Fran Drescher Announces Campaign For Women's Health
By John Morgan, Spotlight Health
Photo credit: Firooz Zahedi
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
"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.
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
"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
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
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."
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Created: 3/28/2004  - John Morgan & Stephen A. Shoop, M.D.
Reviewed: 3/28/2004  - Donnica Moore, M.D.