new survey: canadian women over 40 missing warning signs of reproductive cancers
nearly 60 per cent of women surveyed expressed uncertainty about whether these cancers exhibit early warning signs.
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almost half of women surveyed didn't discuss gynaecological issues during their last healthcare checkup, but 85 per cent wish their healthcare providers would ask.
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a national survey conducted by leger research revealed that an alarming majority of women in canada aren’t sure whether gynaecological cancers have early symptoms—in diseases where early detection is lifesaving.
nearly 60 per cent of women surveyed expressed uncertainty about whether these cancers, also referred to as “reproductive cancers,” exhibit early warning signs. results also showed a gap in knowledge of risk factors, which is considered critical to seeking care and early detection. family history and human papillomavirus (hpv) were the two most recognized risk factors, but fewer women were aware of other common contributors, such as obesity, age and long-term use of hormonal birth control.
ovarian cancer, for example, is the most lethal type of gynaecological cancer. while knowing your family history of ovarian or breast cancer, or if you have breast cancer gene mutations (brca1 or brca2), are red flags, other symptoms are vague and often dismissed, like pelvic pain, bloating and weight gain.
flagging the need for open discussion of gynaecological cancers
the survey was commissioned by the biopharmaceutical company gsk canada and conducted in april among a representative sample of 1,510 canadian women aged 40 and above who are members of leger’s online panel. it illuminates the need for more open discussion of gynaecological cancers and resources to navigate care—which experts in the field recognize is vital for better patient outcomes.
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the results highlight several key reasons why women delay seeking care for gynaecological symptoms, including:
- lack of awareness of symptoms: 69 per cent identified this as a contributing factor.
- symptom dismissal: 61 per cent admitted to dismissing potential signs of cancer.
- confusion with other conditions: 60 per cent reported that symptoms are frequently mistaken for other health issues.
“these findings confirm what we’ve heard from women for decades: female gynaecological cancers are overlooked and not well understood,” tania vrionis, ceo of ovarian cancer canada, stated in a news release about the survey. “the healthcare community and patient organizations have a unique opportunity to drive change that improves women’s healthcare.”
these cancers include ovarian, endometrial (also known as uterine cancer), cervical, vaginal and vulvar cancers. they impact thousands of women every year, yet, as the survey brings to light, there are challenges when it comes to understanding risks, knowing the symptoms and getting to a healthcare provider to talk about it.
dismissing symptoms as ‘change of life’ in menopause
“most of our gynecological cancers manifest around the age of menopause, and menopausal women seem to blame every single new symptom that they have on their changing bodies around menopause,” says dr. patti power, clinical chief of provincial cancer care at newfoundland and labrador health services.
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if women are noticing that their bellies are getting larger but they’re experiencing weight loss and have less of an appetite, they rationalize symptoms as related to menopause, the period where menstruation stops and hormones fluctuate.
“patients say, ‘oh, this is just, to use the colloquial term, change of life,’” she explains, adding that vague symptoms can be warning signs of ovarian cancer.
the attitude of accepting symptoms, even when they persist, is pervasive. and it often means that patients wait too long and finally see a healthcare provider when they’re in stage 3 ovarian cancer—where the cancer has spread and the prognosis is grim. unlike prostate cancer psa (prostate specific antigen) testing, there’s no screening test for ovarian cancer, so the solution to detection lies in being proactive and having more conversations about gynaecological cancers.
dr. jessica mcalpine, division co-head of gynaecologic oncology at the university of british columbia and bc cancer, also says that one of the big hurdles to reproductive cancer prevention and care is women not wanting to complain or draw attention to symptoms.
“women are particularly good at self-justifying symptoms or attributing things to other things or being stoic or not raising them or not wanting to complain and draw attention,” she says.
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that thinking has to change and women need to be aware that if they experience a new symptom that increases in frequency or is persistent, “they need to say, ‘well, look, i do need an answer for this’ and they need to think of how they’re going to get that answer and try to talk with their physician about what else would be causing it? when things come up with another cause and they can be resolved, that’s great. when they are not, they need to be pursued.”
treatment can save lives, but early detection is critical
treatment typically involves a combination of surgery, chemotherapy, radiation therapy, and, now, more targeted therapy or immunotherapy, depending on the cancer type and stage. in any cancer, earlier detection helps boost odds of survival and quality of life, and mcalpine says in many cases of reproductive cancers, there’s a cure. surgery has advanced for cancer removal and prevention, as more women are removing their fallopian tubes when they are undergoing other surgeries, so that they don’t ever develop ovarian cancer at a later date.
“the earlier we know, the more likely we can intervene to cure, to have a less involved surgery for better quality of life, and where they’re less likely to need additional treatment like chemotherapy and radiation,” she says, noting gynaecologic cancers, like other cancers, are no longer just based on where they grow or the organ they’re impacting. tailored treatments can address cancer at the molecular level. “we can approach a patient completely differently than we would have 10 years ago, so what surgery they get, and what treatment they get,” or even not to treat but monitor to begin treatment only when necessary.
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she also mentions advancements in prevention, such as self-screening home kits for human papillomavirus (hpv), the most common sexually transmitted infection in canada and around the world. high-risk types of hpv can lead directly to the development of several cancers, including cervical cancer, with about 70 per cent of invasive cervical cancers attributed to hpv, biology insights reports.
“the ability to do a home test kit is huge and so impactful. we know that there’s a proportion of patients who didn’t feel comfortable with (in-clinic screening) or marginalized or lived remotely. so we’re really encouraging individuals to take that opportunity.”
endometrial cancer on the rise, yet women lack awareness
another significant survey finding is that 80 per cent of respondents revealed they lack awareness of the symptoms and risk factors of endometrial cancer, also known as uterine cancer. this underscores a worrisome gap in knowledge, given its rising prevalence as the most common reproductive cancer in canada.
in 2024, 8,600 canadian women were diagnosed, and 1,600 died from the disease, according to the canadian cancer society. endometrial cancer is expected to become the second most diagnosed cancer among canadian women within the next 15 years.
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“uterine cancer is increasing in incidence and in mortality. it’s one of the few cancers that is increasing in mortality, and we don’t have all the answers as to why that is, and that’s a big focus of our research,” says mcalpine.
major risk factors for endometrial cancer are obesity and family history, but also vaginal bleeding that shouldn’t happen after menopause.
“if women after menopause have any new vaginal bleeding, we really encourage them to seek medical attention. it isn’t normal to have bleeding after you have been through menopause,” power says.
she recently saw a patient with vaginal bleeding who was 70 years old and assumed she hadn’t gone through menopause. the reality is 90 per cent of women are through menopause by the age of 52 or 54. sampling of the patient’s lining of her uterus showed uterine cancer, which had probably been there for many years.
as the leger survey outlines, despite the severity of these cancers, conversations about gynaecological health remain infrequent. almost half of respondents said they did not discuss gynaecological matters during their most recent healthcare checkup or couldn’t recall if they did. here’s the disconnect: 87 per cent noted that their provider is knowledgeable about gynaecological topics and that they feel comfortable discussing related symptoms with them. however, 85 per cent would like healthcare providers to initiate these discussions.
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on that note, power says medical students and family practice residents are getting a “really good education about gynecological cancers.” she explains the lack of primary care physicians, especially in small, rural communities in newfoundland, for instance, represents the main gap in care.
one way to solve access is by establishing the nurse practitioner model of care. this is where nurses with advanced training perform assessments, diagnose conditions, prescribe medications, and manage treatment plans, also linking patients to other professionals and community services.
mcalpine echoes what medical experts and advocates hope is the way forward: more open dialogue. “we want people to advocate, to discuss, to question, to talk with their friends, to talk with their daughters or aunties, their grandparents about some of these symptoms, so that they seek attention and get diagnosed earlier.”
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