On a dark, cold day in January of 2022, Jeanenne Tapia went in for a long overdue checkup with her doctor.

And the news she received matched the somber, wintry weather.

It had been seven years since Jeanenne’s last visit with her obstetrician-gynecologist.

Finally, after enjoying special time with her family over the holidays, Jeanenne booked an appointment for January in her hometown of Trinidad.

The start of a new year seemed like the right time to get answers about health issues that had been troubling her.

Persistent bladder discomfort — something she thought was merely a common symptom after menopause — led her to seek help and ultimately to a profound new journey.

“I haven’t seen you since 2015,” her doctor said.

“Yes, I turned 65,” Jeanenne responded, thinking that she no longer needed regular pelvic exams and Pap smears after age 65.

But her doctor let her know that she should have continued getting regular gynecological exams.

“You still have all of your female organs, Jeanenne, and you need to keep up with all your screenings,” the doctor said.

Is there an age at which women should stop seeing their gynecologist?

Like many women, Jeanenne believed that after menopause, regular gynecological screenings were no longer necessary. That’s a widespread misconception that can put older women at risk.

‘’Somewhere I read that once you turn 65, you no longer need pelvic exams, Pap smears, mammograms. So, I had stopped all that,’’ Jeanenne said.

In fact, women need to keep seeing their doctors regularly as they age. In part, because there are five types of gynecologic cancer that women can get, including the following:

• Cáncer cervical
• Cáncer de ovario
• Endometrial and uterine cancer
• Cáncer de vagina
• Cáncer de vulva

During Jeanenne’s appointment, her gynecologist discovered polyps and ordered a biopsy.

The results shocked Jeanenne.

“I wasn’t even ill,’’ she said.

The biopsy diagnosed vulvar cancer. Imaging exams determined it was stage 4. She was 68.

Why screenings after 65 are so important

Vulvar cancer forms on the outer surface of the vulva. It’s quite rare, striking about 7,500 women each year in the United States.

‘‘I think women just assume, because I know I did, that it will never happen to me. I think that’s the common thought,” Jeanenne said.

“We’re invincible. We’re indestructible. We have families, we have jobs. We can’t get cancer. It’s not going to happen to us.’’

Jeanenne’s doctor in Trinidad referred her to see gynecological specialists at UCHealth University of Colorado Hospital on the Anschutz Medical Campus in Aurora. Following treatments there, Jeanenne was able to see cancer specialists closer to home at the UCHealth Cancer Center at Memorial Hospital Central in Colorado Springs.

As she faced her tough diagnosis, Jeanenne discovered new strength and a new conviction that she shares with other women: be sure to take care of yourself, and get your checkups.

‘‘To say I was frightened and traumatized, in doubt, disbelief and shock, those are all understatements. But I am a strong woman of faith.’’

Postmenopausal women need regular checkups and screenings, just like younger women

Postmenopausal women should follow their doctors’ guidance about the frequency of checkups and recommended screenings.

While there are general guidelines, each situation is unique, and a person’s medical history affects the type, number and frequency of screenings each patient needs.

Research shows that many women approaching age 65 make choices similar to Jeanenne’s and stop undergoing screenings.

For example, when it comes to cervical cancer screenings, experts at the U.S. Centers for Disease Control and Prevention found the following:

• The older women get, the more likely it is that they have either never been tested for cancer or haven’t been screened in the previous five years.
• Approximately one in 20 women between the ages of 66 and 70 has never been tested for cervical cancer.

But it’s vital for women to keep getting preventive care as they age.

Jeanenne dismissed her symptoms until they became overwhelming.

“I developed difficulty with urination, and as a post-menopausal woman, I initially thought it was due to bladder prolapse, which is common in women my age,” she said.

Jeanenne also ignored warning signs, including her 30-pound weight loss over the previous few months before she saw her doctor.

She had spent her life taking care of others. She dedicated 25 years of her career to work in health care.

‘‘During my 25 years in health care, I served in many different capacities.  I began as a switchboard operator, in the old days of actual switchboards.  I worked my way up to serving on a team of four administrators in the role of Director of Human Resources.  I often covered for the CEO in times of his absence.’’

She had been busy with her profession and family throughout her life. Making time for her health wasn’t a priority.

‘‘I found both of my careers very rewarding. At the time I became sick, I had just retired.’’

The risk of vulvar cancer rises as women age

The risk of vulvar cancer goes up as women age, according to researchers at the American Cancer Society.

More than half of vulvar cancer cases occur in women over age 70.  Fewer than 20% of cases surface in women younger than 50.

“Women over age 65 should still be talking to their health care providers about pelvic exams and making individualized decisions,” Dr. Carolyn Lefkowits, gynecologic oncologist at UCHealth Cancer Care – Anschutz Medical Campus – University of Colorado Cancer Center said.

Dr. Lefkowits is part of Jeanenne’s health care team.

Older women should openly discuss any health concerns they may have with their health care providers. Open dialogue about these issues is essential for maintaining the quality of care.

‘‘You and your gynecologists, obstetricians or other health providers should discuss your medical history and the risks and benefits of a pelvic exam. You should make this decision together. Sometimes it’s appropriate to stop getting Pap smears at age 65, but sometimes it’s not,” Lefkowits said.

According to guidelines from the American College of Obstetricians and Gynecologists, women ages 65 and older can discontinue cervical cancer screening if:

• They do not have a history of moderate or severe abnormal cervical cells or cervical cancer and,
• They have had three consecutive negative Pap tests, two consecutive negative HPV (human papillomavirus) tests, or two consecutive negative co-tests within the past decade.

‘‘My recommendation for women over age 65 is to make sure you discuss with your primary care doctor whether you need a pelvic exam and/or a Pap smear and then engage in shared decision making to make sure you’re getting the gynecologic care you need,’’ Lefkowits said.

Bleeding after menopause or a new lump in the vulva or vagina are warning signs that indicate you should seek medical care immediately.

Routine preventive care screenings are important for every age and stage, from your 20s to your 70s and beyond.

Caring for patients with cancer demands a dedicated team of medical professionals, each bringing their unique expertise to provide the highest level of support and treatment for those facing this challenging journey.

‘‘Vulvar cancer is uncommon. It may present symptoms such as a lump on the vulva or it can present with bleeding or could be picked up as a mass at the time of a routine pelvic exam,’’ said Dr. Robert Hoyer, medical director of oncology research at the Cancer Care and Hematology Clinic at UCHealth Memorial Hospital Central, part of the cancer care team that work together to ensure continuous health care for Jeanenne.

‘‘The risk of developing this type of cancer (vulvar) is about one in 133 during a woman’s lifetime,’’ Hoyer said.

Advances in cancer treatment

Jeanenne needed aggressive treatments that included six rounds of chemotherapy and five sessions of radiation therapy.

Her treatment involved chemotherapy to target and damage cancerous cells. Its primary aim is to stop the relentless division and multiplication of harmful cells.

‘‘With almost all cancers, the earlier the cancer is found and treated, the better rate of cure,’’ Hoyer said.

In addition to early diagnosis, advanced treatments make a big difference in how well patients do.

‘‘We know that cancer cells require VEGF, Vascular Endothelial Growth Factor, a protein that plays a crucial role in the formation of new blood vessels, to grow and spread. It is related to the blood supply to cancer,’’ Hoyer said.

As part of her treatment, Jeanenne´s doctors prescribed Bevacizumab, which prevents the cancer from recruiting new blood vessels for growth.

Bevacizumab is a monoclonal antibody used to treat various cancers. As part of its functions, it works by blocking the protein called VEGF.

‘’And also, it helps the chemotherapy get into the tumor better, penetrate into the tumor. We’ve seen with the addition of Bevacizumab to the chemotherapy that there is a better response rate, higher percentages of cancer shrinkage in patients and also longer duration of effectiveness of the chemotherapy and improved survival for patients who receive that drug in conjunction with the chemotherapy,’’ Hoyer said.

By the time doctors discovered Jeanenne’s cancer, it had already spread from her vulva to other parts of her body. That’s what doctors refer to as metastatic disease.

In Jeanenne’s case, her cancer spread to her bones. To help prevent bone fractures, Jeanenne’s doctors prescribed a drug called Xgeva. It helps strengthen the bone when it is weakened and more susceptible to fracture from the cancer.

Jeanenne has responded very well to her treatments.

‘‘The pelvis, lymph nodes and the bone all responded to the treatment,” Hoyer said. “Jeanenne had what’s called a complete response to therapy. She currently has no evidence of any cancer, and we’re monitoring if there’s any evidence of recurrence. We’ll continue monitoring.

‘‘The collaboration with Dr. Carolyn Lefkowits, the gynecologic oncologist in Denver, has been phenomenal, along with the other specialists she has worked with,” she said.

A strong network of support and a woman´s determination

Jeanenne’s unwavering determination and the expertise of a dedicated team of medical specialists have been instrumental in her recovery.

She built a strong network of support and drew on the unwavering love of her husband and encouragement from her community.

‘‘It’s a true privilege to be part of Jeanenne´s care team and to witness the strength and determination both she and Ken have demonstrated throughout this process. Even in the harder times, Jeanenne could always muster a smile and a story about how she was looking forward to getting back to wearing her signature high heels,’’ Lefkowits said.

The physical and emotional support of a cancer patient’s loved ones is essential during the treatment process.

‘‘I am a true living, walking, breathing miracle because of God, cancer treatment, therapy and research at UCHealth,’’ Jeanenne said.

Jeanenne’s husband, Ken Tapia, has been her partner throughout her healing journey.

Ken is a well-known hairdresser in Trinidad. At times, he had to rearrange appointments for clients, but he always put Jeanenne’s care first.

She affectionately describes her husband as an unwavering “advocate”.

Although they had met in high school, they didn’t start dating until later in life.

‘‘It had to be him to get me through this,’’ she said.

The saying “true love is proven in hard times” is exemplified in the story of Jeanenne and Ken, whose love has grown stronger through the health challenges they faced together.

Jeanenne also draws strength and determination from generations of strong women who shaped her.

‘‘I was raised by a fierce, strong mother, who was raised by a fierce, strong mother. We are generations of women who are fierce and strong,’’ she said.

‘‘Dr. Carolyn Lefkowits from UCHealth, gave me this statement: ‘your CAT scan looks great’. Now, for a patient who was at stage 4 cancer, almost terminal, to hear your CAT scan looks great, it was an overwhelming feeling,’’ Jeanenne said.

Patient encourages older women to speak with their doctor about Pap smears and preventive care

Jeanenne once believed she could never get cancer. Once she received her diagnosis, her perspective shifted dramatically. Now, she passionately champions the importance of women’s health, urging other women to prioritize regular medical checkups and to embrace the screenings suited to their age and medical history.

‘‘Stay focused on your body. Listen to your body. If there is something going on, tell the doctor. Don’t assume anything. Let the doctor decide. Always get your mammograms, get your pelvic exams and your Pap smears, whether you have female organs or not. If the doctor decides you don’t need them, let the doctor tell you that,’’ she advised.