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August 6, 2009 – Vol. 3 • No. 12
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Young and old are vulnerable

For a moment, uterine cancer was the subject of national attention.

It required two years of legislative work, but in 2007 President George W. Bush signed into law the Gynecologic Cancer Education and Awareness Act of 2005, or “Johanna’s Law.”

Johanna’s Law was named after Johanna Silver Gordon, a former schoolteacher who did not recognize the symptoms of ovarian cancer and died from its complications.

But the national attention failed to generate research dollars. In fact, the opposite occurred for research of uterine, or endometrial cancer, the leading type of gynecological cancer.

According to the National Cancer Institute, funding decreased from $25.5 million in fiscal year (FY) 2003 to $16.6 million in FY 2007. And that number was a more than 80 percent drop from $31.3 million in FY 2005. In comparison, breast cancer research receives an estimated $550 million per year.

Even with the scant research dollars, public awareness of uterine cancer remains low. Just ask LaToysha Fernandez. At 30 years old, she believed that the chances of her acquiring any sort of cancer were low. So did her doctor at her neighborhood health clinic in Houston, Texas.

Yet 25 percent of women diagnosed with uterine cancer are under the age of 50.

“Don’t worry,” Fernandez said the doctor told her. “You are too young to get cancer.”

But Fernandez knew she had a problem. Her monthly period, always troublesome, was even more strange. In fact, Fernandez said, she bled excessively for three straight months. Plus she was losing weight and strength.

“I couldn’t make it to the bathroom without getting out of breath,” she said.

Finally, she collapsed. She was able to call 911 and was quickly taken to a nearby emergency room. While there, she was given an astonishing eight units of blood to make up for all that was lost. But, she explained, “As fast as they gave it to me, I’d lose it.”

Her problems only got worse. Her stay in the hospital lasted a week, but no one could figure out what was wrong with her.

Because Fernandez did not have health insurance, it took three months to schedule an appointment with another doctor.

Finally, she met with a gynecologist at the Lyndon B. Johnson General Hospital, part of the Harris County Hospital District, in Houston. The news wasn’t good: She had a rare and aggressive form of uterine cancer.
“I was scared,” she said. “I knew people who had cancer and it did not turn out well.”

She also wondered if she would survive the treatments.

“Am I strong enough?” she asked.

If uterine cancer is found before it has a chance to spread, the five-year relative survival rate is roughly 95 percent. Once it has spread to distant parts of the body, survival reduces to 24 percent.

This outcome is especially important for black women. Studies have shown that black women with advanced or recurrent uterine cancer had significantly worse survival rates than white women who received the same treatments. The cause of the disparity is unclear, but may be related to biological, socioeconomic or genetic factors.

Many experts believe the disparity is due mostly to lack of access to adequate care.

It is important to be aware of signs and symptoms — abnormal vaginal bleeding or spotting — since there is no early detection test for uterine cancer.

Pap tests screen for cervical cancer, the lower part of the uterus, but generally cannot detect changes in cells in the lining of the body of the uterus where endometrial cancers grow. Cervical cancer is not the same as uterine cancer.

However, the American Cancer Society recommends that women of high risk — those with hereditary factors, on estrogen treatment or on tamoxifen therapy for breast cancer — should have regular endometrial biopsies beginning at age 35.

Fernandez had few choices. She underwent a radical hysterectomy and removal of abdominal lymph nodes followed by 12 rounds of chemotherapy.

But within a year the cancer returned, and she is now on a new round of chemotherapy. She is anxiously waiting for her next set of CT scans that will tell her whether the treatment has succeeded. If not, she will try another type of medicine.

One thing she knows for sure — she is not giving up.

Fernandez has become a militant medical consumer, arming herself with lots of medical pamphlets and hours of Internet research.

“If you have symptoms — regardless of your age — have them checked out,” she said.

“Ask questions. If you don’t understand the answer, ask again.”

LaToysha Fernandez (right) says she owes her life to Dr. Lois Ramondetta (left) a gynecologic oncologist at M. D. Anderson Cancer Center and Lyndon B. Johnson General Hospital in Houston. Fernandez, 31, was diagnosed with uterine cancer.

Photograph by F. Carter Smith
Used by permission of UT M. D. Anderson Cancer Center 2009

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