May 18, 2023 • 31 mins
Hosted by Actress, Doula & Women's Health Advocate, Rachel Nicks, featuring Dr. Bhavana Pothuri from NYU Langone Perlmutter Cancer Center and Dr. Leslie Randall from VCU Health.
To learn more about gynecologic health, visit tinaswish.org/whattoknow.
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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 Rachel Nicks , and I am an
actress, fierce women'sadvocate, mirror trainer,
doula, and Lululemon AmbassadorTina's Wish funds cutting edge
research for the earlydetection and prevention of
ovarian cancer. Throughout thisprogram, you will learn more
(00:48):
about why this work is socritical. This is an inclusive
journey, and we are honored tohave all of you here with us.
Now, I am so pleased to welcomeand introduce our panelists,
Dr. Bana Peti , a gynecologiconcologist, NYU Langone's,
(01:09):
Pearl Mutter Cancer Center, andDr. Leslie Randall , a
gynecologic oncologist at VCUHealth. I am so excited to be
here with both of you. Let'sget started in honor of
celebrating ovarian CancerAwareness month this month. Can
you please explain to ouraudience why it has been so
(01:30):
important that we have thisconversation? Dr. Randall?
Speaker 3 (01:35):
Thanks, Rachel. I'm so glad to have this
conversation. It's important totalk about it because people
don't talk about it, right? Youdon't really hear ovarian
cancer come up in everydaylanguage. You see breast cancer
all over the place. You seepink ribbons all over , uh, but
you just don't really hear muchabout ovarian cancer, and
that's because luckily it'sfairly rare in United States,
(01:57):
but it's still common enoughand serious enough , um, that
it's great that we're talkingabout it today.
Speaker 2 (02:05):
All right , Dr. Pori , let's start with you. If you
could cover , um, some keystatistics around ovarian
cancer,
Speaker 4 (02:12):
Ovarian cancer, there are about 20,000 new
cases of ovarian cancerestimated in the United States
in the year 2022. Um, there areabout 13,000 estimated deaths
from ovarian cancer. Um, and,you know, ovarian cancer has
actually accounted for themajority of gynecologic cancer
(02:33):
deaths , um, representing over50%. Um, but we are , um,
seeing that endometrial cancermortality is now kind of
creeping up and kind of almostequaling that of ovarian
cancer. But historically,ovarian cancer has been , um,
you know, what we've termed askind of the deadliest
gynecologic cancer. Um, and themajority of women are, the
(02:58):
majority of our patients arediagnosed at a late stage. Um,
and that's stage three or four.
Um, and typically five yearsurvival rates are around 50%.
Speaker 2 (03:12):
And just so that we're all clear , um, does an
early detection screening testsexist for ovarian cancer in the
way that it exists for cancersuch as breast and cervical?
Speaker 4 (03:24):
Rachel, that's a great question. Um, so, you
know, unlike, you know, breastcancer where we have mammograms
and cervical cancer, where wehave a , a pap smear or HPV
now, which is replacing of thepap smear , um, we don't have
anything very specific, youknow, that has been proven ,
(03:45):
um, to reduce , um, yourdetection of early stage
disease. And, you know,ultimately the goal is to
reduce your risk of dying fromthe disease, like for any good
screening strategy, right? Andwe don't really have that in
ovarian cancer. And so weactually do not recommend that,
you know, the generalpopulation get screening , um,
(04:09):
with ultrasounds or even , um,a blood test called a CA 1 25 .
And you know, the reason forthat is we've, you know, you
know, studies have shown that,you know, doing these tests
actually , um, you know, may ,um, cause harm and that you may
undergo unnecessary surgeries.
Speaker 2 (04:28):
Um, where do we think the disease originates
and why is it so difficult todetect?
Speaker 4 (04:34):
Yeah, that's a great question, Rachel. So , um, you
know, we actually think that ,um, ovarian cancer originates
in the fallopian tubes. Um, andyou know, and that's one of the
reasons why we advocate forremoval of your fallopian tubes
in women who are undergoinghysterectomy , um, or needing
(04:55):
surgical sterilization. Um, andthe reason that, you know, it's
so difficult to detect is thatwe don't have effective
screening methods , uh, todetect ovarian cancer. And, you
know, although we haveultrasounds and , you know, ca
1 25 , um, you know, theprevalence of ovarian cancer is
low. And so when you look atthese screening tests, we have
(05:18):
not , um, found them to beeffective , um, in, in
diagnosing , uh, ovarian cancerat an early stage, which is
what you want , um, for ascreening test. Um, and the
other reason that it's sodifficult to detect is the
symptoms are extremely vague.
Um, and so by the time , um, apatient recognizes the
(05:42):
symptoms, they're usually , um,uh, you know, at a more
advanced stage.
Speaker 2 (05:48):
Great. Thank you so much. So, Dr. Randall, what are
the symptoms of ovarian cancerand what should we do if we are
experiencing these symptoms?
Speaker 3 (05:58):
Well, it , thanks for that question, Rachel. It's
really important to know thesymptoms, but like Dr. Pari
mentioned, unfortunately manywomen are not symptomatic until
, um, things are getting into amore advanced stage. So that
makes knowing the symptoms allthe more important because the
sooner you can report those toyour doctor , um, the better.
(06:19):
Um, so most of the, thesymptoms are abdominal , um,
and they include bloating or ,um, distension or swelling of
the abdomen. Um, one veryspecific symptom , um, is that
patients will notice they feelfull soon after they start
eating. Um, and that's notnormal. I mean, I don't know
(06:39):
about you. I love to eat, soit's very hard for me to stop
eating. And then the patientswill notice, you know, if I
take two bites and I'm full andI don't want any more to eat,
then, then that's definitely ared flag. And I think the
difficulty of these symptoms,bloating, distension, they can
be caused by other things. Um,things that are not ovarian
(07:00):
cancer related at all. And sooftentimes when you go to the
physician and you mention thesesymptoms , um, they may try
some things that have nothingto do with cancer. They may try
you on medications that are forindigestion , um, or they may
wait to do any sort of imaging,but the key to these symptoms
(07:21):
is that they're persistent. Um,they're not gonna go away. They
get worse over time instead ofbetter, they don't respond to
any of these , um, any of thesetreatments. So I have a lot of
, I've been in practice for along time, have a lot of
patients who will say, oh, Iwent to my doctor and I said I
had these symptoms, but theygave me an acid and told me to
go away. Well, it was okay togive you an, an acid , but when
(07:45):
it didn't help or didn't, thenyou have to follow up and you
have to go back. And if theyare persistent symptoms, then
you need to , um, stay on topof that. And if your doctor
won't look into your symptomsfurther, then maybe get a
second opinion.
Speaker 2 (08:00):
Yeah, I think I just personally think it's important
that we highlight that,especially as women just ask,
trusting your gut. I mean, I'mno doctor, but really trusting
in knowing your body becauseonly you know your body. Um,
so, you know, I I , I agreewith that a hundred percent.
And, and I think just not beinga doctor, the whole white coat
(08:23):
syndrome, you , we feel thatperhaps if you tell me I'm
fine, then I should believethat. But I , I , I would hope
you guys can encouragewhoever's listening that yes,
you are doctors and you went toschool for a very long time and
know a lot of things and , um,people should trust their
instinct. With that said, areall ovarian cancers the same ?
(08:44):
Um, uh, and if not, what arethe different types?
Speaker 3 (08:48):
That's another great question. You know, there , um,
actually there are a lot ofdifferent types of ovarian
cancer. And when you googleovarian cancer, typically you
get information about the mostcommon type, which is the
epithelial type. It's the typethat , um, Dr. Peti was
speaking of. Um, and that'scertainly what we spend most of
our time taking care of. Uh ,but there are some more rare
(09:11):
tumor types and , um, theyinclude , um, tumors, like
they're called germ cell tumors, um, that can actually a arise
in young women. Um, these acttypically come up in one ovary.
They're often curable. So whenyou google ovarian cancer and
read these statistics , um,they don't apply to every type.
(09:31):
So germ cell tumors are one ofthose types that is potentially
curable and not necessarily thedeadliest , um, gynecologic
cancer, there's a , anothertype called a sex cord stromal
tumor, which additionally ismuch more treatable , um, in
general than the more common ,um, ovarian cancer types . So
there definitely are differenttypes. The prognosis and
(09:54):
treatment is like highlydependent on which type that
you have.
Speaker 2 (09:58):
Amazing, thank you.
And are there ways to reduceyour risk of developing ovarian
cancer? If can , you can dothat one too , and then I'll
pass it to Dr. Pari .
Speaker 3 (10:10):
That's great. There are absolutely are risks or
ways to reduce your risk . So ,um, number one, I, for me, the
number one way to reduce yourrisk is that we know that about
a quarter of ovarian cancersare hereditary. So know your
family history and know ifyou're at risk for inherited
ovarian cancer. And if you havea family history that does have
(10:31):
breast cancer, ovarian cancer,prostate, pancreatic , um,
cancer that you're tested forthe BRCA gene . Um, if you have
a family history thatsuggestive of uterine cancer,
colon cancer, ovarian cancer,or urinary tract cancers, that
could be something called lynchsyndrome. If you don't know,
(10:52):
and like this is overwhelmingamount of information, and, but
you do know that you have afamily history of cancer,
that's all you need to know togo to your doctor to see if you
qualify for genetic testing.
Uh, if you do test positive,you may be an , uh, candidate
for risk reducing surgeries.
That's probably the mosteffective way to reduce the
risk after that. Um, patientswho have used , um, oral
(11:16):
contraceptive birth controlhave a very reduced risk of
ovarian cancer. Um, we knowthat , um, 10 years of risk can
reduce, or 10 years of use canreduce your risk by up to 90%.
And that reduction lasts alifetime. It doesn't just
happen while you're on , um,the birth control pill. It can
(11:38):
persist on, on in life.
Speaker 2 (11:42):
Amazing. Thank you.
That's good to know . So , um,let's see. Um, I'm gonna give
you this, Dr. Ari , can youexplain the value of seeing a
gynecologic oncologistspecifically after an ovarian
cancer diagnosis?
Speaker 4 (11:59):
I think it's really important , um, to seek care
from a , um, a specialist inGYN oncology. And that's
because we spend additionalyears training just to take
care of this disease. And thereare studies that have shown
that women who are treated at atertiary care center, meaning a
(12:22):
center where there arespecialists who can , um, who
know about ovarian cancer , um,actually have better outcomes,
meaning that they live longer.
So , um, it's really , uh, a nobrainer that, you know, any
woman who is diagnosed withovarian cancer, and even if
they're diagnosed with ovariancancer and they're not gonna
(12:45):
have surgery immediately, theyshould see a gynecologic
oncologist before they evenproceed with , um, neoadjuvant
chemotherapy if they're seeinga medical oncologist. You know,
and it's something that, youknow, you can talk to your
doctor about and say, Hey, youknow, can I see a GYN
oncologist to make sure that Idon't need surgery first? Um,
(13:06):
and those are actually part ofthe , um, ASCO recommendations
, um, when you're diagnosedwith ovarian cancer. So it's ,
um, as I said, it's reallycritical to seek the opinion of
a GY oncologist , um, becauseyour outcomes are better.
Speaker 2 (13:21):
Right. And , uh, Dr.
Randall, I guess, whatqualities would you look for in
a gynecologic oncologist?
Speaker 3 (13:29):
Well, I mean, everyone wants a nice per , you
know, a nice per approachablefriendly doctor about , I'll
tell you for this, especially,like you really need someone
who's skilled , um, you needsomeone with training and
experience, just like Dr. Parimentioned , um, it is , uh, a
game changer to have a doctorwho is skilled in this. It's
(13:50):
not a common disease,thankfully. And so if you don't
specialize in it, you justcan't get really good at it.
Um, IGY oncology is so greatbecause we, most of us, or many
of us, provide both surgicaland chemotherapy care to our
patients. And so sometimes, youknow, one is better than the
other, and sometimes acombination of the two are
(14:12):
important. And if you do both,I think personally and, and we
have great medical oncologiststhat take care of ovarian
cancer, but if you are able toprovide both, I feel like
you're less biased as to whicha patient should get. And
you're very, it helps youbecome very, very patient , um,
focused . But I , I think thenumber one quality is skill.
(14:35):
And, but you do want yourdoctor to be very approachable.
These are shared decisions.
There are multiple options. Youknow, one option may be right
for you or you may have abarrier to treatment that you
need to be able to share withyour physician and feel heard
and seen so that you canaddress that barrier so that
you can get the best care. So Ithink, you know, it's really
(14:56):
important to have an awell-rounded physician.
Speaker 2 (14:59):
So I would just love for either of you to, to
suggest where, number one, tofind a gynecologic oncologist,
and two, how do we decipher ifthey're skilled to support us
on this journey?
Speaker 4 (15:11):
Yeah, I think that's a great question, Rachel. And
really, you know , um, reallyimportant, right? You're,
you're given this diagnosis,it's so super scary, you don't
know where to go. Um, so myadvice, you know, is to look
for an NCI designated cancercenter, and you can just Google
that. Um, and most NCIdesignated cancer centers have,
(15:36):
you know, experts. So, and thenyou can find a gynecologic ,
um, oncologist in one of thosecenters that's close to your
home. Um, and the other thingthat these centers, you know,
offer , um, are access toclinical trials, which, you
know, are super important interms of providing , um, you
(15:56):
know , uh, you know, cuttingedge care , um, in terms of
ovarian cancer. So , um, youknow, having these at your
fingertips is really important.
Um, and so if you can really, I, you know, locate one of these
centers that's close to yourhome , um, that's what I would
recommend. Dr. Randall, do youhave other , um, thoughts as
(16:18):
well?
Speaker 3 (16:18):
Yeah, I, you know, I agree with you. I think the NCI
centers are the best place tostart , um, because of the
expertise, because of theclinical trials for sure. Um,
there are centers outside ofthe NCI designated centers that
do provide , um, ovarian cancercare. I think having, again,
it's just going right back tothat question that you asked
(16:39):
before, Rachel, thatgynecologic oncologist, having
that person as you know, thequarterback on your team , um,
is really important. And sosometimes you can find , um, a
GYN oncologist outside of NCI ,um, designated centers. I think
that's like the very best placeto start. Um, patients are
(16:59):
getting more and more savvy,like they're able to look for
these, you know, where can Iget a , where can I go on a
clinical trial? Where are theseNCI centers? I think patients
are becoming much more savvy atfinding these patients are, you
know, organizing. There are ,um, different ovarian cancer
websites . Um, Tina's Wish isone of those , um, the Society
(17:24):
for Gynecologic Oncology or theSGO has a website that lists
providers and patient you cansearch by your area. Um, so it
can be a little bitoverwhelming too, that
internet, right? Because youget some bad information with
the good. Um, but , um, I thinkthat NCI centers, GYN
(17:45):
oncologist , um, clinicaltrials, focusing on those
capabilities is the best way topick the site for you.
Speaker 2 (17:53):
And , um, a thought that came to me too , um, I'm
sure there are stigmas relatedto clinical trials, if I'm
honest, as , um, AfricanAmerican person knowing that
black people's bodies weretested on in this country.
There's an aversion to that. Soif you could just cover , um,
you know, your point of view,and I know Dr. Peturi , you are
(18:14):
a medical director in theclinical trials office at NYU,
Pearl Mater Cancer Center, andthe director of diversity and
Health equity for clinicaltrials, which is important for
people to know as a person ofcolor , um, and at the
Gynecological GynecologicOncology Group Foundation. So ,
um, if you guys can just kindof speak to maybe possibly the
(18:35):
stigma around clinical trialsso that people hearing this can
feel safe to enter them, or ifthere's , um, you know , or
some are better than others or,or how they would feel
comfortable , um,
Speaker 4 (18:48):
Joining. Yeah, Rachel, that's like, so like,
near and dear to my heart, soMe too. That whole question.
Yeah. And , um, I mean, I , Ijust wanna start by, you know,
just, you know, breaking itdown, why, like, why
participate in a clinicaltrial? Right ? Um, well, you
know, two things. One, it givespatients access to novel
(19:10):
therapies that have not, youknow, that they couldn't
otherwise get. And it gives pe, it gives patients hope. Um,
so, you know, having theability to participate in a
trial, it , it , it becomes ,um, it almost is an honor
because you, not only are yougetting something out of it by
having access to these noveltherapies, but you're
(19:33):
contributing to the knowledgewhere, you know, thousands and,
you know, hundreds of thousandsof other women may benefit from
these findings. Um, so, youknow, and, and, you know, and I
just , um, and I know there's alot of stigma associated with
it, you know, given Tuskegeeand, you know, what has
happened in the past, but Ijust wanna highlight that, you
(19:55):
know, I, we've come a long way, um, since those times and,
you know, clinical trials , um,are, you know, so , um,
scrutinized where patientsafety is of utmost importance.
Um, and, you know, everythingwe do , um, for patients on a
(20:16):
clinical trial is always, youknow, making sure the patient
is safe. So , um, I think, youknow, we need to continue, we
need to educate our patientsabout this mm-hmm
. Um, and, and I just wannashare just like a small, you
know, kind of , um, you know,experience , um, given that ,
um, I am at NYU , um, and weactually partner with Bellevue
(20:40):
Hospital, which is the oldest ,um, um, public hospital in the
country. Um, and what we didwas we partnered with a
dedicated navigator there, andwhat we were able to do, and
that navigator screened for us.
Um, so they would screen thecharts from the computer, never
having seen the patient, andthey would identify patients
(21:01):
and they would send them to theclinical team, and then we
would approach patients withclinical trials. And by doing
that, what we did was weincreased our screening by two
and a half fold , and weincreased our clinical trial
accrual by threefold. Um, andthat was just over a six month
period. And then what we foundthat was most interesting was
that all the patients that weaccrued to clinical trial were
(21:25):
of diverse races andethnicities. And so by
instituting this, you know ,um, screener, we took away any
physician bias. So, you know,just like the patients have
their own bias and stigma,physicians have their own bias
and stigmas, you know, thinkingthat, oh, this patient, you
know, will not be able to comein for all the trial visits, or
(21:47):
they're, they're not gonnawanna participate in a clinical
trial, and the physiciandoesn't even offer the patient
the clinical trial. Right? And,and studies have actually shown
that when we offer patientsclinical trials, and we, you
know, we give them theexplanation of why it's
important and how we are gonnachange the way we treat ovarian
(22:08):
cancer , um, by, byparticipating in these clinical
trials and how we bring newmedicines , um, to our
patients, you know, and, and ,and the benefit to the patient
themself of, of being able to ,um, have access to these
cutting edge therapies, we findthat most patients actually
wanna participate. Um, so, youknow, so it's kind of on both
(22:30):
ends that we see these , um,stigmas and biases. Um, so, you
know, I just wanted to sharethat because we've actually
shown that this , um, you know,these kind of interventions are
important. And then you bringup a really important, you
know, point that it's alsoimportant to have people on
your teams that look like you,you know, have people of color,
(22:53):
you know, to explain thesethings. Um, have, you know,
there needs to be some sharedexperience that , um, you know,
people can connect to, toreally , um, understand that
these trials are, are safe andthey are in the best interest
of the patient. Um, so theseare all kind of, you know , um,
initiatives that, you know , Iam trying to spearhead both ,
(23:16):
um, at NYU, but also nationally, um, with the new hat that ,
uh, I'm wearing , um, in termsof the , um, you know, director
for , um, diversity and healthequity for clinical trials. Um,
and I know that Dr. Randall isalso , um, super passionate
about this. And , um, she'salso at a center , um, where ,
(23:38):
um, this is , uh, prioritized.
So I would love to kind of alsohear her perspective.
Speaker 3 (23:43):
Yeah, thanks Bob .
And I couldn't agree more witheverything that you said. And,
you know, I actually , um, cameto , um, Virginia Commonwealth
University or VCU in Richmond,Virginia , um, as a person
trained to do clinical trialsas an investigator who noticed
the terrible disparity that wehave in our clinical trial
(24:06):
enrollment and how it wasgetting worse. And, and you
mentioned African American,Rachel, for our black patients
, um, it used to be that wewould enroll about 10 to 15% of
patients on any given clinicaltrial for cancer would be black
. And if , and that rate hasgone down to about 5%. And the
(24:27):
reason that that's bad isbecause , um, we're developing
all these new, you know,amazing treatments and these
patients are being left behind,they're being left out, and
they're missing out. They'remissing out on a lot of things.
They're missing out on gettingtomorrow's treatment today,
just like Dr. Pati mentioned,but they're also not being
(24:48):
counted. So when this, say thisdrug that was only tested in
one type of person, babasically affluent white
patients, not rural whitepatients, not black, not
necessarily Asian, when, anddifferent, you know, different
types of Asian ethnicities,that drug gets approved. It may
(25:08):
not work for everyone. It mayhave different side effects for
different groups. And so we'renot gonna pick that up in our
clinical trials if we onlyenroll one type of patient. And
so then that drug gets put out,and then that becomes the
standard of care. And then,then we start doing a clinical
clinical trial, meaning I startjust using it in my office, but
it's not really well tested inthat, in that specific group.
(25:31):
You don't , sometimes we don'treally know what to expect. And
so, really, to be honest, like,I hate the term clinical trial
'cause it sounds so scary, itsounds so experimental. Like,
it , it , it really sounds likeyou're gonna hook some up to
electrodes or, I just hate the, the term because it's, it's
intimidating. But every time wegive a patient a cancer
treatment, truly it's aclinical trial. We don't know
(25:53):
if it's gonna help 'em , wedon't know what kind of side
effects they're going to haveand whether, you know, all only
difference is how much priorinformation that we have, but
we may not, even when we'retalking about diverse
populations, we may not evenhave that information available
for those patient groups. Sothat's where it becomes really
important. So to me, it's aninjustice not to be on a trial.
Speaker 2 (26:18):
And I think the last thought I had in, in this , uh,
on this topic would be, youknow, what if you aren't in New
York City or you're not in SanFrancisco, or you know, some
big coastal city that has allof these resources , um, you
know, what do those people do?
And more specifically, if youfind out about a trial that's
(26:39):
not located near you, is therefunding to, to have them come
be a part of that trial?
Wherever that trial exists,
Speaker 3 (26:48):
Thanks to Dr. Pet , there's funding
Speaker 2 (26:51):
, because I'm
sure you, you're a lot of
people, to your point ofanywhere from rural, white to
black, to just, you know, I'min Green Bay or wherever, maybe
Green Bay has an amazing cancercenter, I don't know about. But
, um, you know, as, as citydwellers we get , we're we ,
uh, lose sight of, of ourprivilege to have access across
(27:14):
the board. Um, so I would justlike to inject hope and
opportunity for those peoplethat don't, can't attend NYU
down the street from them , youknow?
Speaker 4 (27:24):
Yeah, no, that's a really important and great
point, Rachel. And you know, Ithink one of the easiest ways
to know , um, what trials areopen or available, you know,
clinical trials.gov and, youknow, patients can search that
as well as physicians. Sothat's a really, you know , um,
simple way. And then once you,you can put in your disease
(27:46):
site and , um, and then optionsfor different trials will pop
up and you can put in yourlocation. So , um, 'cause all
the trials that are open arelisted on that, and so you will
be able to identify a trialthat , um, and then once you've
identified that you reach outto the, you reach out to that
institution and say, Hey, I'minterested. Um, 'cause there
(28:07):
usually will be a contactnumber and, and then they will
, um, help guide you.
Speaker 2 (28:12):
Well , um, before we close, is there anything else
that has come up that either ofyou wanna share , um, with our
audience , um, or closingthoughts? Dr. Randall,
Speaker 3 (28:25):
I just wanna thank you, Rachel, for bringing this
up to light and having thisconversation. You know, here,
we thank , uh, Tina's WishFoundation for carrying on this
conversation. You know, if thisdoesn't reach the people that,
that need to hear the message,then what we do is not quite as
effective or as important,right ? So thank you so much.
Speaker 2 (28:47):
Thank you. And Dr.
Ur ,
Speaker 4 (28:50):
I would like to echo everything. Um, Dr. Vandal
said, yeah, thank you forallowing us to, you know, voice
what we do and, and educateand, and really empower all our
patients. Um, and I just wannasay that, you know, it's a
really exciting time to be inGYN oncology. Um, you know,
(29:13):
there in , you know, just in ,um, ovarian cancer, there have
been, you know, 14 new drugapprovals , um, you know, over
the past decade. And, you know,that's more than in the past 60
years. So there is definite,you know, hope we are making
progress. Um, we know , um,patients are living longer with
(29:35):
ovarian cancer. Um, you know,because we do see the
prevalence going up and that'sreally because, you know,
patients are living longer. Um,so , um, you know,
Speaker 3 (29:46):
But the incidence is going down and I think that
we're starting to see someeffects of our prevention. Yes.
Um , with our removal of thefallopian tubes, like you
talked about, removing theovaries and our, our , our ,
uh, genetic risk patients.
Like, I think we're starting tosee an impact there. So that's
really exciting.
Speaker 4 (30:07):
And I want everyone to, you know, advocate for
themselves. You know, listen toyour bodies, as you said. Um, I
always say, you know, you haveto be your strongest advocate.
Speaker 2 (30:17):
After hearing from Doctors p and Randall, I am
even more convinced why TinaBrosnan's wish for an early
detection for ovarian cancer isalso my wish. Every woman
deserves to have a fightingchance against this disease. A
huge thank you to Dr. P and Dr.
Randall. We truly appreciateyour time and all that you do
(30:40):
to improve the lives of women.
A big thank you to all of youfor tuning in and for your
incredible support of Tina'sWish and our initiatives. Be
well, take care and please beyour own best health advocate.
Speaker 1 (31:03):
For more information about gynecologic health, visit
tina's wish.org/what to know .
That's tina's wish.org/wt,KNOW. And like, follow or
subscribe wherever you listento 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 Rachel Nicks , and I am an
actress, fierce women'sadvocate, mirror trainer,
doula, and Lululemon AmbassadorTina's Wish funds cutting edge
research for the earlydetection and prevention of
ovarian cancer. Throughout thisprogram, you will learn more
(00:48):
about why this work is socritical. This is an inclusive
journey, and we are honored tohave all of you here with us.
Now, I am so pleased to welcomeand introduce our panelists,
Dr. Bana Peti , a gynecologiconcologist, NYU Langone's,
(01:09):
Pearl Mutter Cancer Center, andDr. Leslie Randall , a
gynecologic oncologist at VCUHealth. I am so excited to be
here with both of you. Let'sget started in honor of
celebrating ovarian CancerAwareness month this month. Can
you please explain to ouraudience why it has been so
(01:30):
important that we have thisconversation? Dr. Randall?
Speaker 3 (01:35):
Thanks, Rachel. I'm so glad to have this
conversation. It's important totalk about it because people
don't talk about it, right? Youdon't really hear ovarian
cancer come up in everydaylanguage. You see breast cancer
all over the place. You seepink ribbons all over , uh, but
you just don't really hear muchabout ovarian cancer, and
that's because luckily it'sfairly rare in United States,
(01:57):
but it's still common enoughand serious enough , um, that
it's great that we're talkingabout it today.
Speaker 2 (02:05):
All right , Dr. Pori , let's start with you. If you
could cover , um, some keystatistics around ovarian
cancer,
Speaker 4 (02:12):
Ovarian cancer, there are about 20,000 new
cases of ovarian cancerestimated in the United States
in the year 2022. Um, there areabout 13,000 estimated deaths
from ovarian cancer. Um, and,you know, ovarian cancer has
actually accounted for themajority of gynecologic cancer
(02:33):
deaths , um, representing over50%. Um, but we are , um,
seeing that endometrial cancermortality is now kind of
creeping up and kind of almostequaling that of ovarian
cancer. But historically,ovarian cancer has been , um,
you know, what we've termed askind of the deadliest
gynecologic cancer. Um, and themajority of women are, the
(02:58):
majority of our patients arediagnosed at a late stage. Um,
and that's stage three or four.
Um, and typically five yearsurvival rates are around 50%.
Speaker 2 (03:12):
And just so that we're all clear , um, does an
early detection screening testsexist for ovarian cancer in the
way that it exists for cancersuch as breast and cervical?
Speaker 4 (03:24):
Rachel, that's a great question. Um, so, you
know, unlike, you know, breastcancer where we have mammograms
and cervical cancer, where wehave a , a pap smear or HPV
now, which is replacing of thepap smear , um, we don't have
anything very specific, youknow, that has been proven ,
(03:45):
um, to reduce , um, yourdetection of early stage
disease. And, you know,ultimately the goal is to
reduce your risk of dying fromthe disease, like for any good
screening strategy, right? Andwe don't really have that in
ovarian cancer. And so weactually do not recommend that,
you know, the generalpopulation get screening , um,
(04:09):
with ultrasounds or even , um,a blood test called a CA 1 25 .
And you know, the reason forthat is we've, you know, you
know, studies have shown that,you know, doing these tests
actually , um, you know, may ,um, cause harm and that you may
undergo unnecessary surgeries.
Speaker 2 (04:28):
Um, where do we think the disease originates
and why is it so difficult todetect?
Speaker 4 (04:34):
Yeah, that's a great question, Rachel. So , um, you
know, we actually think that ,um, ovarian cancer originates
in the fallopian tubes. Um, andyou know, and that's one of the
reasons why we advocate forremoval of your fallopian tubes
in women who are undergoinghysterectomy , um, or needing
(04:55):
surgical sterilization. Um, andthe reason that, you know, it's
so difficult to detect is thatwe don't have effective
screening methods , uh, todetect ovarian cancer. And, you
know, although we haveultrasounds and , you know, ca
1 25 , um, you know, theprevalence of ovarian cancer is
low. And so when you look atthese screening tests, we have
(05:18):
not , um, found them to beeffective , um, in, in
diagnosing , uh, ovarian cancerat an early stage, which is
what you want , um, for ascreening test. Um, and the
other reason that it's sodifficult to detect is the
symptoms are extremely vague.
Um, and so by the time , um, apatient recognizes the
(05:42):
symptoms, they're usually , um,uh, you know, at a more
advanced stage.
Speaker 2 (05:48):
Great. Thank you so much. So, Dr. Randall, what are
the symptoms of ovarian cancerand what should we do if we are
experiencing these symptoms?
Speaker 3 (05:58):
Well, it , thanks for that question, Rachel. It's
really important to know thesymptoms, but like Dr. Pari
mentioned, unfortunately manywomen are not symptomatic until
, um, things are getting into amore advanced stage. So that
makes knowing the symptoms allthe more important because the
sooner you can report those toyour doctor , um, the better.
(06:19):
Um, so most of the, thesymptoms are abdominal , um,
and they include bloating or ,um, distension or swelling of
the abdomen. Um, one veryspecific symptom , um, is that
patients will notice they feelfull soon after they start
eating. Um, and that's notnormal. I mean, I don't know
(06:39):
about you. I love to eat, soit's very hard for me to stop
eating. And then the patientswill notice, you know, if I
take two bites and I'm full andI don't want any more to eat,
then, then that's definitely ared flag. And I think the
difficulty of these symptoms,bloating, distension, they can
be caused by other things. Um,things that are not ovarian
(07:00):
cancer related at all. And sooftentimes when you go to the
physician and you mention thesesymptoms , um, they may try
some things that have nothingto do with cancer. They may try
you on medications that are forindigestion , um, or they may
wait to do any sort of imaging,but the key to these symptoms
(07:21):
is that they're persistent. Um,they're not gonna go away. They
get worse over time instead ofbetter, they don't respond to
any of these , um, any of thesetreatments. So I have a lot of
, I've been in practice for along time, have a lot of
patients who will say, oh, Iwent to my doctor and I said I
had these symptoms, but theygave me an acid and told me to
go away. Well, it was okay togive you an, an acid , but when
(07:45):
it didn't help or didn't, thenyou have to follow up and you
have to go back. And if theyare persistent symptoms, then
you need to , um, stay on topof that. And if your doctor
won't look into your symptomsfurther, then maybe get a
second opinion.
Speaker 2 (08:00):
Yeah, I think I just personally think it's important
that we highlight that,especially as women just ask,
trusting your gut. I mean, I'mno doctor, but really trusting
in knowing your body becauseonly you know your body. Um,
so, you know, I I , I agreewith that a hundred percent.
And, and I think just not beinga doctor, the whole white coat
(08:23):
syndrome, you , we feel thatperhaps if you tell me I'm
fine, then I should believethat. But I , I , I would hope
you guys can encouragewhoever's listening that yes,
you are doctors and you went toschool for a very long time and
know a lot of things and , um,people should trust their
instinct. With that said, areall ovarian cancers the same ?
(08:44):
Um, uh, and if not, what arethe different types?
Speaker 3 (08:48):
That's another great question. You know, there , um,
actually there are a lot ofdifferent types of ovarian
cancer. And when you googleovarian cancer, typically you
get information about the mostcommon type, which is the
epithelial type. It's the typethat , um, Dr. Peti was
speaking of. Um, and that'scertainly what we spend most of
our time taking care of. Uh ,but there are some more rare
(09:11):
tumor types and , um, theyinclude , um, tumors, like
they're called germ cell tumors, um, that can actually a arise
in young women. Um, these acttypically come up in one ovary.
They're often curable. So whenyou google ovarian cancer and
read these statistics , um,they don't apply to every type.
(09:31):
So germ cell tumors are one ofthose types that is potentially
curable and not necessarily thedeadliest , um, gynecologic
cancer, there's a , anothertype called a sex cord stromal
tumor, which additionally ismuch more treatable , um, in
general than the more common ,um, ovarian cancer types . So
there definitely are differenttypes. The prognosis and
(09:54):
treatment is like highlydependent on which type that
you have.
Speaker 2 (09:58):
Amazing, thank you.
And are there ways to reduceyour risk of developing ovarian
cancer? If can , you can dothat one too , and then I'll
pass it to Dr. Pari .
Speaker 3 (10:10):
That's great. There are absolutely are risks or
ways to reduce your risk . So ,um, number one, I, for me, the
number one way to reduce yourrisk is that we know that about
a quarter of ovarian cancersare hereditary. So know your
family history and know ifyou're at risk for inherited
ovarian cancer. And if you havea family history that does have
(10:31):
breast cancer, ovarian cancer,prostate, pancreatic , um,
cancer that you're tested forthe BRCA gene . Um, if you have
a family history thatsuggestive of uterine cancer,
colon cancer, ovarian cancer,or urinary tract cancers, that
could be something called lynchsyndrome. If you don't know,
(10:52):
and like this is overwhelmingamount of information, and, but
you do know that you have afamily history of cancer,
that's all you need to know togo to your doctor to see if you
qualify for genetic testing.
Uh, if you do test positive,you may be an , uh, candidate
for risk reducing surgeries.
That's probably the mosteffective way to reduce the
risk after that. Um, patientswho have used , um, oral
(11:16):
contraceptive birth controlhave a very reduced risk of
ovarian cancer. Um, we knowthat , um, 10 years of risk can
reduce, or 10 years of use canreduce your risk by up to 90%.
And that reduction lasts alifetime. It doesn't just
happen while you're on , um,the birth control pill. It can
(11:38):
persist on, on in life.
Speaker 2 (11:42):
Amazing. Thank you.
That's good to know . So , um,let's see. Um, I'm gonna give
you this, Dr. Ari , can youexplain the value of seeing a
gynecologic oncologistspecifically after an ovarian
cancer diagnosis?
Speaker 4 (11:59):
I think it's really important , um, to seek care
from a , um, a specialist inGYN oncology. And that's
because we spend additionalyears training just to take
care of this disease. And thereare studies that have shown
that women who are treated at atertiary care center, meaning a
(12:22):
center where there arespecialists who can , um, who
know about ovarian cancer , um,actually have better outcomes,
meaning that they live longer.
So , um, it's really , uh, a nobrainer that, you know, any
woman who is diagnosed withovarian cancer, and even if
they're diagnosed with ovariancancer and they're not gonna
(12:45):
have surgery immediately, theyshould see a gynecologic
oncologist before they evenproceed with , um, neoadjuvant
chemotherapy if they're seeinga medical oncologist. You know,
and it's something that, youknow, you can talk to your
doctor about and say, Hey, youknow, can I see a GYN
oncologist to make sure that Idon't need surgery first? Um,
(13:06):
and those are actually part ofthe , um, ASCO recommendations
, um, when you're diagnosedwith ovarian cancer. So it's ,
um, as I said, it's reallycritical to seek the opinion of
a GY oncologist , um, becauseyour outcomes are better.
Speaker 2 (13:21):
Right. And , uh, Dr.
Randall, I guess, whatqualities would you look for in
a gynecologic oncologist?
Speaker 3 (13:29):
Well, I mean, everyone wants a nice per , you
know, a nice per approachablefriendly doctor about , I'll
tell you for this, especially,like you really need someone
who's skilled , um, you needsomeone with training and
experience, just like Dr. Parimentioned , um, it is , uh, a
game changer to have a doctorwho is skilled in this. It's
(13:50):
not a common disease,thankfully. And so if you don't
specialize in it, you justcan't get really good at it.
Um, IGY oncology is so greatbecause we, most of us, or many
of us, provide both surgicaland chemotherapy care to our
patients. And so sometimes, youknow, one is better than the
other, and sometimes acombination of the two are
(14:12):
important. And if you do both,I think personally and, and we
have great medical oncologiststhat take care of ovarian
cancer, but if you are able toprovide both, I feel like
you're less biased as to whicha patient should get. And
you're very, it helps youbecome very, very patient , um,
focused . But I , I think thenumber one quality is skill.
(14:35):
And, but you do want yourdoctor to be very approachable.
These are shared decisions.
There are multiple options. Youknow, one option may be right
for you or you may have abarrier to treatment that you
need to be able to share withyour physician and feel heard
and seen so that you canaddress that barrier so that
you can get the best care. So Ithink, you know, it's really
(14:56):
important to have an awell-rounded physician.
Speaker 2 (14:59):
So I would just love for either of you to, to
suggest where, number one, tofind a gynecologic oncologist,
and two, how do we decipher ifthey're skilled to support us
on this journey?
Speaker 4 (15:11):
Yeah, I think that's a great question, Rachel. And
really, you know , um, reallyimportant, right? You're,
you're given this diagnosis,it's so super scary, you don't
know where to go. Um, so myadvice, you know, is to look
for an NCI designated cancercenter, and you can just Google
that. Um, and most NCIdesignated cancer centers have,
(15:36):
you know, experts. So, and thenyou can find a gynecologic ,
um, oncologist in one of thosecenters that's close to your
home. Um, and the other thingthat these centers, you know,
offer , um, are access toclinical trials, which, you
know, are super important interms of providing , um, you
(15:56):
know , uh, you know, cuttingedge care , um, in terms of
ovarian cancer. So , um, youknow, having these at your
fingertips is really important.
Um, and so if you can really, I, you know, locate one of these
centers that's close to yourhome , um, that's what I would
recommend. Dr. Randall, do youhave other , um, thoughts as
(16:18):
well?
Speaker 3 (16:18):
Yeah, I, you know, I agree with you. I think the NCI
centers are the best place tostart , um, because of the
expertise, because of theclinical trials for sure. Um,
there are centers outside ofthe NCI designated centers that
do provide , um, ovarian cancercare. I think having, again,
it's just going right back tothat question that you asked
(16:39):
before, Rachel, thatgynecologic oncologist, having
that person as you know, thequarterback on your team , um,
is really important. And sosometimes you can find , um, a
GYN oncologist outside of NCI ,um, designated centers. I think
that's like the very best placeto start. Um, patients are
(16:59):
getting more and more savvy,like they're able to look for
these, you know, where can Iget a , where can I go on a
clinical trial? Where are theseNCI centers? I think patients
are becoming much more savvy atfinding these patients are, you
know, organizing. There are ,um, different ovarian cancer
websites . Um, Tina's Wish isone of those , um, the Society
(17:24):
for Gynecologic Oncology or theSGO has a website that lists
providers and patient you cansearch by your area. Um, so it
can be a little bitoverwhelming too, that
internet, right? Because youget some bad information with
the good. Um, but , um, I thinkthat NCI centers, GYN
(17:45):
oncologist , um, clinicaltrials, focusing on those
capabilities is the best way topick the site for you.
Speaker 2 (17:53):
And , um, a thought that came to me too , um, I'm
sure there are stigmas relatedto clinical trials, if I'm
honest, as , um, AfricanAmerican person knowing that
black people's bodies weretested on in this country.
There's an aversion to that. Soif you could just cover , um,
you know, your point of view,and I know Dr. Peturi , you are
(18:14):
a medical director in theclinical trials office at NYU,
Pearl Mater Cancer Center, andthe director of diversity and
Health equity for clinicaltrials, which is important for
people to know as a person ofcolor , um, and at the
Gynecological GynecologicOncology Group Foundation. So ,
um, if you guys can just kindof speak to maybe possibly the
(18:35):
stigma around clinical trialsso that people hearing this can
feel safe to enter them, or ifthere's , um, you know , or
some are better than others or,or how they would feel
comfortable , um,
Speaker 4 (18:48):
Joining. Yeah, Rachel, that's like, so like,
near and dear to my heart, soMe too. That whole question.
Yeah. And , um, I mean, I , Ijust wanna start by, you know,
just, you know, breaking itdown, why, like, why
participate in a clinicaltrial? Right ? Um, well, you
know, two things. One, it givespatients access to novel
(19:10):
therapies that have not, youknow, that they couldn't
otherwise get. And it gives pe, it gives patients hope. Um,
so, you know, having theability to participate in a
trial, it , it , it becomes ,um, it almost is an honor
because you, not only are yougetting something out of it by
having access to these noveltherapies, but you're
(19:33):
contributing to the knowledgewhere, you know, thousands and,
you know, hundreds of thousandsof other women may benefit from
these findings. Um, so, youknow, and, and, you know, and I
just , um, and I know there's alot of stigma associated with
it, you know, given Tuskegeeand, you know, what has
happened in the past, but Ijust wanna highlight that, you
(19:55):
know, I, we've come a long way, um, since those times and,
you know, clinical trials , um,are, you know, so , um,
scrutinized where patientsafety is of utmost importance.
Um, and, you know, everythingwe do , um, for patients on a
(20:16):
clinical trial is always, youknow, making sure the patient
is safe. So , um, I think, youknow, we need to continue, we
need to educate our patientsabout this mm-hmm
. Um, and, and I just wannashare just like a small, you
know, kind of , um, you know,experience , um, given that ,
um, I am at NYU , um, and weactually partner with Bellevue
(20:40):
Hospital, which is the oldest ,um, um, public hospital in the
country. Um, and what we didwas we partnered with a
dedicated navigator there, andwhat we were able to do, and
that navigator screened for us.
Um, so they would screen thecharts from the computer, never
having seen the patient, andthey would identify patients
(21:01):
and they would send them to theclinical team, and then we
would approach patients withclinical trials. And by doing
that, what we did was weincreased our screening by two
and a half fold , and weincreased our clinical trial
accrual by threefold. Um, andthat was just over a six month
period. And then what we foundthat was most interesting was
that all the patients that weaccrued to clinical trial were
(21:25):
of diverse races andethnicities. And so by
instituting this, you know ,um, screener, we took away any
physician bias. So, you know,just like the patients have
their own bias and stigma,physicians have their own bias
and stigmas, you know, thinkingthat, oh, this patient, you
know, will not be able to comein for all the trial visits, or
(21:47):
they're, they're not gonnawanna participate in a clinical
trial, and the physiciandoesn't even offer the patient
the clinical trial. Right? And,and studies have actually shown
that when we offer patientsclinical trials, and we, you
know, we give them theexplanation of why it's
important and how we are gonnachange the way we treat ovarian
(22:08):
cancer , um, by, byparticipating in these clinical
trials and how we bring newmedicines , um, to our
patients, you know, and, and ,and the benefit to the patient
themself of, of being able to ,um, have access to these
cutting edge therapies, we findthat most patients actually
wanna participate. Um, so, youknow, so it's kind of on both
(22:30):
ends that we see these , um,stigmas and biases. Um, so, you
know, I just wanted to sharethat because we've actually
shown that this , um, you know,these kind of interventions are
important. And then you bringup a really important, you
know, point that it's alsoimportant to have people on
your teams that look like you,you know, have people of color,
(22:53):
you know, to explain thesethings. Um, have, you know,
there needs to be some sharedexperience that , um, you know,
people can connect to, toreally , um, understand that
these trials are, are safe andthey are in the best interest
of the patient. Um, so theseare all kind of, you know , um,
initiatives that, you know , Iam trying to spearhead both ,
(23:16):
um, at NYU, but also nationally, um, with the new hat that ,
uh, I'm wearing , um, in termsof the , um, you know, director
for , um, diversity and healthequity for clinical trials. Um,
and I know that Dr. Randall isalso , um, super passionate
about this. And , um, she'salso at a center , um, where ,
(23:38):
um, this is , uh, prioritized.
So I would love to kind of alsohear her perspective.
Speaker 3 (23:43):
Yeah, thanks Bob .
And I couldn't agree more witheverything that you said. And,
you know, I actually , um, cameto , um, Virginia Commonwealth
University or VCU in Richmond,Virginia , um, as a person
trained to do clinical trialsas an investigator who noticed
the terrible disparity that wehave in our clinical trial
(24:06):
enrollment and how it wasgetting worse. And, and you
mentioned African American,Rachel, for our black patients
, um, it used to be that wewould enroll about 10 to 15% of
patients on any given clinicaltrial for cancer would be black
. And if , and that rate hasgone down to about 5%. And the
(24:27):
reason that that's bad isbecause , um, we're developing
all these new, you know,amazing treatments and these
patients are being left behind,they're being left out, and
they're missing out. They'remissing out on a lot of things.
They're missing out on gettingtomorrow's treatment today,
just like Dr. Pati mentioned,but they're also not being
(24:48):
counted. So when this, say thisdrug that was only tested in
one type of person, babasically affluent white
patients, not rural whitepatients, not black, not
necessarily Asian, when, anddifferent, you know, different
types of Asian ethnicities,that drug gets approved. It may
(25:08):
not work for everyone. It mayhave different side effects for
different groups. And so we'renot gonna pick that up in our
clinical trials if we onlyenroll one type of patient. And
so then that drug gets put out,and then that becomes the
standard of care. And then,then we start doing a clinical
clinical trial, meaning I startjust using it in my office, but
it's not really well tested inthat, in that specific group.
(25:31):
You don't , sometimes we don'treally know what to expect. And
so, really, to be honest, like,I hate the term clinical trial
'cause it sounds so scary, itsounds so experimental. Like,
it , it , it really sounds likeyou're gonna hook some up to
electrodes or, I just hate the, the term because it's, it's
intimidating. But every time wegive a patient a cancer
treatment, truly it's aclinical trial. We don't know
(25:53):
if it's gonna help 'em , wedon't know what kind of side
effects they're going to haveand whether, you know, all only
difference is how much priorinformation that we have, but
we may not, even when we'retalking about diverse
populations, we may not evenhave that information available
for those patient groups. Sothat's where it becomes really
important. So to me, it's aninjustice not to be on a trial.
Speaker 2 (26:18):
And I think the last thought I had in, in this , uh,
on this topic would be, youknow, what if you aren't in New
York City or you're not in SanFrancisco, or you know, some
big coastal city that has allof these resources , um, you
know, what do those people do?
And more specifically, if youfind out about a trial that's
(26:39):
not located near you, is therefunding to, to have them come
be a part of that trial?
Wherever that trial exists,
Speaker 3 (26:48):
Thanks to Dr. Pet , there's funding
Speaker 2 (26:51):
people, to your point ofanywhere from rural, white to
black, to just, you know, I'min Green Bay or wherever, maybe
Green Bay has an amazing cancercenter, I don't know about. But
, um, you know, as, as citydwellers we get , we're we ,
uh, lose sight of, of ourprivilege to have access across
(27:14):
the board. Um, so I would justlike to inject hope and
opportunity for those peoplethat don't, can't attend NYU
down the street from them , youknow?
Speaker 4 (27:24):
Yeah, no, that's a really important and great
point, Rachel. And you know, Ithink one of the easiest ways
to know , um, what trials areopen or available, you know,
clinical trials.gov and, youknow, patients can search that
as well as physicians. Sothat's a really, you know , um,
simple way. And then once you,you can put in your disease
(27:46):
site and , um, and then optionsfor different trials will pop
up and you can put in yourlocation. So , um, 'cause all
the trials that are open arelisted on that, and so you will
be able to identify a trialthat , um, and then once you've
identified that you reach outto the, you reach out to that
institution and say, Hey, I'minterested. Um, 'cause there
(28:07):
usually will be a contactnumber and, and then they will
, um, help guide you.
Speaker 2 (28:12):
Well , um, before we close, is there anything else
that has come up that either ofyou wanna share , um, with our
audience , um, or closingthoughts? Dr. Randall,
Speaker 3 (28:25):
I just wanna thank you, Rachel, for bringing this
up to light and having thisconversation. You know, here,
we thank , uh, Tina's WishFoundation for carrying on this
conversation. You know, if thisdoesn't reach the people that,
that need to hear the message,then what we do is not quite as
effective or as important,right ? So thank you so much.
Speaker 2 (28:47):
Thank you. And Dr.
Ur ,
Speaker 4 (28:50):
I would like to echo everything. Um, Dr. Vandal
said, yeah, thank you forallowing us to, you know, voice
what we do and, and educateand, and really empower all our
patients. Um, and I just wannasay that, you know, it's a
really exciting time to be inGYN oncology. Um, you know,
(29:13):
there in , you know, just in ,um, ovarian cancer, there have
been, you know, 14 new drugapprovals , um, you know, over
the past decade. And, you know,that's more than in the past 60
years. So there is definite,you know, hope we are making
progress. Um, we know , um,patients are living longer with
(29:35):
ovarian cancer. Um, you know,because we do see the
prevalence going up and that'sreally because, you know,
patients are living longer. Um,so , um, you know,
Speaker 3 (29:46):
But the incidence is going down and I think that
we're starting to see someeffects of our prevention. Yes.
Um , with our removal of thefallopian tubes, like you
talked about, removing theovaries and our, our , our ,
uh, genetic risk patients.
Like, I think we're starting tosee an impact there. So that's
really exciting.
Speaker 4 (30:07):
And I want everyone to, you know, advocate for
themselves. You know, listen toyour bodies, as you said. Um, I
always say, you know, you haveto be your strongest advocate.
Speaker 2 (30:17):
After hearing from Doctors p and Randall, I am
even more convinced why TinaBrosnan's wish for an early
detection for ovarian cancer isalso my wish. Every woman
deserves to have a fightingchance against this disease. A
huge thank you to Dr. P and Dr.
Randall. We truly appreciateyour time and all that you do
(30:40):
to improve the lives of women.
A big thank you to all of youfor tuning in and for your
incredible support of Tina'sWish and our initiatives. Be
well, take care and please beyour own best health advocate.
Speaker 1 (31:03):
For more information about gynecologic health, visit
tina's wish.org/what to know .
That's tina's wish.org/wt,KNOW. And like, follow or
subscribe wherever you listento your favorite podcasts.
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