term to manage symptoms
  • Loss of fertility—complete childbearing before surgery
  • Psychological impact of preventive surgery

Hysterectomy for Lynch Syndrome

Adding hysterectomy to BSO in Lynch syndrome carriers:

  • Eliminates endometrial cancer risk
  • Removes ovarian cancer risk from ovaries
  • No need for ongoing endometrial surveillance

Can often be performed through minimally invasive approach.

Managing High-Risk Conditions

Certain medical conditions increase gynecologic cancer risk and require specialized management:

Endometrial Hyperplasia

Thickening of uterine lining with abnormal cells, sometimes progressing to endometrial cancer. Management includes:

  • Hormonal treatment with progesterone
  • Repeat biopsies to monitor response
  • Hysterectomy if hyperplasia persists or shows atypical features

Polycystic Ovary Syndrome (PCOS)

PCOS increases endometrial cancer risk through chronic lack of ovulation and unopposed estrogen exposure. Risk reduction strategies:

  • Weight management
  • Periodic progesterone to shed uterine lining
  • Oral contraceptives
  • Regular monitoring

Endometriosis

While endometriosis itself is benign, certain subtypes (especially ovarian endometriomas) slightly increase ovarian cancer risk. Management focuses on treating endometriosis symptoms while monitoring for concerning changes.

Lifestyle and Cancer Risk

While not all gynecologic cancers are preventable through lifestyle changes, certain modifications reduce risk:

Obesity

Obesity significantly increases endometrial cancer risk through increased estrogen production. Weight loss reduces risk.

Physical Activity

Regular exercise reduces endometrial cancer risk and may benefit ovarian cancer risk.

Diet

While no specific diet prevents gynecologic cancers, overall healthy eating patterns support well-being.

Smoking

Smoking increases cervical cancer risk and makes HPV infections more likely to persist. Smoking cessation reduces risk.

Oral Contraceptives

Birth control pills reduce ovarian and endometrial cancer risk by 30-50% with increasing protection with longer use. Benefits persist years after discontinuation.

Early Detection Through Screening

Beyond cervical cancer screening, other gynecologic cancers lack effective population-wide screening tests. However, women at high risk may benefit from:

Transvaginal Ultrasound

For women with strong family history or genetic mutations, periodic pelvic ultrasound may detect ovarian masses earlier, though benefit in reducing mortality is unclear.

CA-125 Blood Test

Tumor marker elevated in some ovarian cancers. Limited value for average-risk women but may be used in high-risk individuals.

Endometrial Biopsy

For women with Lynch syndrome or other high endometrial cancer risk, annual biopsy detects early cancers or precancerous changes.

Dr. Aiswarya develops individualized screening plans based on personal and family history, genetic testing results, and risk assessment.

Second Opinions and Risk Assessment

If you’ve been told you’re at high cancer risk or need genetic testing, second opinions can provide:

  • Comprehensive risk assessment
  • Genetic counseling and testing coordination
  • Discussion of screening vs. risk-reducing surgery
  • Support in complex decision-making

Dr. Aiswarya welcomes consultations for cancer risk assessment and preventive planning.

Empowering Informed Decisions

Preventive oncology involves complex decisions with significant life impact—from genetic testing to prophylactic surgery to enhanced screening. Dr. Aiswarya provides:

  • Thorough risk assessment based on personal and family history
  • Genetic counseling and testing coordination
  • Explanation of screening and prevention options
  • Support throughout decision-making
  • Respect for individual values and preferences

Your Partner in Prevention

Whether you’re concerned about family history, have genetic mutations, need management of precancerous conditions, or simply want appropriate screening, Dr. Aiswarya provides expert, compassionate preventive oncology care.

Prevention and early detection save lives. If you have concerns about gynecologic cancer risk, schedule a consultation to discuss screening, genetic testing, and risk-reduction strategies. Contact us today.

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