February 15, 2023 • 32 mins
Disparities When It Comes To Gynecologic Cancers & How We Can Close the Gap
Featuring: Valerie Smaldone, Moderator, Media Personality, Radio Host & Ovarian Cancer Survivor
Carol Brown, MD; Gynecologic Surgeon, SVP & Chief Health Equity Officer, Memorial Sloan Kettering Cancer Center
Dineo Khabele, MD; Chief of Obstetrics & Gynecology, Washington University School of Medicine in St. Louis
To learn more about gynecologic health, visit tinaswish.org/whattoknow.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
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):
Hello, my name is Valerie Mone . I call myself a
media personality, a radiohost, actress, voice artist,
talent coach, and producer. Myradio show and podcast is
called Bagels and Broadway,where I get to interview people
from the world of entertainmentand restaurants and food arts.
And I also produce a podcastseries on healing and wellbeing
(00:50):
called Healing Wisdom. It's forthe European Hospitality Group,
healing Hotels of the world.
And I'm a faculty member of theArts College School of Visual
Arts here in New York. But inaddition to all of that, I am
an ovarian cancer survivor as avery early stage ovarian cancer
patient. Now, about 20 yearsago, I became the poster child
(01:11):
for early detection,experiencing this challenging
medical condition. And alongwith my media background, I was
able to become a healthadvocate for women speaking out
about it, producing a publicaffairs series on radio and
television , uh, doingfundraisers to raise money for
ovarian cancer awareness andresearch, speaking at medical
(01:34):
conferences around the world,and to small groups as well.
And that is how I met one ofthe physicians joining us
today. And I'll get to thatstory in just a little bit. But
first, I wanna thank Tina'swish for inviting me to
moderate today's panel, and I'mvery excited to be here today.
This is an inclusive journey,and we are so honored to have
(01:55):
all of you here with us today.
So now let's get right to ourhonored panelists. I'm so
excited to introduce you to Dr.
Carol Brown, gynecologicsurgeon, senior Vice President
and Chief Health Equity Officerat Memorial Sloan Kettering
Cancer Center, and Dr. DeoCabbel , chair of Obstetrics
and Gynecology, a gynecologiconcologist at Washington
(02:16):
University. Doctors. I'mthrilled to have both of you
with us here today to have thiswonderful conversation, this
important conversation. And ,and Dr. Brown, let me begin
with you. But first I want totell everybody how we met. And
, uh, as you remember, it was ,uh, an auspicious day in
September. You and I were doingwhat is known as a press
(02:37):
junket. We were talking aboutgynecologic Cancer Awareness
month in September, and thedate was September 11th, 2001.
Dr. Brown we're forever bondedbecause of that experience.
Yeah,
Speaker 3 (02:50):
It's so true. It's so true. Uh , we were actually
doing a , uh, live , uh, radiobroadcast at the time , uh,
that , uh, the planes at thetowers. And , uh, we will never
forget that. And we are , uh,eternally bonded, but so happy
to be with you , uh, heretoday. And wanna thank you for
(03:11):
all the great , uh, work you'vedone then and since in , uh,
increasing awareness for GYNcancers.
Speaker 2 (03:18):
Thank you, doctor.
Thank you. Yeah, the worldchanged after that , but here
we are so many years laterdoing such important work , uh,
empowering women. So let'sstart Dr. Brown with the very
first question as a recap, howwould you describe gynecologic
cancer? What is the definitionof that?
Speaker 3 (03:36):
So, g gynecologic or GYN cancers are any cancer that
affects the a woman'sreproductive organs. So that
includes cancer of the uterusor womb cancer of the ovaries,
the fallopian tubes, thecervix, which is the tip or the
mouth of the womb , um, thevagina and the vulva. So it's
(03:58):
basically anything related to ,uh, what some people call their
lady parts or their femaleparts. Right .
Speaker 2 (04:05):
And of course, there is a web on this ASO that you
can refer to on Tina's wishwebsite. Let's talk
specifically about disparitieswhen it comes to gynecologic
health and what kinds ofdisparities exist. Tell us
about that.
Speaker 3 (04:22):
Well, when we talk about disparities, we're
basically talking aboutdifferences. Um, and when we're
talking about cancer, there canbe disparities or differences,
and they can be based onseveral different factors that
each woman may bring to hercancer journey. It could be
related to age, it could berelated to the language that
(04:43):
she speaks. It could be relatedto her , her socioeconomic
status, her access to healthinsurance. It could be related
to her race, to her ethnicity,to her culture, to her sexual
orientation, or even to genderidentity and physical ability.
So these are some of the lensesor , um, things that might make
each woman a unique person thatcan affect and result in
(05:07):
differences in her cancerjourney. And the measures, or
the things that we look at thatcan be different include the
rate at which , uh, a certainpopulation gets cancer or the
incidence of cancer. Itincludes , um, the risk of
dying from cancer, which is themortality rate, but it also
(05:29):
includes , um, general outcomemeasures. Like how likely is a
woman to survive for five years, uh, after being diagnosed
with cancer. So basically,disparities or differences. And
they can be , um, affected by alot of different things that
each woman brings to her cancerjourney.
Speaker 2 (05:49):
Thank you , Dr.
Brown . Dr . Kabel , welcome tothe web series today . Um , can
you speak more specifically andgive some examples of the
inequities in gynecologiccancers?
Speaker 4 (06:01):
Definitely. Well, first of all, thank you so much
for inviting me to participatein this panel. I think it's
just so important to raiseawareness about gynecological
cancers, and especially amongwomen who sometimes don't have
equal access to care, totreatment, to diagnosis. And
specifically, we have a numberof , uh, inequities related to
(06:24):
race. Um, I'm gonnaparticularly focus on the
differences , um, in race andethnicity between black women
and white women, where blackwomen are more, more likely to
die from cervical cancer,ovarian cancer, and uterine
cancers. And , um, this is ,uh, these are star statistics
(06:47):
that occur primarily we believedue to inequities in our
society that are limitingaccess to care and appropriate
diagnosis and treatment.
Speaker 2 (07:01):
What are the possible solutions behind these
disparities? Uh, and what arethe causes too? Why does this
exist? We've heard you talkabout the tiers of racial
inequity. What are they andwhat disparities exist therein?
Speaker 4 (07:19):
Well, I think that certainly as Dr. Brown
mentioned, there are numerousfactors that are related to
what a patient , uh, factorsrelated to a patient's
identity, a patient's , um,access to care due to
socioeconomic status. I thinkthat we also have to look at ,
um, healthcare providers andphysicians and nurses, and look
at the fact that we reallydon't have enough diversity in
(07:42):
our workforce to take care ofthe population that we're
talking about. In addition,there's some deep-seated
systemic issues related toracism and , um, and , uh, lack
of access to economic progressin our country that are
certainly affecting these , um,inequities and disparities. And
I think one of the ways we dealwith this is to recognize that
(08:06):
this is a problem, raiseawareness, and then really
tackle the issues of workforcedisparity, raising awareness
about gynecological cancersthat affect all women. And ,
um, and then tackling some ofthe systemic issues that we
have in our society.
Speaker 2 (08:23):
Are there any other ways we can really decrease
these disparities that are socommon a , amongst our society?
Speaker 4 (08:32):
Well, certainly I think that , um, education is
critical , um, raisingawareness just as we're doing
today. Um, certainly I, I thinkthat people don't recognize
that , um, we've made so muchprogress with clinical trials ,
uh, in gynecologic cancers andmaking sure that we , um, are ,
(08:53):
uh, uh, encouraging people toparticipate in trials and, and
recognizing that as a positiveand not a negative. I think
it's important to , um, to makesure that , uh, people
understand that economically weneed to increase access to
healthcare . ExpandingMedicaid, for example, in the
state of Missouri is animportant way we're addressing
(09:16):
inequities.
Speaker 2 (09:18):
I'm glad you brought up clinical trials. It's , it's
such an important piece of thepuzzle. So, Dr. Brown , uh,
let's talk about how we canmake this an effective way to
reduce or eliminate disparitiesin cancer clinical trials.
Let's, let's elaborate on thata little bit.
Speaker 3 (09:34):
So , uh, cancer clinical trials , uh, what we
have found through our workhere is at Sloan Kettering is
that cancer clinical trials arereally a great way and one
strategy to work to eliminate ,uh, cancer disparities,
particularly those that arebased or solely due to access
(09:56):
to care. And here's why.
Because when you participate ina cancer clinical trial, you
are really guaranteed that youare going to get exceptional
care. You're going to getaccess to the latest and best
and most advanced treatmentspossible, and you're going to
be monitored very closely,often more closely than you
(10:17):
would be outside of a clinicaltrial. And this is going to
ensure that some of thechallenges that can happen ,
um, due to your socioeconomicstatus or due to your
geographic location, et cetera,are really taken care of. Um,
and I think it's important for,for patients with cancer and
particularly women of color ,um, and women from populations
(10:40):
that may have some inherentmistrust of the medical system
to understand that clinicaltrials nowadays, particularly
cancer clinical trials, reallydo not , uh, involve being a
Guinea pig. You , you're notgonna be in a trial where
you're gonna be gettingsomething that has absolutely
no chance of working at all.
(11:02):
For the vast majority ofpatients with cancer, you're
usually gonna be gettingsomething that is a super duper
hyped up version of somethingthat's known to, to work well,
or you're gonna be gettingsomething that's added to , um,
a known , uh, way to attackcancer. So I think it's really,
really important that peopleunderstand, particularly for
(11:23):
cancer patients anyway, thatnowadays clinical trials , um,
really are not , are notfocused on experimenting with
things that we don't alreadyknow work. The other thing
that's really important to reto realize is that in the last
just five years, there's reallybeen a revolution in clinical
cancer clinical trials. They nolonger take, you know, seven in
(11:45):
eight years to finish. They nolonger have to involve, you
know, thousands and thousandsof patients. In fact, the
majority of the advances thathave been made in therapies
and, and actual cures foradvanced ovarian cancer and
uterine cancer and cervicalcancer, three cancers, as Dr.
Cabbel mentioned, have verysignificant lower five-year
(12:07):
survivals for black women inthe United States. Um, the, the
majority of the advances thathave come, have come through
clinical trials that are whatwe call phase two trials.
They're smaller, they're donemore rapidly. They can be done
in multiple sites at the sametime, and many of them can be
done in , uh, communityoncology settings and don't
(12:27):
necessarily require going to ,um, a , a tertiary cancer
center. Many of these trialsinvolve targeted therapies or
therapies that are taken bymouth and have fewer or very
different side effects than thetraditional chemotherapies. So
it's a really exciting timeactually to participate in
(12:48):
clinical trials and for certaindiseases, for example,
endometrial cancer, where weknow that black women with
advanced endometrial cancerhave significantly worse
outcomes , uh, than whitewomen. Um, you know, the recent
approval of immunotherapy andtargeted therapy, this, this
happened because of womenparticipating in clinical
(13:09):
trials. So, you know, I reallythink that this is a , a way ,
uh, one strategy to approachit. Um, not the only one, but
given the exciting advancesthat we're seeing in all three
of the major , uh, gynecologiccancers just in the last few
years with targeted therapy andimmunotherapy, clinical trials
(13:29):
are really important tool.
Speaker 2 (13:31):
Well, that's very compelling, what you just
mentioned, but how do we getgreater enrollment in clinical
trials? How do we also get theword out to the community?
Speaker 3 (13:40):
Well, thank you for asking that question. Um, so
the , the work that, that I'vebeen doing here at Memorial
Sloan Kettering and that manyof my colleagues are doing ,
um, around the country,including Dr. Cabbel , uh, and
others at other cancer centers,is recognizing the concept with
act , which actually PresidentBiden , um, had popularized
(14:02):
during , uh, his cancermoonshot time in the White
House, is that 70% of people inthe United States receive their
cancer care in a communitysetting. So if we want people
to participate in clinicaltrials, and we want them to
benefit from the great advanceswe have to take these advances
from the places like MemorialSloan Kettering and bring them
(14:26):
to people in their communities.
So , um, here at SloanKettering and many of , um, my
colleagues here in New YorkCity and elsewhere, and I
believe also at Wash u, haveformed partnerships with
community oncologists and withpeople who are delivering care
in the community, cancer carein the community to , uh, bring
the clinical trials from theacademic center to be done at
(14:49):
the site, as well as partneringdirectly with , uh,
pharmaceutical sponsors to dotheir trials in these community
settings. So I think, you know,all of oncology is actually
rapidly changing and people aregetting their care where they
live. So I think this is areally important way for us to
adapt. Um, and it also breeds alot of , uh, more trust , uh,
(15:12):
in the system. Uh, and itreally, it is an important ,
uh, way I think we can approachthis.
Speaker 2 (15:18):
Well, you have a new role as Chief Health Equity
Officer at Memorial SloanKettering Cancer Center. First
of all, congratulations onthat. Uh, what other ways are
you and the institutionattempting to address these
health disparities? And youjust mentioned something very
important, some other ways,perhaps, that are in the works.
Speaker 3 (15:38):
So I think , um, as Dr. Gelli mentioned, the social
determinants of health arereally critical and being aware
of them, but also doingsomething and offering some
support and strategies toovercome some of the social de
negatively affecting socialdeterminants of health, such as
, um, access to insurancecoverage , um, access to
(16:01):
transportation, access to food.
Um, you know, we have a lot of, uh, our patients are food
insecure. We've dis we'vediscovered just by asking them.
And we have an amazing programrun by Dr. Francesca Ganey of
our cancer and immigrant healthdisparity service that has
provided , uh, food banks atall of our sites for patients ,
(16:23):
um, so that when they come fortreatment, they can also , um,
get food from our foodpantries.
Speaker 2 (16:29):
Thank you, Dr.
Brown. So, Dr. Kabel , let'stalk about some of the myths
and stereotypes aroundgynecologic cancers in the
African American community.
Let's address them in then ,let's clear them up.
Speaker 4 (16:42):
Well, thank you for that. And I just wanna , before
I answer that directly, Iwanted to follow up on what Dr.
Brown said about trust. And Ithink one of the best ways to
gain trust is to be moretrustworthy. And so I think
that the onus really is uponmajor academic medical centers
and cancer centers likeMemorial Sloan Kettering Cancer
Center, the Siteman CancerCenter, which is here at
(17:05):
Washington University in St.
Louis to make ourselves moretrustworthy. And this will
allow us to get at the deepseated myths and stereotypes
that exist not just in blackcommunities, because there
multiple communities, it's notjust one. Uh , but also within
the medical and scientificcommunities, for example , uh,
(17:27):
there's a myth that the RCAmutations, which , uh,
predispose women to developingbreast and ovarian cancers are
not common amongst AfricanAmerican women and black women.
And we know women , that's nottrue. So , uh, genetic testing
for these conditions and familyhistories and counseling are
limited , um, uh, because weare believing this myth and
(17:50):
stereotype, which is not true.
Um, another myth is that blackwomen are not willing to
undergo treatment. And I thinkthat that is absolutely not
true. I think that we have tobe more trustworthy in asking
why people have reservationsabout particular types of
treatment, but most people arewilling to undergo treatment.
And then finally, back toclinical trials, that black
(18:12):
women are less likely to wantto participate in clinical
trials. And we know from theliterature that if black women
are asked in the right way,they are more than willing to
participate in clinical trials.
So those a few examples,
Speaker 2 (18:27):
And that's bringing us right back to the trust you
just mentioned, Dr. Cabbel .
Um, and, and the onus of thepartnership between the patient
and the medical staff. W wouldyou agree with that?
Speaker 4 (18:39):
Absolute , absolutely. And it's beyond
just the physicians, I think weneed to look at nurses and
schedulers and medicalassistants, and it's the whole
healthcare system that , um,that says, we are welcoming and
we're willing to take care ofanybody who comes through our
doors, and you can trust us tohelp you through our journey.
Um, and so I think that, thatwe are doing a lot of work here
(19:03):
at Washington University at theSiteman Cancer Center. Dr.
Brown, who is a mentor of minefor many, many years, has
really led the field in thisand is, is really showing the
way and how we can address someof these, these deep-seated
issues. And we have to, becauseI believe that if we can , um,
address some of these issues,particularly for the most
(19:23):
vulnerable, this is gonna helpeverybody.
Speaker 2 (19:26):
So, Dr. Brown, let's talk about some other
communities and other myths.
For example, in the Hispaniccommunity when it comes to
gynecologic cancers or ageageism. You know, a lot of
people would say, oh, you know,ovarian cancer is only for
older women or socioeconomicchallenges, and I've given you
three different areas. But ifwe can tease that out, that
(19:48):
would be wonderful.
Speaker 3 (19:49):
Sure. I think it's important to recognize that for
Hispanic and Latino, theHispanic Latino community , um,
there is very limitedinformation about cancer
disparities, particularly GYNcancer disparities. And the
same is actually true for , uh,different populations , um,
(20:10):
that are labeled and bunchedtogether as Asian. Um, and
again, to recognize that , uh,I appreciate that Dr. Uh ,
Cabela said communities,because there is not a Hispanic
Latino community, there is notan Asian population. Um, we are
understanding , um, more andmore as we have scientists, and
(20:32):
we have to remind ourselvesrace is not a scientific
concept, it's asociodemographic concept. Um,
and so we need to actually be alot more specific , um, in
terms of what communities we'retalking about and what groups
of people. Um, I will say therehas been some work , um, done ,
(20:53):
um, looking at Hispanic Latina, uh, women with endometrial
cancer that has shown that theytend to get endometrial cancer
at a younger age, a youngermedian age , um, than other
groups. Uh, and I, we, we don'tknow for sure yet. But the
(21:14):
concern is that , um, having itat a younger age, you're less
likely to be diagnosed becausethe symptoms of abnormal
bleeding are gonna not be takenas seriously if you're in your
late thirties or early forties,as if you are older, if you're
postmenopausal. So , um, reallytrying to understand the
symptom pattern that women arepresenting with and really
(21:36):
trying to educate women thatyounger women can get
endometrial cancer. And I thinkone of the, the greatest
messages that we can bring towomen is that, you know, your
body, you know what you , ifyou're getting your menstrual
cycle, you know what it's like,and you really need to feel
empowered. You need to feelempowered that if you notice a
change, that you bring it toyour doctor's or your nurse
(21:59):
practitioner's attention, andthat you really, you know, if
you're over 35, you really needto challenge them to make sure
that there's not a possibilitythat this could be some type of
cancer or pre-cancer going on ,um, in your uterus. And that's
really kind of a radicalconcept, because as Dr. Cabal ,
(22:21):
I nicely pointed out, I ammany, many years older than
her, and I've been around, I'mjust kidding. And I've been
around since, in my training,we were taught that only
elderly women over 70 who wereobese got endometrial cancer.
Well, that's not true at allanymore . So, but
unfortunately, I think manyproviders still have that in
(22:42):
their heads. And so whensomeone who's 40 or 41 comes in
and says, you know, my last twoperiods have been really heavy
and I had some bleeding inbetween, you know, women, you
need to have that message thatmaybe you should have a biopsy,
maybe you should have anultrasound and not just have it
dismissed as , um, oh, youknow, it's, you know, it's
(23:03):
nothing, particularly if youare a woman of color. And
that's the message that wewanna send because we, we do
have information that'ssuggesting you are at higher
risk. Also, if you have afamily history of colon cancer,
of breast cancer, uterinecancer, bladder cancer, you
could have coming from a Lynch, uh, syndrome family. So
again, you would be atincreased risk for uterine
(23:25):
cancer. So I think it'simportant to recognize that
just as we didn't discover thatblack women had significantly
or similar rates of BRCAmutations , um, until we
started looking and doing thetesting, I think the same thing
is gonna be true. And again, toremember that many of these
disparities are caused by theinteractions of social
(23:48):
determinants of health , um,and not really related to the
color of your skin, the amountof melan in your skin, what
language you speak, et cetera.
Um, with regard to age, it'sbeen a long known , uh, fact
that , uh, women who are older, um, have , uh, worse outcomes
, uh, particularly in ovariancancer. However, there is
(24:11):
really good news because thishas been known for , uh, really
about two or three decades. Andmany of the research
organizations including , um,the NRG Gynecologic Oncology
Group , um, uh, SGO ASCO havedeveloped clinical trials
(24:31):
specifically to be done inolder women with ovarian cancer
that have identified the better, um, types of , uh, drugs to
use that have less side effects, uh, and also , uh, how to
safely use targeted therapy inthis population. So I, I do
think that this age , um, uh,poor survival in older women
(24:53):
with ovarian cancer, we'regonna start seeing that gap
narrowed, which is really goodnews. Um, and then I forgot
what the other, your thirdquestion was, sorry.
Speaker 2 (25:03):
The socioeconomic
Speaker 3 (25:05):
Disparities. Oh, well, again, I think, you know,
we've already mentioned, so ,um, social determinants of
health and socioeconomic statusas a reflection of that is
really in , in my opinion, thecritical factor that , uh,
affects all people with cancer,and that can really , uh,
(25:25):
result in them having a worseoutcome. Um, and, you know, you
asked earlier what we could do.
Well , what we could do is ,uh, as a country , uh, is
develop a policy that makessure that every cancer patient
, um, has guaranteed access tocare and doesn't have to worry
about whether their insuranceis gonna cover them having
(25:48):
cancer surgery, or whethertheir insurance is going to
cover them going on , uh, thisnew targeted therapy that their
doctor is prescribing. And thisreally goes across
socioeconomic status. It's notjust , um, patients who have no
insurance. This is a hugeproblem for everyone in this
country. And I think that timeis now, I don't , I don't think
(26:09):
that the country is ready for ,uh, Medicare for all, but I
think we are ready for cancercare for all, in my opinion.
And I think that's somethingthat , um, we should really
start from a policy front , uh,aggressively working on.
Speaker 2 (26:22):
We're gonna take questions from our audience in
just a minute, but first, justvery quickly, Dr. Cabbel , we
are talking about age, and I'mcurious to know if you can
share perhaps the youngest ,uh, gynecologic , uh, cancer
patient that you have met , uh,in , in your career.
Speaker 4 (26:39):
Well, I mean, they're very rare gynecologic
cancers that affect babiesthat, that affect , uh,
children. And so I've hadpatients as young as two years
old , uh, but those are reallyrare. Very, very rare. But
there are other types ofgynecologic cancers that affect
reproductive age women thatare, that less common types of
(27:01):
ovarian cancer, for example.
And so I think that that's ,um, that's something that
people have to be aware of, andthat's why raising awareness
about symptoms , uh, you know ,uh, persistent symptoms,
abnormal vaginal bleeding , uh,bloating, unexpected weight
gain or weight loss , um, uh,feeling full early after eating
(27:24):
, uh, bleeding in betweenperiods, bleeding with sex. I
think that these are symptomsthat we just need to over and
over again, remind people majorchanges in your bowel or
bladder habits that persist toget those symptoms worked up ,
and make sure that included inthat workup is , uh, a visit to
(27:44):
the gynecologist so that we canmake sure that we're not
missing a gynecologic cancer .
Speaker 2 (27:49):
Always important to remind people how important it
is to have those visits. Okay.
Let's go to some questions fromthe audience. And we know we'll
not be able to answer all thequestions that we're receiving
, uh, but like we did lastmonth, we will provide replies
to each question on our websiteand in our follow up e-blast.
So thank you very much forparticipating. The first
(28:10):
question , uh, in youropinions, do you feel that
these inequities or disparitiesare improving, given the
spotlight that has been shownon them throughout the past
year? And it's always nice toknow, should we be feeling
hopeful? I'll start with you,Dr. Kelli .
Speaker 4 (28:27):
Um, so I think that it's very important that
there's been a spotlight. Um,uh, but yesterday I was looking
at some statistics where thingsare not getting better. Uh ,
the number of , uh, as far asour workforce, the number of
black men going into medicineis lower now than it was in
1978. Uh, there are only 307black women professors in
(28:53):
medical schools out of 38,000plus. So we have a long way to
go. So I'm very encouraged thatthere's a spotlight. Um, but ,
uh, I think that we need a lotmore action. Um, I think that a
lot of our patients are beingleft behind because people are
not listening. So the spotlightis raising awareness and making
(29:16):
sure that people are hearing,but I think we need to really
listen , um, because women aretelling people about their
symptoms. Women are saying thatthey've been bloated, that
they're gaining weight, andthey're being sent to a variety
of different doctors and notgetting an early diagnosis. So
I am hopeful that we can keepthe pressure on so that we can
(29:38):
actually move from awareness toaction. And , um, I , and I'm
happy to be a part of that.
Speaker 2 (29:45):
Dr. Brown, are there any specific actions that
patients should be taking?
We're talking about therelationship between patients
and medical community. Whatshould patients be doing?
Speaker 3 (29:55):
It's very important not to let your fear of getting
COVID keep you from gettingyour checkups, your procedures,
if they are available to you.
And as, as Dr. Gelli mentioned,it's not available to everyone
because covid is affectingdifferent areas differently.
But if you are in an area thatyou can get to your providers
(30:17):
for your routine screenings,for your checkups, for your
blood pressure check, pleasedon't be afraid to do it
because of covid. Um, becauseagain, I think we're gonna be
seeing the residual of thepandemic in the next couple of
years, that more patients aregonna be sicker with more
advanced cancers.
Speaker 2 (30:35):
Very important point. Thank you for that Dr.
Brown. And last question, Dr.
Kabel , we've mentioneddisparities today. What is the
most challenging to eliminateand why?
Speaker 4 (30:48):
I I think we, we have large inequities and
disparities in trust, and thatis the most challenging. Um,
and that relates to awareness,that relates to the ability to
listen and to understand , um,other people's plight. I think
the biggest , uh, challenge inour country is , uh, relates to
(31:09):
that, but more importantlyrelates to underlying systemic
issues that if we don't start ,um, really tackling them from a
policy and from a nationallevel, they're going to
persist. And , um, and so Ithink that that's, that's the
thing that I struggle with themost. And I think that that's
our biggest challenge. Um , butI am so encouraged and so, so
(31:31):
grateful that we've had theopportunity to talk about these
issues today , um, in thispublic forum. And , um, and I'm
hoping it'll make a differencefor somebody. Thank you.
Speaker 2 (31:42):
Well, a huge thank you to you , both colleagues
and friends, Dr. Brown, Dr.
Cabbel , we so appreciate yourtime and all that you do to
improve the lives of women inrelation to their gynecologic
health. And also a big thankyou to you who've tuned in.
Thank you all so very much. I'mValerie Mone . Be well.
Speaker 1 (32:07):
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 oow . 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):
Hello, my name is Valerie Mone . I call myself a
media personality, a radiohost, actress, voice artist,
talent coach, and producer. Myradio show and podcast is
called Bagels and Broadway,where I get to interview people
from the world of entertainmentand restaurants and food arts.
And I also produce a podcastseries on healing and wellbeing
(00:50):
called Healing Wisdom. It's forthe European Hospitality Group,
healing Hotels of the world.
And I'm a faculty member of theArts College School of Visual
Arts here in New York. But inaddition to all of that, I am
an ovarian cancer survivor as avery early stage ovarian cancer
patient. Now, about 20 yearsago, I became the poster child
(01:11):
for early detection,experiencing this challenging
medical condition. And alongwith my media background, I was
able to become a healthadvocate for women speaking out
about it, producing a publicaffairs series on radio and
television , uh, doingfundraisers to raise money for
ovarian cancer awareness andresearch, speaking at medical
(01:34):
conferences around the world,and to small groups as well.
And that is how I met one ofthe physicians joining us
today. And I'll get to thatstory in just a little bit. But
first, I wanna thank Tina'swish for inviting me to
moderate today's panel, and I'mvery excited to be here today.
This is an inclusive journey,and we are so honored to have
(01:55):
all of you here with us today.
So now let's get right to ourhonored panelists. I'm so
excited to introduce you to Dr.
Carol Brown, gynecologicsurgeon, senior Vice President
and Chief Health Equity Officerat Memorial Sloan Kettering
Cancer Center, and Dr. DeoCabbel , chair of Obstetrics
and Gynecology, a gynecologiconcologist at Washington
(02:16):
University. Doctors. I'mthrilled to have both of you
with us here today to have thiswonderful conversation, this
important conversation. And ,and Dr. Brown, let me begin
with you. But first I want totell everybody how we met. And
, uh, as you remember, it was ,uh, an auspicious day in
September. You and I were doingwhat is known as a press
(02:37):
junket. We were talking aboutgynecologic Cancer Awareness
month in September, and thedate was September 11th, 2001.
Dr. Brown we're forever bondedbecause of that experience.
Yeah,
Speaker 3 (02:50):
It's so true. It's so true. Uh , we were actually
doing a , uh, live , uh, radiobroadcast at the time , uh,
that , uh, the planes at thetowers. And , uh, we will never
forget that. And we are , uh,eternally bonded, but so happy
to be with you , uh, heretoday. And wanna thank you for
(03:11):
all the great , uh, work you'vedone then and since in , uh,
increasing awareness for GYNcancers.
Speaker 2 (03:18):
Thank you, doctor.
Thank you. Yeah, the worldchanged after that , but here
we are so many years laterdoing such important work , uh,
empowering women. So let'sstart Dr. Brown with the very
first question as a recap, howwould you describe gynecologic
cancer? What is the definitionof that?
Speaker 3 (03:36):
So, g gynecologic or GYN cancers are any cancer that
affects the a woman'sreproductive organs. So that
includes cancer of the uterusor womb cancer of the ovaries,
the fallopian tubes, thecervix, which is the tip or the
mouth of the womb , um, thevagina and the vulva. So it's
(03:58):
basically anything related to ,uh, what some people call their
lady parts or their femaleparts. Right .
Speaker 2 (04:05):
And of course, there is a web on this ASO that you
can refer to on Tina's wishwebsite. Let's talk
specifically about disparitieswhen it comes to gynecologic
health and what kinds ofdisparities exist. Tell us
about that.
Speaker 3 (04:22):
Well, when we talk about disparities, we're
basically talking aboutdifferences. Um, and when we're
talking about cancer, there canbe disparities or differences,
and they can be based onseveral different factors that
each woman may bring to hercancer journey. It could be
related to age, it could berelated to the language that
(04:43):
she speaks. It could be relatedto her , her socioeconomic
status, her access to healthinsurance. It could be related
to her race, to her ethnicity,to her culture, to her sexual
orientation, or even to genderidentity and physical ability.
So these are some of the lensesor , um, things that might make
each woman a unique person thatcan affect and result in
(05:07):
differences in her cancerjourney. And the measures, or
the things that we look at thatcan be different include the
rate at which , uh, a certainpopulation gets cancer or the
incidence of cancer. Itincludes , um, the risk of
dying from cancer, which is themortality rate, but it also
(05:29):
includes , um, general outcomemeasures. Like how likely is a
woman to survive for five years, uh, after being diagnosed
with cancer. So basically,disparities or differences. And
they can be , um, affected by alot of different things that
each woman brings to her cancerjourney.
Speaker 2 (05:49):
Thank you , Dr.
Brown . Dr . Kabel , welcome tothe web series today . Um , can
you speak more specifically andgive some examples of the
inequities in gynecologiccancers?
Speaker 4 (06:01):
Definitely. Well, first of all, thank you so much
for inviting me to participatein this panel. I think it's
just so important to raiseawareness about gynecological
cancers, and especially amongwomen who sometimes don't have
equal access to care, totreatment, to diagnosis. And
specifically, we have a numberof , uh, inequities related to
(06:24):
race. Um, I'm gonnaparticularly focus on the
differences , um, in race andethnicity between black women
and white women, where blackwomen are more, more likely to
die from cervical cancer,ovarian cancer, and uterine
cancers. And , um, this is ,uh, these are star statistics
(06:47):
that occur primarily we believedue to inequities in our
society that are limitingaccess to care and appropriate
diagnosis and treatment.
Speaker 2 (07:01):
What are the possible solutions behind these
disparities? Uh, and what arethe causes too? Why does this
exist? We've heard you talkabout the tiers of racial
inequity. What are they andwhat disparities exist therein?
Speaker 4 (07:19):
Well, I think that certainly as Dr. Brown
mentioned, there are numerousfactors that are related to
what a patient , uh, factorsrelated to a patient's
identity, a patient's , um,access to care due to
socioeconomic status. I thinkthat we also have to look at ,
um, healthcare providers andphysicians and nurses, and look
at the fact that we reallydon't have enough diversity in
(07:42):
our workforce to take care ofthe population that we're
talking about. In addition,there's some deep-seated
systemic issues related toracism and , um, and , uh, lack
of access to economic progressin our country that are
certainly affecting these , um,inequities and disparities. And
I think one of the ways we dealwith this is to recognize that
(08:06):
this is a problem, raiseawareness, and then really
tackle the issues of workforcedisparity, raising awareness
about gynecological cancersthat affect all women. And ,
um, and then tackling some ofthe systemic issues that we
have in our society.
Speaker 2 (08:23):
Are there any other ways we can really decrease
these disparities that are socommon a , amongst our society?
Speaker 4 (08:32):
Well, certainly I think that , um, education is
critical , um, raisingawareness just as we're doing
today. Um, certainly I, I thinkthat people don't recognize
that , um, we've made so muchprogress with clinical trials ,
uh, in gynecologic cancers andmaking sure that we , um, are ,
(08:53):
uh, uh, encouraging people toparticipate in trials and, and
recognizing that as a positiveand not a negative. I think
it's important to , um, to makesure that , uh, people
understand that economically weneed to increase access to
healthcare . ExpandingMedicaid, for example, in the
state of Missouri is animportant way we're addressing
(09:16):
inequities.
Speaker 2 (09:18):
I'm glad you brought up clinical trials. It's , it's
such an important piece of thepuzzle. So, Dr. Brown , uh,
let's talk about how we canmake this an effective way to
reduce or eliminate disparitiesin cancer clinical trials.
Let's, let's elaborate on thata little bit.
Speaker 3 (09:34):
So , uh, cancer clinical trials , uh, what we
have found through our workhere is at Sloan Kettering is
that cancer clinical trials arereally a great way and one
strategy to work to eliminate ,uh, cancer disparities,
particularly those that arebased or solely due to access
(09:56):
to care. And here's why.
Because when you participate ina cancer clinical trial, you
are really guaranteed that youare going to get exceptional
care. You're going to getaccess to the latest and best
and most advanced treatmentspossible, and you're going to
be monitored very closely,often more closely than you
(10:17):
would be outside of a clinicaltrial. And this is going to
ensure that some of thechallenges that can happen ,
um, due to your socioeconomicstatus or due to your
geographic location, et cetera,are really taken care of. Um,
and I think it's important for,for patients with cancer and
particularly women of color ,um, and women from populations
(10:40):
that may have some inherentmistrust of the medical system
to understand that clinicaltrials nowadays, particularly
cancer clinical trials, reallydo not , uh, involve being a
Guinea pig. You , you're notgonna be in a trial where
you're gonna be gettingsomething that has absolutely
no chance of working at all.
(11:02):
For the vast majority ofpatients with cancer, you're
usually gonna be gettingsomething that is a super duper
hyped up version of somethingthat's known to, to work well,
or you're gonna be gettingsomething that's added to , um,
a known , uh, way to attackcancer. So I think it's really,
really important that peopleunderstand, particularly for
(11:23):
cancer patients anyway, thatnowadays clinical trials , um,
really are not , are notfocused on experimenting with
things that we don't alreadyknow work. The other thing
that's really important to reto realize is that in the last
just five years, there's reallybeen a revolution in clinical
cancer clinical trials. They nolonger take, you know, seven in
(11:45):
eight years to finish. They nolonger have to involve, you
know, thousands and thousandsof patients. In fact, the
majority of the advances thathave been made in therapies
and, and actual cures foradvanced ovarian cancer and
uterine cancer and cervicalcancer, three cancers, as Dr.
Cabbel mentioned, have verysignificant lower five-year
(12:07):
survivals for black women inthe United States. Um, the, the
majority of the advances thathave come, have come through
clinical trials that are whatwe call phase two trials.
They're smaller, they're donemore rapidly. They can be done
in multiple sites at the sametime, and many of them can be
done in , uh, communityoncology settings and don't
(12:27):
necessarily require going to ,um, a , a tertiary cancer
center. Many of these trialsinvolve targeted therapies or
therapies that are taken bymouth and have fewer or very
different side effects than thetraditional chemotherapies. So
it's a really exciting timeactually to participate in
(12:48):
clinical trials and for certaindiseases, for example,
endometrial cancer, where weknow that black women with
advanced endometrial cancerhave significantly worse
outcomes , uh, than whitewomen. Um, you know, the recent
approval of immunotherapy andtargeted therapy, this, this
happened because of womenparticipating in clinical
(13:09):
trials. So, you know, I reallythink that this is a , a way ,
uh, one strategy to approachit. Um, not the only one, but
given the exciting advancesthat we're seeing in all three
of the major , uh, gynecologiccancers just in the last few
years with targeted therapy andimmunotherapy, clinical trials
(13:29):
are really important tool.
Speaker 2 (13:31):
Well, that's very compelling, what you just
mentioned, but how do we getgreater enrollment in clinical
trials? How do we also get theword out to the community?
Speaker 3 (13:40):
Well, thank you for asking that question. Um, so
the , the work that, that I'vebeen doing here at Memorial
Sloan Kettering and that manyof my colleagues are doing ,
um, around the country,including Dr. Cabbel , uh, and
others at other cancer centers,is recognizing the concept with
act , which actually PresidentBiden , um, had popularized
(14:02):
during , uh, his cancermoonshot time in the White
House, is that 70% of people inthe United States receive their
cancer care in a communitysetting. So if we want people
to participate in clinicaltrials, and we want them to
benefit from the great advanceswe have to take these advances
from the places like MemorialSloan Kettering and bring them
(14:26):
to people in their communities.
So , um, here at SloanKettering and many of , um, my
colleagues here in New YorkCity and elsewhere, and I
believe also at Wash u, haveformed partnerships with
community oncologists and withpeople who are delivering care
in the community, cancer carein the community to , uh, bring
the clinical trials from theacademic center to be done at
(14:49):
the site, as well as partneringdirectly with , uh,
pharmaceutical sponsors to dotheir trials in these community
settings. So I think, you know,all of oncology is actually
rapidly changing and people aregetting their care where they
live. So I think this is areally important way for us to
adapt. Um, and it also breeds alot of , uh, more trust , uh,
(15:12):
in the system. Uh, and itreally, it is an important ,
uh, way I think we can approachthis.
Speaker 2 (15:18):
Well, you have a new role as Chief Health Equity
Officer at Memorial SloanKettering Cancer Center. First
of all, congratulations onthat. Uh, what other ways are
you and the institutionattempting to address these
health disparities? And youjust mentioned something very
important, some other ways,perhaps, that are in the works.
Speaker 3 (15:38):
So I think , um, as Dr. Gelli mentioned, the social
determinants of health arereally critical and being aware
of them, but also doingsomething and offering some
support and strategies toovercome some of the social de
negatively affecting socialdeterminants of health, such as
, um, access to insurancecoverage , um, access to
(16:01):
transportation, access to food.
Um, you know, we have a lot of, uh, our patients are food
insecure. We've dis we'vediscovered just by asking them.
And we have an amazing programrun by Dr. Francesca Ganey of
our cancer and immigrant healthdisparity service that has
provided , uh, food banks atall of our sites for patients ,
(16:23):
um, so that when they come fortreatment, they can also , um,
get food from our foodpantries.
Speaker 2 (16:29):
Thank you, Dr.
Brown. So, Dr. Kabel , let'stalk about some of the myths
and stereotypes aroundgynecologic cancers in the
African American community.
Let's address them in then ,let's clear them up.
Speaker 4 (16:42):
Well, thank you for that. And I just wanna , before
I answer that directly, Iwanted to follow up on what Dr.
Brown said about trust. And Ithink one of the best ways to
gain trust is to be moretrustworthy. And so I think
that the onus really is uponmajor academic medical centers
and cancer centers likeMemorial Sloan Kettering Cancer
Center, the Siteman CancerCenter, which is here at
(17:05):
Washington University in St.
Louis to make ourselves moretrustworthy. And this will
allow us to get at the deepseated myths and stereotypes
that exist not just in blackcommunities, because there
multiple communities, it's notjust one. Uh , but also within
the medical and scientificcommunities, for example , uh,
(17:27):
there's a myth that the RCAmutations, which , uh,
predispose women to developingbreast and ovarian cancers are
not common amongst AfricanAmerican women and black women.
And we know women , that's nottrue. So , uh, genetic testing
for these conditions and familyhistories and counseling are
limited , um, uh, because weare believing this myth and
(17:50):
stereotype, which is not true.
Um, another myth is that blackwomen are not willing to
undergo treatment. And I thinkthat that is absolutely not
true. I think that we have tobe more trustworthy in asking
why people have reservationsabout particular types of
treatment, but most people arewilling to undergo treatment.
And then finally, back toclinical trials, that black
(18:12):
women are less likely to wantto participate in clinical
trials. And we know from theliterature that if black women
are asked in the right way,they are more than willing to
participate in clinical trials.
So those a few examples,
Speaker 2 (18:27):
And that's bringing us right back to the trust you
just mentioned, Dr. Cabbel .
Um, and, and the onus of thepartnership between the patient
and the medical staff. W wouldyou agree with that?
Speaker 4 (18:39):
Absolute , absolutely. And it's beyond
just the physicians, I think weneed to look at nurses and
schedulers and medicalassistants, and it's the whole
healthcare system that , um,that says, we are welcoming and
we're willing to take care ofanybody who comes through our
doors, and you can trust us tohelp you through our journey.
Um, and so I think that, thatwe are doing a lot of work here
(19:03):
at Washington University at theSiteman Cancer Center. Dr.
Brown, who is a mentor of minefor many, many years, has
really led the field in thisand is, is really showing the
way and how we can address someof these, these deep-seated
issues. And we have to, becauseI believe that if we can , um,
address some of these issues,particularly for the most
(19:23):
vulnerable, this is gonna helpeverybody.
Speaker 2 (19:26):
So, Dr. Brown, let's talk about some other
communities and other myths.
For example, in the Hispaniccommunity when it comes to
gynecologic cancers or ageageism. You know, a lot of
people would say, oh, you know,ovarian cancer is only for
older women or socioeconomicchallenges, and I've given you
three different areas. But ifwe can tease that out, that
(19:48):
would be wonderful.
Speaker 3 (19:49):
Sure. I think it's important to recognize that for
Hispanic and Latino, theHispanic Latino community , um,
there is very limitedinformation about cancer
disparities, particularly GYNcancer disparities. And the
same is actually true for , uh,different populations , um,
(20:10):
that are labeled and bunchedtogether as Asian. Um, and
again, to recognize that , uh,I appreciate that Dr. Uh ,
Cabela said communities,because there is not a Hispanic
Latino community, there is notan Asian population. Um, we are
understanding , um, more andmore as we have scientists, and
(20:32):
we have to remind ourselvesrace is not a scientific
concept, it's asociodemographic concept. Um,
and so we need to actually be alot more specific , um, in
terms of what communities we'retalking about and what groups
of people. Um, I will say therehas been some work , um, done ,
(20:53):
um, looking at Hispanic Latina, uh, women with endometrial
cancer that has shown that theytend to get endometrial cancer
at a younger age, a youngermedian age , um, than other
groups. Uh, and I, we, we don'tknow for sure yet. But the
(21:14):
concern is that , um, having itat a younger age, you're less
likely to be diagnosed becausethe symptoms of abnormal
bleeding are gonna not be takenas seriously if you're in your
late thirties or early forties,as if you are older, if you're
postmenopausal. So , um, reallytrying to understand the
symptom pattern that women arepresenting with and really
(21:36):
trying to educate women thatyounger women can get
endometrial cancer. And I thinkone of the, the greatest
messages that we can bring towomen is that, you know, your
body, you know what you , ifyou're getting your menstrual
cycle, you know what it's like,and you really need to feel
empowered. You need to feelempowered that if you notice a
change, that you bring it toyour doctor's or your nurse
(21:59):
practitioner's attention, andthat you really, you know, if
you're over 35, you really needto challenge them to make sure
that there's not a possibilitythat this could be some type of
cancer or pre-cancer going on ,um, in your uterus. And that's
really kind of a radicalconcept, because as Dr. Cabal ,
(22:21):
I nicely pointed out, I ammany, many years older than
her, and I've been around, I'mjust kidding. And I've been
around since, in my training,we were taught that only
elderly women over 70 who wereobese got endometrial cancer.
Well, that's not true at allanymore . So, but
unfortunately, I think manyproviders still have that in
(22:42):
their heads. And so whensomeone who's 40 or 41 comes in
and says, you know, my last twoperiods have been really heavy
and I had some bleeding inbetween, you know, women, you
need to have that message thatmaybe you should have a biopsy,
maybe you should have anultrasound and not just have it
dismissed as , um, oh, youknow, it's, you know, it's
(23:03):
nothing, particularly if youare a woman of color. And
that's the message that wewanna send because we, we do
have information that'ssuggesting you are at higher
risk. Also, if you have afamily history of colon cancer,
of breast cancer, uterinecancer, bladder cancer, you
could have coming from a Lynch, uh, syndrome family. So
again, you would be atincreased risk for uterine
(23:25):
cancer. So I think it'simportant to recognize that
just as we didn't discover thatblack women had significantly
or similar rates of BRCAmutations , um, until we
started looking and doing thetesting, I think the same thing
is gonna be true. And again, toremember that many of these
disparities are caused by theinteractions of social
(23:48):
determinants of health , um,and not really related to the
color of your skin, the amountof melan in your skin, what
language you speak, et cetera.
Um, with regard to age, it'sbeen a long known , uh, fact
that , uh, women who are older, um, have , uh, worse outcomes
, uh, particularly in ovariancancer. However, there is
(24:11):
really good news because thishas been known for , uh, really
about two or three decades. Andmany of the research
organizations including , um,the NRG Gynecologic Oncology
Group , um, uh, SGO ASCO havedeveloped clinical trials
(24:31):
specifically to be done inolder women with ovarian cancer
that have identified the better, um, types of , uh, drugs to
use that have less side effects, uh, and also , uh, how to
safely use targeted therapy inthis population. So I, I do
think that this age , um, uh,poor survival in older women
(24:53):
with ovarian cancer, we'regonna start seeing that gap
narrowed, which is really goodnews. Um, and then I forgot
what the other, your thirdquestion was, sorry.
Speaker 2 (25:03):
The socioeconomic
Speaker 3 (25:05):
Disparities. Oh, well, again, I think, you know,
we've already mentioned, so ,um, social determinants of
health and socioeconomic statusas a reflection of that is
really in , in my opinion, thecritical factor that , uh,
affects all people with cancer,and that can really , uh,
(25:25):
result in them having a worseoutcome. Um, and, you know, you
asked earlier what we could do.
Well , what we could do is ,uh, as a country , uh, is
develop a policy that makessure that every cancer patient
, um, has guaranteed access tocare and doesn't have to worry
about whether their insuranceis gonna cover them having
(25:48):
cancer surgery, or whethertheir insurance is going to
cover them going on , uh, thisnew targeted therapy that their
doctor is prescribing. And thisreally goes across
socioeconomic status. It's notjust , um, patients who have no
insurance. This is a hugeproblem for everyone in this
country. And I think that timeis now, I don't , I don't think
(26:09):
that the country is ready for ,uh, Medicare for all, but I
think we are ready for cancercare for all, in my opinion.
And I think that's somethingthat , um, we should really
start from a policy front , uh,aggressively working on.
Speaker 2 (26:22):
We're gonna take questions from our audience in
just a minute, but first, justvery quickly, Dr. Cabbel , we
are talking about age, and I'mcurious to know if you can
share perhaps the youngest ,uh, gynecologic , uh, cancer
patient that you have met , uh,in , in your career.
Speaker 4 (26:39):
Well, I mean, they're very rare gynecologic
cancers that affect babiesthat, that affect , uh,
children. And so I've hadpatients as young as two years
old , uh, but those are reallyrare. Very, very rare. But
there are other types ofgynecologic cancers that affect
reproductive age women thatare, that less common types of
(27:01):
ovarian cancer, for example.
And so I think that that's ,um, that's something that
people have to be aware of, andthat's why raising awareness
about symptoms , uh, you know ,uh, persistent symptoms,
abnormal vaginal bleeding , uh,bloating, unexpected weight
gain or weight loss , um, uh,feeling full early after eating
(27:24):
, uh, bleeding in betweenperiods, bleeding with sex. I
think that these are symptomsthat we just need to over and
over again, remind people majorchanges in your bowel or
bladder habits that persist toget those symptoms worked up ,
and make sure that included inthat workup is , uh, a visit to
(27:44):
the gynecologist so that we canmake sure that we're not
missing a gynecologic cancer .
Speaker 2 (27:49):
Always important to remind people how important it
is to have those visits. Okay.
Let's go to some questions fromthe audience. And we know we'll
not be able to answer all thequestions that we're receiving
, uh, but like we did lastmonth, we will provide replies
to each question on our websiteand in our follow up e-blast.
So thank you very much forparticipating. The first
(28:10):
question , uh, in youropinions, do you feel that
these inequities or disparitiesare improving, given the
spotlight that has been shownon them throughout the past
year? And it's always nice toknow, should we be feeling
hopeful? I'll start with you,Dr. Kelli .
Speaker 4 (28:27):
Um, so I think that it's very important that
there's been a spotlight. Um,uh, but yesterday I was looking
at some statistics where thingsare not getting better. Uh ,
the number of , uh, as far asour workforce, the number of
black men going into medicineis lower now than it was in
1978. Uh, there are only 307black women professors in
(28:53):
medical schools out of 38,000plus. So we have a long way to
go. So I'm very encouraged thatthere's a spotlight. Um, but ,
uh, I think that we need a lotmore action. Um, I think that a
lot of our patients are beingleft behind because people are
not listening. So the spotlightis raising awareness and making
(29:16):
sure that people are hearing,but I think we need to really
listen , um, because women aretelling people about their
symptoms. Women are saying thatthey've been bloated, that
they're gaining weight, andthey're being sent to a variety
of different doctors and notgetting an early diagnosis. So
I am hopeful that we can keepthe pressure on so that we can
(29:38):
actually move from awareness toaction. And , um, I , and I'm
happy to be a part of that.
Speaker 2 (29:45):
Dr. Brown, are there any specific actions that
patients should be taking?
We're talking about therelationship between patients
and medical community. Whatshould patients be doing?
Speaker 3 (29:55):
It's very important not to let your fear of getting
COVID keep you from gettingyour checkups, your procedures,
if they are available to you.
And as, as Dr. Gelli mentioned,it's not available to everyone
because covid is affectingdifferent areas differently.
But if you are in an area thatyou can get to your providers
(30:17):
for your routine screenings,for your checkups, for your
blood pressure check, pleasedon't be afraid to do it
because of covid. Um, becauseagain, I think we're gonna be
seeing the residual of thepandemic in the next couple of
years, that more patients aregonna be sicker with more
advanced cancers.
Speaker 2 (30:35):
Very important point. Thank you for that Dr.
Brown. And last question, Dr.
Kabel , we've mentioneddisparities today. What is the
most challenging to eliminateand why?
Speaker 4 (30:48):
I I think we, we have large inequities and
disparities in trust, and thatis the most challenging. Um,
and that relates to awareness,that relates to the ability to
listen and to understand , um,other people's plight. I think
the biggest , uh, challenge inour country is , uh, relates to
(31:09):
that, but more importantlyrelates to underlying systemic
issues that if we don't start ,um, really tackling them from a
policy and from a nationallevel, they're going to
persist. And , um, and so Ithink that that's, that's the
thing that I struggle with themost. And I think that that's
our biggest challenge. Um , butI am so encouraged and so, so
(31:31):
grateful that we've had theopportunity to talk about these
issues today , um, in thispublic forum. And , um, and I'm
hoping it'll make a differencefor somebody. Thank you.
Speaker 2 (31:42):
Well, a huge thank you to you , both colleagues
and friends, Dr. Brown, Dr.
Cabbel , we so appreciate yourtime and all that you do to
improve the lives of women inrelation to their gynecologic
health. And also a big thankyou to you who've tuned in.
Thank you all so very much. I'mValerie Mone . Be well.
Speaker 1 (32:07):
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 oow . And like,
follow or subscribe whereveryou listen to your favorite
podcasts.
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