Photo credit: Firooz Zahedi

By John Morgan, Spotlight Health
With medical adviser Stephen A. Shoop, M.D.

Women's health is a topic with which Drescher is all too familiar. The 46 year-old actress chronicled her victorious battle with uterine cancer in her book Cancer Schmancer. Now Drescher is hoping to write a new chapter in her campaign against women's cancers.

"Women have to have an extra loud voice at almost every level, but especially when it comes to our health," Drescher says. "Improving basic gynecological healthcare is extremely important. It's like when women weren't allowed to vote. It's a no-brainer."

Drescher's biggest campaign issue is that she says current standards for a woman's annual examination are woefully inadequate and do not utilize many new medical advances.

"The big problem with the typical exam is we don't get tested for anything north of the cervix," Drescher states. "What about the uterus and the ovaries? The doctor still gives you a manual pelvic exam which is like something out of the Dark Ages."

Drescher is particularly critical of this "archaic" procedure given the explosion of obesity facing American women. "Patients being overweight make it even more unlikely that a doctor can evaluate the uterus properly by digital or manual exam and pressing down on her abdomen."

"The epidemic of obesity does make it more difficult to examine the patient and it is not as accurate an exam," says Sheila Bolour, an internal medicine specialist and assistant director, Women's Health Program at Cedars-Sinai Medical Center in Los Angeles. "The thinner a woman is -- the better the digital exam you can do."

According to Bolour, a digital exam often does allow the gynecologist to feel the ovaries as well as the size of the uterus. "For the general population, it is a good, low-cost screening tool as part of the normal exam," Bolour says.

Technological advance

But both Bolour and Drescher note that there is a relatively inexpensive technology now available that generally surpasses the accuracy of the digital exam.

"In my opinion, every woman should be getting a trans-vaginal ultrasound every time she goes to the gynecologist for her annual exam," Drescher states. "And every gynecologist should become skilled in using this technology."

Trans-vaginal ultrasound is an imaging procedure where an ultrasound probe is inserted into the vagina to get a closer look at the pelvic organs, including the uterus, fallopian tubes and the ovaries. It is believed this procedure is more sensitive than placing the instrument on the abdomen.

"It's like putting a pair of eyes on the ends of the doctor's fingers," Drescher notes. "It enables the doctor to better see what is going on in a woman's body. Otherwise, I believe the exam is essentially incomplete."

Drescher likens it to a dentist only examining a third of your mouth, yet telling you your teeth are perfectly healthy. "You'd say, 'Wait a minute, you didn't really check my whole mouth.'"

Ultrasound allows the gynecologist to view "the entire mouth."

"Trans-vaginal ultrasound does give you more information because you are actually looking at the pelvic structures and organs," Bolour adds. "With a digital exam you are feeling for structures. You can't see what's going on."

Trans-vaginal ultrasound does get a lot of votes from women's health practitioners, because the procedure can be used to:

• Evaluate perimenopausal women who develop longer or heavier periods
• Examine the ovaries and detect cysts
• Detect masses on the ovaries
• Examine the uterus and the uterine lining
• Detect fibroids on the uterus

But should every woman who goes to their gynecologist get a trans-vaginal ultrasound?

"There are times when trans-vaginal ultrasound is definitely beneficial," Bolour explains.

"If a post-menopausal woman has vaginal bleeding, then the ultrasound is the first thing you should do. We look at the lining of the uterus to see if it has thickened, because this can be a sign of hyperplasia or cancer."

Trans-vaginal ultrasound can also be useful for examining:

• Pre-menopausal women who are spotting in between periods
• Women with unexplained pelvic or lower abdominal pain
• Women with a palpable mass

Cost benefit

Studies also indicate that trans-vaginal ultrasound for women who are high-risk - like those with the BRCA mutation or who have a strong family history of ovarian cancer - has some benefit as a screening tool. These women start off with a higher risk so if an abnormality is detected, it's often more likely to be malignant.

Bolour points out that not all women are high risk. In fact, most patients are healthy women who are not experiencing any problems. And because ovaries change constantly and can often form benign cysts, Bolour does not recommend trans-vaginal ultrasound as a general screening tool for all women. 

"Since the incidence of ovarian cancer is relatively low compared to the incidence of benign changes in the ovaries, we can end up doing a lot of unnecessary procedures," Bolour explains. "This doesn't mean we shouldn't do ultrasounds. We just have to determine it on an individual basis."

But Drescher argues a survivor's perspective of 'better safe than sorry.' She feels that since ovarian cancer remains silent until it's frequently too far advanced to treat successfully, it's better to detect abnormalities early and rule out benign occurrences than miss tumors completely because an incomplete exam is employed.

"About 80% of women who get ovarian cancer find out in the late stages of the disease, and around 70% of these women will die," Drescher notes. "Early detection equals survival. If you're out of Stage 1, you've reduced your chances of surviving considerably."

Drescher says part of the problem is doctors are "bludgeoned" by insurance companies to go the least expensive route in diagnostic testing.

"Trans-vaginal ultrasound results might encourage doctors to order additional tests which will cost more money," Drescher states. "It all comes down to money. The business of healthcare has superceded the care of good health."

Bolour cautions that the most important thing for good female health is that if a woman's period changes, or there is bleeding in between periods, or if she is post menopausal and has bleeding - she should definitely be examined carefully by her doctor.

"We don't have a good tool yet to detect early ovarian cancer in young healthy women," Bolour concludes. "Trans-vaginal may be helpful, but it is not the answer to solving this problem."

In the meantime, Drescher has beaten her cancer problem.

"I feel like I am cured," says Drescher, who believes she is the right candidate for the job of improving women's and men's health. "The fact that I am well and able to talk about my experience has provided me a very purposeful path to help other people. It's time now to make an even bigger impact."

Spotlight Health is the leading creator of celebrity-featured health-issue awareness campaigns, connecting consumers with impassioned celebrities whose personal health battles can open eyes, dispel myths and change lives. Spotlight Health helps sufferers and caregivers meet the challenges of difficult health circumstances with understandable, in-depth medical information, compassionate support and the inspiration needed to make informed healthcare choices.

Created: 3/28/2004  -  John Morgan & Stephen A. Shoop, M.D.
Reviewed: 3/28/2004  -  Donnica Moore, M.D.