6 OCTOBER 2019 • HEALTHCARE INNOVATIONS


Innovative healthcare & alternative remedies


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CHECK YOUR RISK FACTORS Ovarian: risk factors • Hereditary cancer syndrome (BRCA1 /BRCA2), Lynch syndrome


• PCOS , endometriosis, infertility • Conventional HRT • Early menarche, late menopause


Endometrial (lining of the womb): risk factors • Increasing age • PCOS, diabetes, infertility • Hormone therapy for breast cancer


• Obesity (excessive fat alters hormone balance)


• Changes in hormone balance • Longer years of menstruation (ideal age of menopause is 50-51 years)


• Inherited colon cancer syndrome (HNPCC)


• Use of an intrauterine device (IUD) • Having had breast or ovarian cancer in the past


• Having had endometrial hyperplasia in the past


Cervical cancer: risk factors • Many sexual partners, early sexual activity


Personalised cancer screening : A new concept in women’s health


Experienced gynaecologist Mr Ashfaq Khan explains how we all have similar, but not identical, external and internal biochemical environments


T at’s why each of us responds to the same infection very diff erently. T e medical profession hasn’t learnt completely how each disease develops and progresses, hence it off ers generic types of treatment to patients. If those elements that contribute to the devel- opment of cancer — or those changes that occur prior to the development of a full-blown cancer — can be identi- fi ed, perhaps it can be managed more successfully? However, this requires careful risk assessment and an indi- vidualised management plan. As the head of one of the largest


colposcopy and valval units in the NHS, and the medical director of a successful independent gynaecology clinic in Harley Street, I constantly come across dissatisfi ed patients who feel doctors failed to assess their personal worries and off er something that suited their circumstances. Let’s look at a few examples. Ms


A is worried about a recent positive HPV test result with abnormal smear test. She’s going to have a colpos- copy (camera test) and a biopsy (the process of extracting a sample of tissue from the cervix for further examination). Unfortunately,


that’s


not going give the full answer to her problem. She might end up with unnecessary invasive treatment or false reassurance. In these common circumstances, unlike conventional treatment, in order to produce a clear and effi cient understanding, I’d usually carry out a risk-based assess- ment (RBA) along with conventional colposcopy and biopsy test. Mrs D, aged 62, has been suff ering from vulval itching and a burning sensa- tion and the only treatment she’s received was anti-candida (thrush) creams and tablets. Mrs D waited


RISK ASSESSMENT IS A TERM USED TO DESCRIBE THE OVERALL PROCESS OR METHOD WHERE YOU IDENTIFY RISK FACTORS THAT HAVE THE POTENTIAL TO CAUSE HARM. THE CONCEPT IS NEW IN HEALTHCARE


eight years before she was diagnosed with Lichen sclerosus at a specialised vulval clinic, and during a follow-up visit, early vulval cancer (pre-cancer stage) was diagnosed. She was then eff ectively managed with minor laser surgery, thus avoiding extensive surgery and radiotherapy.


WHAT ARE RISK-BASED ASSESSMENTS? Risk assessment is a term used to describe the overall process or method where you identify risk factors that have the potential to cause harm; evaluate the risk asso- ciated with that hazard (utilising the appropriate tools) and fi nally deter- mine the appropriate ways to elimi- nate or monitor the hazard, or control the risk (by experienced and appropri- ately trained personnel). T is concept is new in healthcare, but slowly and surely will be the cornerstone of future healthcare management. T e current cervical screening programme is designed to reduce


cervical cancer only. However we now know the same HPV infection that causes cervical cancer is also responsible vaginal, vulval and anal pre-cancer and cancer. T e HPV vaccine is going to give a high level of protection to the younger gener- ation of women who were luckily vaccinated when they were teen- agers. Unfortunately , mature women aren’t similarly protected. A study of women aged 35 to 60, released in early 2013, found that HPV in women during or after the menopause may be the results of an infection acquired years ago. T e reactivation risk may increase around the age 50. So, it’s important to monitor not


only your cervix, but also vagina and vulva. Vaginal and vulval cancer, though, are rare and usually appear after the age of 60. If women are checked for vaginal pre-cancer in their 40s and 50s, then this risk could have been reduced signifi cantly.


WHAT CAN YOU DO DIFFERENTLY? Usually you ask for a doctor’s review if become symptomatic and it’s very important to continue to do that if you have: • Unusual vaginal bleeding (espe- cially after intercourse or after menopause)


• Watery vaginal discharge • A lump or mass in your vagina • Painful urination • Frequent urination, constipation and/or pelvic pain


• Vulval itching, burning sensations


HOW INDIVIDUALISED MANAGE- MENT IS PLANNED ON THE BASIS OF RBA? 1. Identify risk factors 2. Decide an appropriate check-up


plan (scan or colposcopy and biomarker [blood] tests)


3. Act on the report. You may decide not to be treated but monitor the condition, or you may decide to have conventional treatment or an alternative method of treatment


Some of the tools are already available in the NHS as well as in private clinics. Unfortunately, either these aren’t off ered to the general population in the NHS or they’re used injudiciously in many private clinics. We use these tools once women are symptomatic. An ultrasound scan has been used for women experiencing bleeding after the menopause, while CA 12-5 is now off ered to women who have already developed a cyst or tumour on their ovaries. I was also involved in research in biomarkers at University College London, which helped to understand individualised preventative medicine using biomarkers along with other available tools. Risk factors can help you seek


further investigation and test to assess your current health status. T ere’s no established screening programme for any gynaecological cancers except cervical. However, new evidence and new scientifi c inno- vations developed over the last two decades can off er useful tools with


Mr Ashfaq Khan FRCOG is the medical director at Harley Street Gynaecology as well as being the head of the colposcopy and vulva disease unit and cervical screening provider lead at the Whittington Hospital (NHS). E: info@harleystreetgynaecology.com ashfaqkhan.com harleystreetgynaecology.com For appointments T: 020 3303 0316 E: pa@harleystreetgynaecology.com


• Genital warts and HPV infection • Not been (HPV) vaccinated • Other sexually transmitted infections (STIs) • A weak immune system • Smoking


Vulval cancer: risk factors • Increasing age. The average age at diagnosis is 65


• Human papillomavirus (HPV) infection


• Smoking • HIV and other immune, compromised condition


• History of vulval pre-cancer • History of vulval Lichen sclerosus


Vaginal cancer: risk factors • Increasing age • Pre-cancer of vagina or cervix • Exposure to miscarriage prevention drug known as DES (diethylstilbestrol)


• Smoking • HIV or immune compromised condition, multiple sexual partners


which to make a risk-based assess- ment to plan an individualised care. T is method of check-up isn’t guar- anteed to pick up cancer or predict cancer risk. However, it’s defi nitely better than doing nothing and waiting for symptoms to develop. Harley Street Gynaecology has a team of dedicated gynaecologists, along with a specialist pathologist and state-of- the-art pathology laboratory, to off er such care until becomes the norm in the NHS.


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