Practical Resources
The diagnosis of cancer is one of the most feared diagnoses given by physicians. Though great strides have been made in the last half century, a malignancy is still one of the most intimidating diagnoses in modern society. However, though this diagnosis is dreaded, ignorance about cancer is still rampant among all cultures and genders. Accurate knowledge through education is the most important proactive attack to save lives of those affected by gynecologic cancers. Gynecologic cancers, or cancers of the female reproductive tract, are quietly killing nearly 28,000 women every year; many of these deaths are preventable by education, self-awareness, earlier detection, and preventive care.
Women are very concerned about cancer, but register limited knowledge about gynecologic cancers. Based on a recent public opinion poll, 70% of women report concern about their risk for ovarian cancer, while 68% are concerned about cervical cancer and 66% are concerned about uterine cancer. Despite this, nearly one-third of American women feel that they are not knowledgeable about gynecologic cancers, and 55% feel that they are somewhat knowledgeable. A plurality of 45% are not aware of any of the risk factors for developing a gynecologic cancer, and even fewer women are aware of any ways to reduce their risk. Women are similarly uneducated about the symptoms associated with gynecologic cancers, with 47% unable to name any symptoms. Women are uncertain of what type of specialist they would see if they were diagnosed with a gynecologic cancer. Just 11% mention that they would see a gynecologic oncologist. Congressman Dan Burton says, “This is a national tragedy, and what makes it even more tragic is the fact that many of those deaths could have been prevented if more women and their doctors knew the risk factors and recognized the early warning signs.”
Gynecologic Oncologists treat the cancers of the reproductive tract including the cervix, endometrium, fallopian tubes, ovaries, uterus, and vagina. Gynecologic Oncologists are cancer specialists whose training is first that of an obstetrician/gynecologist, after which they have had two to four years of structured training in all of the effective forms of treatment of gynecologic cancers (surgery, radiation therapy, chemotherapy, and experimental treatments) as well as the biology and pathology of gynecologic cancer. This training takes place in a limited number of medical centers. The exceptional training allows patients to receive the mode of therapy (i.e., surgery, chemotherapy or radiation therapy) or combinations of therapy most likely to be successful without fragmenting their care among too many physicians. Gynecologic oncologists practice in a variety of settings including hospitals, cancer centers, and private practices. Below are descriptions of three of the most prevalent of the gynecologic cancers.
1. Cervical cancer is caused by abnormal cellular changes in the cervix and is the only gynecologic cancer that can currently be prevented by regular screening. In addition to an effective screening test, women can be protected by early vaccination with a vaccine that targets the causative agent of most cervical cancers, Human Papillomavirus (HPV). Early vaccination, currently recommended between 9-27 years of age, with regular screening is now the best way to prevent cervical cancer. Cervical cancer usually affects women between the ages of 30 and 55, but has been found as early as the teen years. Despite consistent outreach programs, there is still too large a percentage of women not following preventative measures to combat cervical cancer.
2. Ovarian cancer, the seventh most common cancer among women, usually arises on the surface of the ovary in the epithelial cells. About 85% to 90% of ovarian cancers are epithelial ovarian cancers. Ovarian cancer is the fifth leading cause of cancer-related death in women. Unfortunately, nearly two-thirds of women diagnosed with ovarian cancer are diagnosed with advanced stage disease and currently, 55 percent of the women diagnosed with ovarian cancer die from it within five years.
3. Most uterine cancers begin in the lining of the uterus (endometrium), usually after menopause. Endometrial cancer (which affects the lining of the uterus) is the most common gynecologic cancer in the United States, affecting almost 40,000 women a year. According to data from the National Cancer Institute, endometrial cancer is the only malignancy for which survival has actually decreased over the past 30 years. Even benign tumors of the uterus (fibroids) can negatively impact on women’s health. Fibroids are the most common female solid pelvic tumor, occurring in up to 70% of women and resulting in over 360,000 hysterectomies in the United States annually.
Quality of Care
The Institute of Medicine’s recent publication, Ensuring Quality Cancer Care, drew national attention to the quality of cancer care and concluded that many Americans with cancer are not receiving ideal care. Providing the appropriate surgical treatment for women with gynecologic cancer is one of the most effective ways to improve outcomes. Because optimal surgery is associated with improved survival, efforts should be made to ensure that all women with gynecologic cancer, especially those who are vulnerable because of age, race or socioeconomic status, are referred to centers or surgeons from whom they are more likely to get optimal surgery. Unfortunately, due to misinformation or ignorance too many women are not seeking the proper medical treatment.
II. THE RESPONSE
WORD is aggressively seeking to meet the challenges presented in the fields of education and research of gynecologic cancers. WORD has developed the necessary partnerships to produce quality, reproducible, and accurate material that will be effective in informing women about how personal advocacy and awareness are the most important weapons in the battle against gynecologic cancers. WORD is poised to bring together the best from science, medicine, media, publications, communications, and education to inform the women of the United States military and Department of Defense of the preventions, signs, symptoms, and treatments of gynecologic cancers.
WORD will create an extensive and holistic educational campaign entitled “Because She Should Know!” (BSSK) using various forms of media both digital and print. WORD’s goal is to lessen occurrences, increase earlier detection and diagnosis, increase proper care and treatment, decrease medical intervention necessary for full remission, and empower a proactive movement among women of personal advocacy and self-awareness.
THREE PRIMARY INTERVENTIONS
WORD’s strategy can be categorized into three primary health education interventions. Together, over a five-year period, each intervention provides a complex, thorough, and reproducible educational campaign for all women of the Department of Defense.
1. Website Education and Media Directed Promotional Campaign. (Focus of years 1-2)
WORD proposes the development of a state-of-the-art educational website on the risks, signs, symptoms, and treatments of gynecologic cancers. The website will mix the newest of gynecologic cancer educational expertise, the latest applicable and effective internet technology, with the best marketing and print materials driven to encourage women of the Department of Defense to visit the http://www.becausesheshouldknow.us website repeatedly in order to reduce risk behaviors and act on potential signs and symptoms.
Together with WORD’s primary partners, Purdue University and Publicis, WORD will complete market research; develop an in-depth, dialogue-driven website; and prepare marketing materials including but not limited to television spots, radio spots, direct mail pieces, poster distribution, viral email distribution, launch events, and more. WORD anticipates using both military-specific mediums as well as general-market mediums depending on their researched effectiveness through the campaign’s market research.
WORD has chosen to launch BSSK with a state-of-the-art website founded on the belief that web interventions are the most fiscally responsible and effective allocation of resources with the greatest potential to reach the largest audience. As a research paper states, “The effect size comparisons in the use of Web-based interventions compared to non-Web-based interventions showed an improvement in outcomes for individuals using Web-based interventions to achieve the specified knowledge and/or behavior change for the studied outcome variables.”
2. Active Military Training Printed Campaign and E-learning Intervention. (Focus Years 2-3)
WORD proposes utilizing the unique opportunities of active duty female personnel serving in the United States military by producing an interactive, internet-based classroom experience to be placed in training situations for women of all the armed services. This internet-based class, patterned after the successful 1998 CD-Rom created by Macro International , will be available to all active duty military personnel and will provide assessment materials. Accompanying this course will be a printed “Field Journal to Gynecologic Cancer Prevention and Diagnosis,” as well as a portable cd-rom/dvd-rom version of the course. The printed publication will provide a suggested checklist of self-care and advocacy that any woman can institute in their lifestyle.
3. Primary Care Physician Training and Networking (Developed and Launched Years 4-5)
WORD will utilize various methods to develop unique training opportunities for primary care physicians (PCPs). WORD will help PCP’s identify when to do additional testing, how to best train women in prevention, when to refer to specialists, and give the physician screening guides. WORD will utilize American College Obstetrics & Gynecology recommendations, Society of Gynecologic Oncology recommendations, as well as original resources designed and researched by WORD personnel such as OCRA (Ovarian Cancer Risk Assessment) to help PCPs know when to refer to a gynecologic oncologist. `
