November 1, 2023 • 21 mins
Hosted by comedian and 2x ovarian cancer survivor, Karen Mills, and featuring Dr. Gizelka David-West, Gynecologic Oncologist at Northwell Health and lead singer of the band N.E.D.
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Episode Transcript
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Speaker 1 (00:05):
Welcome to What To Know Down Below by Tina's Wish.
We're here to empower you withthe knowledge and tools you
need to advocate for your owngynecologic health. Knowledge
is power, and we encourageeveryone to join us in learning
more about what you need toknow down below.
Speaker 2 (00:28):
Hi everyone. My name is Karen Mills, and I've been a
nationally touring comedian forover 25 years, and am a
two-time ovarian cancersurvivor. I'm here with Dr.
Gazelka , David West,gynecologic oncologist and lead
singer of the band , NED, forthe next installment of our
ovarian cancer 1 0 1 series.
(00:49):
Today we'll be talking aboutwhat puts someone at a higher
risk for ovarian cancer and thesteps you can take to reduce
that risk . Risk . You know ,um, for me it really wasn't
even on my radar. And , uh, andI had, you know, I had no idea
that I was at risk for ovariancancer. In fact, I didn't even
(01:11):
think I was at risk for cancer.
I mean, it's not my history.
Um, no one in my family. Imean, we've had, I have , I had
an uncle with skin cancer and Ihad , uh, an aunt with , uh,
breast cancer. But, you know, Ihave a big family. Nobody else
(01:31):
has ever had any cancer riskand , um, cancer , uh,
occurrences. So I really nevereven considered that because I
put so much stock in geneticsand I learned quickly that ,
um, that you can still have ahigh risk for , um, for ovarian
cancer. And I'm sure othercancers as well, whether or not
(01:55):
you're , it's your familyhistory or not. Is that
correct, doctor?
Speaker 3 (01:58):
Correct. Yeah. So , um, family history definitely
plays a major role in it. Um,but , um, there can be , um,
some genetic predispositionthat maybe doesn't come up
until the person , um,presenting with the cancer. You
know, you could be the firstone in the family, right?
Speaker 2 (02:16):
Yes. That's what I was thinking. You know, I I I
just feel like I thought, well,it couldn't be that, you know,
because my mom had a , um, hada, had a benign tumor years
ago, so I immediately, when,when they said I had a tumor ,
uh, I thought , there's no way.
It's just like she had, it's afibro , just like she had. And,
(02:37):
and so I was shocked mm-hmm . Because my
family, we, you know, we don'tget cancer. We eat gravy and
biscuits for 50 years, clog ourarteries and have strokes. So
that's what we do.
Speaker 3 (02:48):
That's what you were preventing , that's what you
were trying to focus onprevention for , right? Yep .
Not cancer , but you're , butyou're absolutely right. And
those are the more commonthings, you know, know if you,
the number one killer of womenheart disease, you know, this
is, these are the things that ,um, uh, are kind of it , we
were reminded of and being toldof, you know, protect your
(03:10):
heart and eat healthy exercise.
Um, so yeah, ovarian cancer maynot be on your radar at all.
And the general population riskfor ovarian cancer is quite
low. It's at around 1.4%. So,you know, it's really not
something that really is thatcommon, but when it does come
(03:31):
up, it is deadly, and it'simportant to know what risk
factors there are .
Speaker 2 (03:36):
And I also , um, I have not been married. I've not
had children. And does thatalso up my risk? I've, I've
heard that it does.
Speaker 3 (03:45):
Yes. Well, the not having kids part, but the not
being married part doesn't , might increase your
risk 'cause of stress andstuff. Who knows ,
Speaker 2 (03:56):
Takes some stress down. Yeah .
Speaker 3 (03:58):
That might be , that might balance things out for
you. But , um, but yes, you ,you highlighted on some of the
risk factors that you hadpersonally and that are risk
factors, non-child bearing ornot ever having children. Um ,
other risk factors are, let'ssay , um, use use of fertility
drugs or maybe a history ofinfertility can be a risk
factor. Hormone replacementtherapy can be a risk factor.
(04:22):
Um, age older. The age you are,the higher the risk of any
cancer development. Um, andthen , um, obesity. Obesity
has, is a , in chronicinflammation state, chronic
inflammation, chronic stress inthe body is a risk for cancer
in general. And then we, andthen we go, go to the history,
the family history that wetouched on, right? So family
(04:43):
history is a big one. You know,there may not be a genetic
marker, but if there's a strongfamily history that can clue
you into are you somebody atrisk? And then there is a
patient , uh, population , uh,the Ashkenazi Jewish population
, um, in the world aresignificantly higher risk for
ovarian cancer.
Speaker 2 (05:03):
Isn't that interesting that one group of
people have such a higher risk,but what about , um, the BRCA
gene ? Like if you have , um,breast cancer, but you haven't
had any , uh, ovarian cancer,say in your family, but you
carry that gene, then that is a, puts you at a higher risk,
correct?
Speaker 3 (05:21):
Yeah, absolutely. So we can talk about that, right?
So , um, this is where kind ofknowing your risk , knowing
family history may then leadyou to a genetics counselor,
somebody who will counsel youand tell you what are, how high
percentage risks you may havegiven your family history , um,
and then recommend genetictesting. And the genetic
(05:43):
testing is where we find genessuch as the BRCA gene. So BRCA
one and BRCA two are the mostcommonly associated with breast
and ovarian cancer. There areothers, we won't go into all
those details, but BRCA one andtwo are the most common , um,
with , um, up to 40% risk withthe BRCA one and the , and up
to 20% risk with BRCA two. Andthat's risk for ovarian cancer
(06:06):
with those genes.
Speaker 2 (06:08):
This is like , uh, with Angelina Jolie , you know,
she had that gene and so shehad the mastectomy, she had
ovaries removed. I mean, isthat something that is
recommended?
Speaker 3 (06:19):
Yep . So our governing bodies do have
guidelines that we follow , um,regarding these genetic , um,
mutations. And so , um, as wetalked about in our first
episode, screening and earlydetection, there's no good
tests or screening for thegeneral population. But once we
know you are high risk with oneof these high risk gene
(06:41):
mutations, then we do have aprotocol we do have for the
younger patients , um, who arenot ready to pro perform these
risk reducing surgeries. Thereare certain screenings that we
do with pelvic ultrasound andthat ca 1 25 that we mentioned,
and that trend of those testswill clue us in to is there
(07:04):
something early evolving? Isthere something more advanced,
evolving? And so it's not aperfect test at all, but it
gives us something to followthese high risk patients with.
Um, then in the patients whoare ready for risk reducing
surgery, we do recommend thetubes and ovaries get removed.
(07:24):
And so that's a procedurecalled a bilateral cell pingle
ectomy.
Speaker 2 (07:29):
I thought so .
Speaker 3 (07:30):
Huh?
Speaker 2 (07:31):
I thought that's what it was called.
Speaker 3 (07:33):
Yeah . Great
, but removal of tubes and
ovaries is good enough. Right?
. So , um, and so ourguidelines state that by age
35, or when you're done withchildbearing and you harbor a
BRCA one or two mutation, therecommendation is to remove the
tubes and ovaries to preventovarian cancer.
Speaker 2 (07:54):
Well , um, and age wise is, is most , uh, ovarian
cancer, does most of that occur, uh, at menopause or
perimenopause, or is there Ihave heard of people getting it
really young. Mm-hmm
Speaker 3 (08:07):
. Yeah
. So , um, uh, for the general
population , um, the patientswho present as spontaneous,
spontaneous ovarian cancer, nogenetic risk. We tend to see it
in the age sixties and up,that's the most common age
group. Um, when you harbor agenetic mutation like BRCA one,
it's a lot earlier, 35, 40years old, or in your forties,
(08:28):
you can develop ovarian cancerfor BRCA two, it's a little bit
more in like the eight in thefifties , um, age range,
fifties to sixties. And so whenwe make these guidelines
recommending these riskreducing surgeries, 35, age 35
is kind of the number we use ,but it's really geared towards
those BRCA one patients becausethey are so much higher risk,
up to 40% risk of developingovarian cancer at that earlier
(08:51):
age bracket, BRCA two carriers.
They , um, we , you know, youcan kind of push that age limit
along a bit because we know ifthey're gonna get ovarian
cancer, it's more likely tohappen in the fifties age
bracket. Um, but age does, itdoes make a difference.
Speaker 2 (09:09):
I was 54 when I was first diagnosed. Yeah . And ,
uh, you know, I know thatestrogen is also so important
for your heart and otherthings, and, but you can't
really take much estrogenbeyond, I mean, after ovarian
cancer. Right.
Speaker 3 (09:27):
So I will say it , it , it gets into a little bit
more granular discussion, butit's all kind of dependent on
the type of ovarian cancer thatyou had, the cell type, if
there was hormone receptors onit or not. There's some young
women, let's say they had anovarian cancer in their
thirties and they had to haveovaries removed, which puts you
into menopause definitively.
(09:48):
Right? That's why it's a verybig deal for young women to
have these risk reducingsurgeries, right? You're gonna
go into menopause. So it's,it's hard pill to swallow
ovarian cancer, super highrisk, or the reality of
menopause at 35. I , so it'svery hard. Um, and so again,
depending on what type of cellswere found at the ovarian
(10:08):
cancer, and if you're young ,um, it's a conversation with
your doctor, weigh risks ,benefits, and we have put
patients on estrogen afterovarian cancer diagnosis that
they're very young and if theywere the right candidate,
right? Because like you said,heart health, bone health,
mental health, you know , theseare things that are estrogen is
so important for,
Speaker 2 (10:28):
I am on a very low dose mm-hmm .
But, you know, because of my,of heart health, basically.
Yeah .
Speaker 3 (10:35):
Right. And then again, likely your cancer cell
type was not driven byestrogen. So you're , um,
likely, you know, a goodcandidate for that. And it
makes sense.
Speaker 2 (10:46):
How , uh, how important , uh, do you feel
diet is in all of this?
Speaker 3 (10:52):
Um, so I wish I had more education on diet and
nutrition in our training, butas, as I go through my , um,
career now I learn more andmore. And , uh, we work with
excellent nutritionists who doa lot of cancer nutrition
counseling. Uh, but my generalrule of thumb with patients is
eat the rainbow, meaning high ,um, high protein, more
(11:14):
vegetable protein , um,colorful vegetables and fruits,
things that are, have morenutritional value, right? The
bland or the plate , the lessnutrition that you're seeing on
that plate. Um, and I think ,um, trying to minimize
inflammation. Right? Um, and sothe types of things that you
eat, what is causinginflammation? Um, low sugar is
(11:36):
better than high sugar, right?
Low fat is better than highfat. These just like the basic
tenants and principles and thengetting into nitty gritties of
the diet. Um, I leave that tothe professionals,
Speaker 2 (11:47):
Right? ?
Well , I , uh, I, and this isjust something I feel
personally, I , I haven't had aprofessional say this to me
necessarily, but I've been a, aroad comic for, you know, 29
years. And I , um, early onparticularly, I ate a lot of
fast food 'cause it was cheap.
And at that time, I, that'swhat I could afford. And , um,
(12:10):
and as a result, I just feellike everything jacked up with
hormones and everything else. Ijust feel like that it
contributed. I just, I just do,
Speaker 3 (12:20):
You can't deny that there's gotta be a link.
There's gotta be somecorrelation. It's , um, we
don't, just to do the study totest fast food and ovarian
cancer, you need a lot ofpeople. I don't think
anybody would sign up for thatstudy either,
Speaker 2 (12:36):
. Oh ,
that's true. Um, but , uh, and
I also , uh, was recently , um,diagnosed with an autoimmune
that my understanding is occursa lot with ovarian cancer
patients.
Speaker 3 (12:54):
Mm-hmm
.
Speaker 2 (12:55):
Mm-hmm
. So is that something you ,
uh, you have to deal with withyour patients a lot? Or, or you
do you see that very often?
Yeah,
Speaker 3 (13:02):
So , um, I've seen it a , a handful of times. I
will say it's , um, uh, thetimes I've seen it was at onset
of the disease, right? Like atpresentation, they, it coupled
with some kind of autoimmunecondition. And when we treated
the disease that autoimmunecondition subsided mm-hmm
. Um , but thenit can also be something that
may come up as a consequence ofthe treatment that you get
(13:25):
certain, certain chemotherapiesor maintenance therapies can
create these autoimmuneconditions. And then we see
that later on, like these, well, when we have long-term
survivors, you kind of end upseeing a lot of these , um,
these sort of things pop upthat you wouldn't expect.
Speaker 2 (13:43):
And, and once you , uh, you go through the
hysterectomy and everything, Imean, is is hormone replacement
an option? Not an option.
Speaker 3 (13:55):
So that's a great question. So , um, so I would
say the easy answer is yes,it's an option. It's, it's just
requires a conversation andevaluation of risk assessment.
So let's just talk about theBRCA mutation carriers, for
example. Um, let's say thispatient has had the mastectomy,
right? Um, so they have riskreduction for breast cancer,
(14:15):
and now they've want to proceedwith their total hysterectomy
and , um, tubes and ovariesout. Um, that patient, if
they're premenopausal, yes,they can , um, get on some
hormone replacement therapy.
And in that case, because theuterus has been removed, they
can just have estrogen alone.
(14:36):
And estrogen alone is muchsafer than estrogen plus
progesterone when you're doinghormone replacement. Um, lower
risk of , um, side effects or ,or blood clot risk or cancer
risk when you just have the onewith the estrogen. Um, there
are some patients who maybestill have their breasts or the
BRCA patients who have adiagnosis of breast cancer
(14:57):
already, they unfortunatelycannot get the hormone
replacement, especially iftheir breast cancer was hormone
positive, right? So it really,it's a discussion. It's an
figuring out, you know, yourrisk category. If the uterus
was left in, then you have todo progesterone with the
estrogen, because now estrogenalone on the uterus is a risk
(15:19):
for uterus cancer. So lots ofconversation, lots of , um,
really looking at the patientas a whole to then figure out
really what's the benefit wecan achieve with this hormone
replacement? What's the risk?
And I always tell patients it'san up and down that we wanna
make sure the the benefit ishigher and the risk is lower.
Speaker 2 (15:38):
And it's really something you need to , uh, a
personal , um, yeah . Situationwith your doctor that you have
to
Speaker 3 (15:45):
Absolutely, absolutely. There's some women
who they just are afraid of theidea of hormone replacement.
And so then I discussalternatives. It's important to
know that there arenon-hormonal options for the
symptoms that , um, patientscan and will experience with
menopause.
Speaker 2 (16:01):
So is it fair to say that the majority of people
diagnosed with ovarian cancerdo not even have a genetic
variant?
Speaker 3 (16:08):
Correct. Yeah. So I listened to a podcast sometime
ago about kind of genetics andhow we're so focused on
genetics and cancer, and theperson speaking was like, well,
you know what? Not e majorityof cancers are not even related
to genetics. So we've gottathink about the environment,
we've gotta think about otherthings. And he was right.
Really only about 25% ofovarian cancer is genetically
(16:30):
linked . So we're dealing with75% of our population that we
don't know why they are gettingovarian cancer. Um, I think we
focus so much on geneticsbecause we can do something
about it, right? We can helpprevent this deadly disease
with intervention. Or if you'rediagnosed with ovarian cancer
(16:53):
and have these geneticmutations, we know that certain
medicines will work better foryou. Right? So this is why
there's so much focus andattention because we have
things that we can do to helpthat population. So why not? If
knowledge is power, if you knowmore, you can get more
information that could help youget it, go out there and seek ,
seek it out. Um, uh, meet witha genetics counselor , um, and
(17:18):
if you are a candidate forgenetic testing, then you will
get tested. And it's a veryeasy process.
Speaker 2 (17:23):
And what other ways are there to, for a person to
reduce the , uh, her risk,their risk of , uh, of ovarian
cancer?
Speaker 3 (17:32):
Right. So , um, um, believe it or not, even though
we were talking about hormonesand the good and bad ,
hormonal birth control isactually a preventative
mechanism, right? So hormonalbirth control, when you're
young, you go on birth controlpills, it puts your ovaries in
this quiescent suppressedstate, right? And one of the
theories of ovarian cancer isthat this constant ovulation
(17:56):
and , um, um, division of cellsdivision and breakdown of cells
at that, at the , in theseovaries can be , uh, priming an
environment where cells can getout of control, right? They
can, they're overacting orthey're rapidly dividing.
Mutations can occur. Thecheckpoints that our DNA have
may miss a mutation. And thenthat's, that's it. That's what
(18:19):
turns into cancer. So birthcontrol puts your ovaries in a
suppressed state, and really, Ithink , um, 10 years of birth
control , um, really is adramatic decrease in the
ovarian cancer risk. So that'sone. And then preventative
surgery that we talked a lotabout. Um, you know, I have
many patients who come to mewith a strong family history.
Their mother had ovarian cancermm-hmm . Um, but
(18:42):
she was genetic testednegative. The patient is
genetic testing ne negative,but now she's approaching
menopause and is , and says,you know what? I just want
these ovaries out. I don'twanna risk it . My mom was 52
and I am 49. Let's just takethem out. Right? So
preventative surgery isdefinitely the recommendation
for the patients with BRCAmutations, but then a strong
(19:04):
family history can also be areason to have a preventative
surgery.
Speaker 2 (19:10):
And, and how do you find a genetic counselor if you
feel like you need one and what, what exactly do they do?
Speaker 3 (19:16):
Sure. So , um, speaking with your primary care
doctor or with yourgynecologist , um, really any
of your doctors could , um,plug you in. Um , I work at the
cancer center here withNorthwell, and so we have the
genetics counselors built intoour practice. And so it's very
easy for us to just , um, senda referral, but it's really a
(19:37):
referral through your doctor .
And , um, they do a verycomprehensive review of your
family tree and really , um,assess your risk categories,
right? And if you don't reallymeet criteria, could you pay
out of pocket for genetictesting? Sure, you can, you can
do whatever you want. Um , butif you wanted your insurance to
cover it, that had , you haveto meet a certain criteria to
(19:59):
then get it covered and thenget the testing.
Speaker 2 (20:03):
Okay. Well , um, you know, it's so, so much great
information, you know, anyother remarks you have
regarding this topic before wemove on?
Speaker 3 (20:12):
I think , uh, kind of the take home or the
reminder here, I think it's abig one, is family history or
just knowing your own personalhistory, right? Knowing what in
your personal history puts youat risk and keeping that at the
forefront of your discussionswith your doctors. If you have
certain risk factors that wehave mentioned and you start
(20:33):
having these vague symptomsthat we discussed , bring that
to your doctor and say, listen,I have this family history, or
I've never had kids, you know,I, I've had fertility drug
treatment, now I'm havingbloating, I'm having pelvic
pressure, I'm having theseurinary symptoms. What's going
on? Could this be ovariancancer? Could there , could I
(20:55):
be at higher risk? Right? Andso that may help clue in , um,
and clin your diagnosis soonerthan later.
Speaker 2 (21:02):
And if it does, just turn out to be menopause and
good for you, but
Speaker 3 (21:06):
That's right.
Exactly. We'll take it.
Speaker 2 (21:09):
Yeah , exactly.
Well, thank you so much foryour words of expertise and a
big thank you to everyonelistening. We hope you all feel
more empowered to take controlof your health. Tune in for our
, uh, final episode in ourovarian Cancer 1 0 1 series as
we discuss why early detectionis so critical to fighting
ovarian cancer.
Speaker 1 (21:36):
For more information about gynecologic health, visit
tina's wish.org/what to know .
That's tina's wish.org/wH-A-T-T-O-K-N-O-W . And like,
follow or subscribe whereveryou listen to your favorite
podcasts.
Welcome to What To Know Down Below by Tina's Wish.
We're here to empower you withthe knowledge and tools you
need to advocate for your owngynecologic health. Knowledge
is power, and we encourageeveryone to join us in learning
more about what you need toknow down below.
Speaker 2 (00:28):
Hi everyone. My name is Karen Mills, and I've been a
nationally touring comedian forover 25 years, and am a
two-time ovarian cancersurvivor. I'm here with Dr.
Gazelka , David West,gynecologic oncologist and lead
singer of the band , NED, forthe next installment of our
ovarian cancer 1 0 1 series.
(00:49):
Today we'll be talking aboutwhat puts someone at a higher
risk for ovarian cancer and thesteps you can take to reduce
that risk . Risk . You know ,um, for me it really wasn't
even on my radar. And , uh, andI had, you know, I had no idea
that I was at risk for ovariancancer. In fact, I didn't even
(01:11):
think I was at risk for cancer.
I mean, it's not my history.
Um, no one in my family. Imean, we've had, I have , I had
an uncle with skin cancer and Ihad , uh, an aunt with , uh,
breast cancer. But, you know, Ihave a big family. Nobody else
(01:31):
has ever had any cancer riskand , um, cancer , uh,
occurrences. So I really nevereven considered that because I
put so much stock in geneticsand I learned quickly that ,
um, that you can still have ahigh risk for , um, for ovarian
cancer. And I'm sure othercancers as well, whether or not
(01:55):
you're , it's your familyhistory or not. Is that
correct, doctor?
Speaker 3 (01:58):
Correct. Yeah. So , um, family history definitely
plays a major role in it. Um,but , um, there can be , um,
some genetic predispositionthat maybe doesn't come up
until the person , um,presenting with the cancer. You
know, you could be the firstone in the family, right?
Speaker 2 (02:16):
Yes. That's what I was thinking. You know, I I I
just feel like I thought, well,it couldn't be that, you know,
because my mom had a , um, hada, had a benign tumor years
ago, so I immediately, when,when they said I had a tumor ,
uh, I thought , there's no way.
It's just like she had, it's afibro , just like she had. And,
(02:37):
and so I was shocked mm-hmm
family, we, you know, we don'tget cancer. We eat gravy and
biscuits for 50 years, clog ourarteries and have strokes. So
that's what we do.
Speaker 3 (02:48):
That's what you were preventing , that's what you
were trying to focus onprevention for , right? Yep .
Not cancer , but you're , butyou're absolutely right. And
those are the more commonthings, you know, know if you,
the number one killer of womenheart disease, you know, this
is, these are the things that ,um, uh, are kind of it , we
were reminded of and being toldof, you know, protect your
(03:10):
heart and eat healthy exercise.
Um, so yeah, ovarian cancer maynot be on your radar at all.
And the general population riskfor ovarian cancer is quite
low. It's at around 1.4%. So,you know, it's really not
something that really is thatcommon, but when it does come
(03:31):
up, it is deadly, and it'simportant to know what risk
factors there are .
Speaker 2 (03:36):
And I also , um, I have not been married. I've not
had children. And does thatalso up my risk? I've, I've
heard that it does.
Speaker 3 (03:45):
Yes. Well, the not having kids part, but the not
being married part doesn't ,
risk 'cause of stress andstuff. Who knows ,
Speaker 2 (03:56):
Takes some stress down. Yeah .
Speaker 3 (03:58):
That might be , that might balance things out for
you. But , um, but yes, you ,you highlighted on some of the
risk factors that you hadpersonally and that are risk
factors, non-child bearing ornot ever having children. Um ,
other risk factors are, let'ssay , um, use use of fertility
drugs or maybe a history ofinfertility can be a risk
factor. Hormone replacementtherapy can be a risk factor.
(04:22):
Um, age older. The age you are,the higher the risk of any
cancer development. Um, andthen , um, obesity. Obesity
has, is a , in chronicinflammation state, chronic
inflammation, chronic stress inthe body is a risk for cancer
in general. And then we, andthen we go, go to the history,
the family history that wetouched on, right? So family
(04:43):
history is a big one. You know,there may not be a genetic
marker, but if there's a strongfamily history that can clue
you into are you somebody atrisk? And then there is a
patient , uh, population , uh,the Ashkenazi Jewish population
, um, in the world aresignificantly higher risk for
ovarian cancer.
Speaker 2 (05:03):
Isn't that interesting that one group of
people have such a higher risk,but what about , um, the BRCA
gene ? Like if you have , um,breast cancer, but you haven't
had any , uh, ovarian cancer,say in your family, but you
carry that gene, then that is a, puts you at a higher risk,
correct?
Speaker 3 (05:21):
Yeah, absolutely. So we can talk about that, right?
So , um, this is where kind ofknowing your risk , knowing
family history may then leadyou to a genetics counselor,
somebody who will counsel youand tell you what are, how high
percentage risks you may havegiven your family history , um,
and then recommend genetictesting. And the genetic
(05:43):
testing is where we find genessuch as the BRCA gene. So BRCA
one and BRCA two are the mostcommonly associated with breast
and ovarian cancer. There areothers, we won't go into all
those details, but BRCA one andtwo are the most common , um,
with , um, up to 40% risk withthe BRCA one and the , and up
to 20% risk with BRCA two. Andthat's risk for ovarian cancer
(06:06):
with those genes.
Speaker 2 (06:08):
This is like , uh, with Angelina Jolie , you know,
she had that gene and so shehad the mastectomy, she had
ovaries removed. I mean, isthat something that is
recommended?
Speaker 3 (06:19):
Yep . So our governing bodies do have
guidelines that we follow , um,regarding these genetic , um,
mutations. And so , um, as wetalked about in our first
episode, screening and earlydetection, there's no good
tests or screening for thegeneral population. But once we
know you are high risk with oneof these high risk gene
(06:41):
mutations, then we do have aprotocol we do have for the
younger patients , um, who arenot ready to pro perform these
risk reducing surgeries. Thereare certain screenings that we
do with pelvic ultrasound andthat ca 1 25 that we mentioned,
and that trend of those testswill clue us in to is there
(07:04):
something early evolving? Isthere something more advanced,
evolving? And so it's not aperfect test at all, but it
gives us something to followthese high risk patients with.
Um, then in the patients whoare ready for risk reducing
surgery, we do recommend thetubes and ovaries get removed.
(07:24):
And so that's a procedurecalled a bilateral cell pingle
ectomy.
Speaker 2 (07:29):
I thought so .
Speaker 3 (07:30):
Huh?
Speaker 2 (07:31):
I thought that's what it was called.
Speaker 3 (07:33):
Yeah . Great
ovaries is good enough. Right?
35, or when you're done withchildbearing and you harbor a
BRCA one or two mutation, therecommendation is to remove the
tubes and ovaries to preventovarian cancer.
Speaker 2 (07:54):
Well , um, and age wise is, is most , uh, ovarian
cancer, does most of that occur, uh, at menopause or
perimenopause, or is there Ihave heard of people getting it
really young. Mm-hmm
Speaker 3 (08:07):
population , um, the patientswho present as spontaneous,
spontaneous ovarian cancer, nogenetic risk. We tend to see it
in the age sixties and up,that's the most common age
group. Um, when you harbor agenetic mutation like BRCA one,
it's a lot earlier, 35, 40years old, or in your forties,
(08:28):
you can develop ovarian cancerfor BRCA two, it's a little bit
more in like the eight in thefifties , um, age range,
fifties to sixties. And so whenwe make these guidelines
recommending these riskreducing surgeries, 35, age 35
is kind of the number we use ,but it's really geared towards
those BRCA one patients becausethey are so much higher risk,
up to 40% risk of developingovarian cancer at that earlier
(08:51):
age bracket, BRCA two carriers.
They , um, we , you know, youcan kind of push that age limit
along a bit because we know ifthey're gonna get ovarian
cancer, it's more likely tohappen in the fifties age
bracket. Um, but age does, itdoes make a difference.
Speaker 2 (09:09):
I was 54 when I was first diagnosed. Yeah . And ,
uh, you know, I know thatestrogen is also so important
for your heart and otherthings, and, but you can't
really take much estrogenbeyond, I mean, after ovarian
cancer. Right.
Speaker 3 (09:27):
So I will say it , it , it gets into a little bit
more granular discussion, butit's all kind of dependent on
the type of ovarian cancer thatyou had, the cell type, if
there was hormone receptors onit or not. There's some young
women, let's say they had anovarian cancer in their
thirties and they had to haveovaries removed, which puts you
into menopause definitively.
(09:48):
Right? That's why it's a verybig deal for young women to
have these risk reducingsurgeries, right? You're gonna
go into menopause. So it's,it's hard pill to swallow
ovarian cancer, super highrisk, or the reality of
menopause at 35. I , so it'svery hard. Um, and so again,
depending on what type of cellswere found at the ovarian
(10:08):
cancer, and if you're young ,um, it's a conversation with
your doctor, weigh risks ,benefits, and we have put
patients on estrogen afterovarian cancer diagnosis that
they're very young and if theywere the right candidate,
right? Because like you said,heart health, bone health,
mental health, you know , theseare things that are estrogen is
so important for,
Speaker 2 (10:28):
I am on a very low dose mm-hmm
But, you know, because of my,of heart health, basically.
Yeah .
Speaker 3 (10:35):
Right. And then again, likely your cancer cell
type was not driven byestrogen. So you're , um,
likely, you know, a goodcandidate for that. And it
makes sense.
Speaker 2 (10:46):
How , uh, how important , uh, do you feel
diet is in all of this?
Speaker 3 (10:52):
Um, so I wish I had more education on diet and
nutrition in our training, butas, as I go through my , um,
career now I learn more andmore. And , uh, we work with
excellent nutritionists who doa lot of cancer nutrition
counseling. Uh, but my generalrule of thumb with patients is
eat the rainbow, meaning high ,um, high protein, more
(11:14):
vegetable protein , um,colorful vegetables and fruits,
things that are, have morenutritional value, right? The
bland or the plate , the lessnutrition that you're seeing on
that plate. Um, and I think ,um, trying to minimize
inflammation. Right? Um, and sothe types of things that you
eat, what is causinginflammation? Um, low sugar is
(11:36):
better than high sugar, right?
Low fat is better than highfat. These just like the basic
tenants and principles and thengetting into nitty gritties of
the diet. Um, I leave that tothe professionals,
Speaker 2 (11:47):
Right?
Well , I , uh, I, and this isjust something I feel
personally, I , I haven't had aprofessional say this to me
necessarily, but I've been a, aroad comic for, you know, 29
years. And I , um, early onparticularly, I ate a lot of
fast food 'cause it was cheap.
And at that time, I, that'swhat I could afford. And , um,
(12:10):
and as a result, I just feellike everything jacked up with
hormones and everything else. Ijust feel like that it
contributed. I just, I just do,
Speaker 3 (12:20):
You can't deny that there's gotta be a link.
There's gotta be somecorrelation. It's , um, we
don't, just to do the study totest fast food and ovarian
cancer, you need a lot ofpeople
anybody would sign up for thatstudy either,
Speaker 2 (12:36):
I also , uh, was recently , um,diagnosed with an autoimmune
that my understanding is occursa lot with ovarian cancer
patients.
Speaker 3 (12:54):
Mm-hmm
Speaker 2 (12:55):
Mm-hmm
uh, you have to deal with withyour patients a lot? Or, or you
do you see that very often?
Yeah,
Speaker 3 (13:02):
So , um, I've seen it a , a handful of times. I
will say it's , um, uh, thetimes I've seen it was at onset
of the disease, right? Like atpresentation, they, it coupled
with some kind of autoimmunecondition. And when we treated
the disease that autoimmunecondition subsided mm-hmm
may come up as a consequence ofthe treatment that you get
(13:25):
certain, certain chemotherapiesor maintenance therapies can
create these autoimmuneconditions. And then we see
that later on, like these, well, when we have long-term
survivors, you kind of end upseeing a lot of these , um,
these sort of things pop upthat you wouldn't expect.
Speaker 2 (13:43):
And, and once you , uh, you go through the
hysterectomy and everything, Imean, is is hormone replacement
an option? Not an option.
Speaker 3 (13:55):
So that's a great question. So , um, so I would
say the easy answer is yes,it's an option. It's, it's just
requires a conversation andevaluation of risk assessment.
So let's just talk about theBRCA mutation carriers, for
example. Um, let's say thispatient has had the mastectomy,
right? Um, so they have riskreduction for breast cancer,
(14:15):
and now they've want to proceedwith their total hysterectomy
and , um, tubes and ovariesout. Um, that patient, if
they're premenopausal, yes,they can , um, get on some
hormone replacement therapy.
And in that case, because theuterus has been removed, they
can just have estrogen alone.
(14:36):
And estrogen alone is muchsafer than estrogen plus
progesterone when you're doinghormone replacement. Um, lower
risk of , um, side effects or ,or blood clot risk or cancer
risk when you just have the onewith the estrogen. Um, there
are some patients who maybestill have their breasts or the
BRCA patients who have adiagnosis of breast cancer
(14:57):
already, they unfortunatelycannot get the hormone
replacement, especially iftheir breast cancer was hormone
positive, right? So it really,it's a discussion. It's an
figuring out, you know, yourrisk category. If the uterus
was left in, then you have todo progesterone with the
estrogen, because now estrogenalone on the uterus is a risk
(15:19):
for uterus cancer. So lots ofconversation, lots of , um,
really looking at the patientas a whole to then figure out
really what's the benefit wecan achieve with this hormone
replacement? What's the risk?
And I always tell patients it'san up and down that we wanna
make sure the the benefit ishigher and the risk is lower.
Speaker 2 (15:38):
And it's really something you need to , uh, a
personal , um, yeah . Situationwith your doctor that you have
to
Speaker 3 (15:45):
Absolutely, absolutely. There's some women
who they just are afraid of theidea of hormone replacement.
And so then I discussalternatives. It's important to
know that there arenon-hormonal options for the
symptoms that , um, patientscan and will experience with
menopause.
Speaker 2 (16:01):
So is it fair to say that the majority of people
diagnosed with ovarian cancerdo not even have a genetic
variant?
Speaker 3 (16:08):
Correct. Yeah. So I listened to a podcast sometime
ago about kind of genetics andhow we're so focused on
genetics and cancer, and theperson speaking was like, well,
you know what? Not e majorityof cancers are not even related
to genetics. So we've gottathink about the environment,
we've gotta think about otherthings. And he was right.
Really only about 25% ofovarian cancer is genetically
(16:30):
linked . So we're dealing with75% of our population that we
don't know why they are gettingovarian cancer. Um, I think we
focus so much on geneticsbecause we can do something
about it, right? We can helpprevent this deadly disease
with intervention. Or if you'rediagnosed with ovarian cancer
(16:53):
and have these geneticmutations, we know that certain
medicines will work better foryou. Right? So this is why
there's so much focus andattention because we have
things that we can do to helpthat population. So why not? If
knowledge is power, if you knowmore, you can get more
information that could help youget it, go out there and seek ,
seek it out. Um, uh, meet witha genetics counselor , um, and
(17:18):
if you are a candidate forgenetic testing, then you will
get tested. And it's a veryeasy process.
Speaker 2 (17:23):
And what other ways are there to, for a person to
reduce the , uh, her risk,their risk of , uh, of ovarian
cancer?
Speaker 3 (17:32):
Right. So , um, um, believe it or not, even though
we were talking about hormonesand the good and bad
hormonal birth control isactually a preventative
mechanism, right? So hormonalbirth control, when you're
young, you go on birth controlpills, it puts your ovaries in
this quiescent suppressedstate, right? And one of the
theories of ovarian cancer isthat this constant ovulation
(17:56):
and , um, um, division of cellsdivision and breakdown of cells
at that, at the , in theseovaries can be , uh, priming an
environment where cells can getout of control, right? They
can, they're overacting orthey're rapidly dividing.
Mutations can occur. Thecheckpoints that our DNA have
may miss a mutation. And thenthat's, that's it. That's what
(18:19):
turns into cancer. So birthcontrol puts your ovaries in a
suppressed state, and really, Ithink , um, 10 years of birth
control , um, really is adramatic decrease in the
ovarian cancer risk. So that'sone. And then preventative
surgery that we talked a lotabout. Um, you know, I have
many patients who come to mewith a strong family history.
Their mother had ovarian cancermm-hmm
(18:42):
she was genetic testednegative. The patient is
genetic testing ne negative,but now she's approaching
menopause and is , and says,you know what? I just want
these ovaries out. I don'twanna risk it . My mom was 52
and I am 49. Let's just takethem out. Right? So
preventative surgery isdefinitely the recommendation
for the patients with BRCAmutations, but then a strong
(19:04):
family history can also be areason to have a preventative
surgery.
Speaker 2 (19:10):
And, and how do you find a genetic counselor if you
feel like you need one and what, what exactly do they do?
Speaker 3 (19:16):
Sure. So , um, speaking with your primary care
doctor or with yourgynecologist , um, really any
of your doctors could , um,plug you in. Um , I work at the
cancer center here withNorthwell, and so we have the
genetics counselors built intoour practice. And so it's very
easy for us to just , um, senda referral, but it's really a
(19:37):
referral through your doctor .
And , um, they do a verycomprehensive review of your
family tree and really , um,assess your risk categories,
right? And if you don't reallymeet criteria, could you pay
out of pocket for genetictesting? Sure, you can, you can
do whatever you want. Um , butif you wanted your insurance to
cover it, that had , you haveto meet a certain criteria to
(19:59):
then get it covered and thenget the testing.
Speaker 2 (20:03):
Okay. Well , um, you know, it's so, so much great
information, you know, anyother remarks you have
regarding this topic before wemove on?
Speaker 3 (20:12):
I think , uh, kind of the take home or the
reminder here, I think it's abig one, is family history or
just knowing your own personalhistory, right? Knowing what in
your personal history puts youat risk and keeping that at the
forefront of your discussionswith your doctors. If you have
certain risk factors that wehave mentioned and you start
(20:33):
having these vague symptomsthat we discussed , bring that
to your doctor and say, listen,I have this family history, or
I've never had kids, you know,I, I've had fertility drug
treatment, now I'm havingbloating, I'm having pelvic
pressure, I'm having theseurinary symptoms. What's going
on? Could this be ovariancancer? Could there , could I
(20:55):
be at higher risk? Right? Andso that may help clue in , um,
and clin your diagnosis soonerthan later.
Speaker 2 (21:02):
And if it does, just turn out to be menopause and
good for you, but
Speaker 3 (21:06):
That's right.
Exactly. We'll take it
Speaker 2 (21:09):
Yeah , exactly.
Well, thank you so much foryour words of expertise and a
big thank you to everyonelistening. We hope you all feel
more empowered to take controlof your health. Tune in for our
, uh, final episode in ourovarian Cancer 1 0 1 series as
we discuss why early detectionis so critical to fighting
ovarian cancer.
Speaker 1 (21:36):
For more information about gynecologic health, visit
tina's wish.org/what to know .
That's tina's wish.org/wH-A-T-T-O-K-N-O-W . And like,
follow or subscribe whereveryou listen to your favorite
podcasts.
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