March 13, 2023 • 30 mins
The Role Genetics Plays in Gynecologic Cancers
Featuring:
Susan Domchek, MD; Medical Oncologist, Executive Director of the Basser Center for BRCA, Penn Medicine
Amanda Ganzak, MS, CGS; Lead Genetic Counselor at Yale School of Medicine
Moderated by Leslie Zmugg, General Counsel at Gordon Brothers and a member of the Tina's Wish Boston Gathering Committee.
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):
Hi everyone. My name is Leslie's mug . I'm general
counsel at Gordon Brothers, andI'm also a member of the Tina's
Wish Boston GatheringCommittee. Three years ago, I
attended a Tina's Wish event inBoston. It was my first and
what I learned that eveningchanged my life as well as
those closest to me. I'drecently received a report
through the AncestralConnection Service 23 and me
(00:50):
that I had the BRCA two genemutation, and then my sister
received the same news with oneof our two brothers having had
prostate cancer. We all of asudden realized that we had
this secret family history thatwas unknown to us. And from
that Tina's wish panel, I wasgiven a roadmap for what to do
with that startling newinformation, which was
(01:10):
priceless to me and to myfamily. So I'm so excited to
moderate today's panel becauseit is personal to me. I'm
grateful to Tina's Wish, whosemission it is to find an early
detection mechanism for ovariancancer, for creating this
series so that one day allwomen will have the opportunity
to have a fighting chanceagainst this disease. And now
(01:33):
let's welcome our panelists.
First we have Dr. Susan Domek,medical oncologist and
executive director for theVassar Center for BRCA or BRCA
at Penn Medicine.
Speaker 3 (01:45):
Thanks so much for having me.
Speaker 2 (01:47):
Welcome and genetic counselor, Amanda Ganza from
Yale School of Medicine.
Speaker 3 (01:54):
Thank you so much for having me here today.
Speaker 2 (01:57):
Thanks to you both, Susan and Amanda. I'm really
excited to be here with both ofyou, and I'm thrilled that I
have the opportunity to be inthis conversation with you for
the next 30 minutes. So,without further ado, let's,
let's dig in. Um , we'll startwith probably the most burning
question for the attendees. Um, and we'll go first to , um,
(02:18):
Dr. Domek , what is a geneticmutation Exactly. And if I have
one, will I develop cancer?
Speaker 3 (02:26):
Yes. A genetic mutation or if you've seen a
recent path , uh, report, itwill be called a pathogenic
variant. Periodically, we liketo change the words just to
confuse everyone. Uh, no , thatwas, that was just a joke. Uh,
but , uh, those are synonymousterms, mutation or pathogenic
variant. And the different testreports will say things
(02:47):
differently, but both of themmean the same thing, which is,
as a reminder, the DNA is the,the blueprint, the instruction
manual for a cell. And based onwhat the DNA says, proteins are
made. And if there is amutation or an abnormal
variant, pathogenic variant ,um, in the DNA , then the
protein that is made is notfunctional. And either it can't
(03:11):
bind to things or it isn'texpressed at all. And because
that protein is not functional,that is what increases cancer
risk. So even if you have amutation , uh, that you're born
with, this increases your riskof cancer. But it does not mean
that you will get cancer, or aswe tend to say, genetics is not
destiny. But some of thesegenetic mutations increase your
(03:34):
risk by quite a , quite a greatdeal. And so it really depends
on the specific gene and thespecific mutation, what your
cancer risks may be. And it'svery important to be informed
and to talk to people who knowthe details to get the best
information.
Speaker 2 (03:50):
So, so what are the different mutations that one
can have ?
Speaker 3 (03:55):
Right. So there are genes that everybody has. So
for instance, all of us haveBRC one and B RCA A two genes.
The normal function of thesegenes and these proteins in the
cell is to help repair your DNA. So actually BRC one and BRC
two are good for the cell. Butif you have a mutation in one
(04:15):
of these genes that leads tothe protein not working, that's
what causes problems. Somutations in BRA one and BCA
two increase your risk ofbreast cancer with lifetime
risks of up to 70%. Theyincrease your risk of ovarian
cancer. Those risks are higherfor BA one mutations than for
BA two mutations. But for BAone, those risks are as high as
(04:37):
45%. These, the mutations inthese genes also increase the
risk of male breast cancer,prostate cancer, and pancreatic
cancer, particularly for BRCtwo. But those aren't the only
genes. Those are the ones thatpeople tend to know the most
about because of Angelina Jolieand just a lot of discussion in
the media. But there areothers. And so there's a
(04:58):
syndrome called Lynch syndrome.
And Lynch syndrome isassociated with mutations in,
in , in multiple genes. Andthis is associated with a high
risk of colon cancer, but alsoendometrial cancer or uterine
cancer, which is relevant forour discussion today. And other
cancers. Um, there aremutations in genes such as RAD
51 C , RAD 50 1D and B brip .
(05:21):
And these , um, increase yourrisk of ovarian cancer, but
more like in the 10% range,which is still significantly
higher , uh, given thedifficulty with ovarian cancer.
And there are other , uh, uh,mutations in , in rare genes
that probably we won't get intotoday. Uh, but there's a range
of genes and a range of risk .
And that's why it's important ,uh, to know exactly what you're
(05:42):
being tested for and exactlywhat the implications are when
these mutations are found.
Speaker 2 (05:49):
So , um, let's unpack. There's so much to
unpack in, in all of thatinformation. I think I found in
my journey, one of the , um,points of misunderstanding is
that men cannot inherit thosegenes. Um, can you, can you
tell us what the truth isbehind that statement?
Speaker 3 (06:10):
Absolutely. And I'm sure Amanda's gonna touch on
this , uh, uh, additionally ,um, when she's talking about
the role of counselors, forwhatever reason , um, women,
men and their physicians oftenreally look to the mother side
of the family when we'retalking about, if you will,
female cancers. Um, but whenyou take a step back, if you
line up all the BRA onemutation carriers in the world,
(06:32):
half of them will be men. Okay? And half of the time when we
find an individual who has aBRC one or two mutation, she
has inherited that mutationfrom her father. In addition,
there are risks to men. Um ,those, these risks are
different and they're not assignificant , uh, meaning in
terms of an absolute number,but they matter quite a bit.
(06:53):
And particularly for BRC too ,there's a significantly
increased risk for male breastcancer with a lifetime risk of
up to 10%. That might not soundlike very much, but the
baseline risk in the populationis 0.1%. So you get the idea,
this is a massive elevation ofrisk. There is an increased
risk of prostate cancer, andthis is the type of prostate
(07:14):
cancer that's aggressive. Or aswe say, it's the type of cancer
that you die of, not that youdie with. It's not benign
prostate cancer. And again,this increased risk of , uh,
pancreatic cancer, which we'vetalked about, which affects ,
uh, both men and women. Uh , sothese risks are significant.
And in addition, if one has aBRC one or two mutation,
(07:35):
there's a 50% chance that thatcould be passed along to each
individual child. Uh, so thisis really important, not only
for the man, but also for theirfamily.
Speaker 2 (07:47):
Well , thank you for that. And you touched on the
role of a genetic counselor.
For me in my journey that wasso important. Um, I , I don't
think that I was fully awarethat that function existed,
that that source of helpexisted. So, Amanda, tell us
what , um, is the role of agenetic counselor?
Speaker 4 (08:08):
Absolutely. And that's probably the the first
question I always ask patientswhen they walk through the
door, you know, this isprobably the first time you
ever heard of a geneticcounselor, and you have no idea
what you're about toexperience. So let me just give
you a quick recap. Butbasically how I start every
time I meet with a new patient.
So I see my role and myfunction in patient care is
really , um, helping patientsto provide 'em with education,
(08:31):
to guide and support them.
Through this journey oflearning about inherited cancer
risks and pursuing genetictesting, I'm really there to
help translate those technicalgenetic terms in a friendly and
understandable way so thatpatients walk away
understanding this is my risk,and this is what it's gonna
mean for me, for my children,for my family. And that they
(08:56):
can then communicate thateasily because they understand
it , um, from our conversations, um, so that their family
members can and themselves usethat information as an
opportunity to , um, go after.
And , uh, you know, futurescreening and cancer prevention
strategies and planning, all ofthat information can really be
(09:16):
, um, obtained once , uh,really once that , uh, patient
has a true understanding ofwhat genetics mean and whether
, uh, mutation and how doesthis impact myself and my
family. And I'm really there tohelp alongside the patient,
walk them through that process.
Um, I also see myself as , uh,there to help identify
(09:37):
resources. So patient advocacygroups and other families that
I can get them in touch with,that they can talk to and, you
know, can be there for them as,you know, going through with
them or having gone through itbefore to give them some advice
or to go through some researchopportunities that they might
be eligible for, that theymight not have been aware of
otherwise. So I sort of seemyself in that way too, to open
(09:59):
other doors that they might nothave realized were even there.
Speaker 2 (10:04):
Um , and that was my experience too. Um, so how do
people determine if they andtheir family are at high risk
for cancer? And if they wouldbenefit from , uh, a specific
assessment, a geneticsevaluation, and then a risk
assessment?
Speaker 4 (10:22):
Yeah, so I, I always tell patients , uh, ask your
family first. The, the reallyimportant step in the beginning
is gathering as much details aspossible. And in some families,
that's not possible. People areadopted or they've lost touch
with family. Um , but , uh, youknow, I try to get some people
to do some homework before theycome into their first visit
because as much detailedinformation that we have about
(10:45):
the types of cancers in thefamily who was affected, how
old were they when they werediagnosed, are all important
information that we use toprovide an accurate risk
assessment for an individual.
Um, so kind of doing thathomework in advance really
helps us understand who's gonnabe best suited for a genetics
evaluation. Um, and for mostpeople, I would say, if you are
(11:08):
concerned about your risk forcancer, meeting with a cancer
genetic specialist is a reallythe best first step. Have us
look at someone's personal andfamily history in detail,
really give them a good idea.
Is this something we need to beworried about or not? Um, and
in general, the families thatare kind of higher risk for us
for a hereditary cancer riskare those where we're starting
(11:30):
to see the same or relatedtypes of cancers on the same
side of the family, like breastand ovarian cancer clustering
together. Um, young onsetcancers like breast cancer
before the age of 50. Um, morerare cancers like ovarian
cancer or pancreatic cancer,regardless of kind of what a ,
what are the family history orthe age in which they were
(11:51):
diagnosed. And even in someindividuals with certain
ancestral backgrounds such asAshkenazi, Jewish ancestry,
also have a higher risk. Sowhen we start to see some of
those patterns in someone'sfamily history, those are the
people who we really say wouldbenefit the most. And even
people who might not hit allthose highlights, they still
might be , uh, you know, kindof worth meeting with a
(12:13):
counselor and a geneticsprofessional to really have a
better understanding of whattheir risk might look like.
Speaker 2 (12:19):
Dr. Domek, what percentage of gynecologic
cancer patients have a geneticmutation?
Speaker 3 (12:26):
Yeah , it , it, a little bit depends on how you
count , uh, to, to, to behonest. And , uh, we always
have these conversations thatif you test for more genes, you
find more stuff, whether or notit's related to the cancer at
hand. But to give some sort ofrough estimates , uh, for
ovarian cancer, it's in therange of about 15%. Uh, when
we're talking about , uh,uterine cancer, it's probably
(12:49):
more in the 3% range. Uh ,cervical cancer is not , uh,
closely is not known to beassociated with inherited
cancer susceptibility. Uh, itis more strongly linked to , to
HBV and environmental , uh,causes. Um, and , uh, and so it
is really important, as youknow, Amanda has, has , uh,
(13:10):
outlined to know the details ofa person's family and personal
history, because ovariancancer, when I'm talking about
ovarian cancer here, I'm, I'mtalking really about epithelial
ovarian cancer, sort of, if youwill, the , uh, the , the more
common cancer. But there aresome rare ovarian cancer types
that are associated with othergene mutations. And so that's
(13:31):
why as part of this , um, uh,assessment , um, that a lot of
information will be obtained,I'm sure we're gonna talk about
later, you know, about the factthat, you know, in the
Ashkenazi Jewish community, onein 40 individuals of Ashkenazi
Jewish descent does have amutation in VRC one or two .
And so that is one of thesituations where , um, we
(13:53):
remain , uh, that familyhistory may not be the most
important thing as ethnicity.
Um, it's all , it's stillimportant. It's still more
likely that if you have afamily history and you're
Ashkenazi Jewish , uh, that ,uh, you have a mutation. Well,
Speaker 2 (14:07):
Let's talk about insurance , um, and how that
plays into it because it isvery relevant. Mm-hmm
. Um, when we'retalking about, you know,
putting the word out andencouraging people to go get
tested, particularly when you,like I have had a diagnosis ,
um, should people be concernedif they , um, you know, for
(14:28):
example, are young, don't yethave their own personal
insurance, they'll then have apreexisting condition. Um, what
do you think about that andwhat can you advise people to
do?
Speaker 4 (14:39):
Yeah, so there are , um, discrimination laws that
are in place both federally andStatewise, that provide some
level of protection fromdiscrimination based on results
of genetic testing. One of thelarger federal laws is called
the Genetic InformationNon-Discrimination Act, or GINA
for short. Um, there's awonderful website , um, that
(15:00):
you can go to as well to learnmore information , um, about
Gina and what it protections itprovides, but also protections
that it doesn't provide. It'snot a perfect law. Um, I think
where it falls short is reallywhen it comes to , um, life
insurance, long-term care ordisability insurance. That's
really where Gina does notprovide protection a , against
(15:22):
results of genetic testing. Um, as well as those individuals
who might be looking to servein the active military results
of genetic testing can be usedto decide about fitness or
eligibility for the military.
So though that's really whereGina , um, I think doesn't
always provide the bestprotection. And so for patients
who might be worried about thator concerned about that prior
(15:43):
to genetic testing, it might beworth them kind of learning a
little bit more about thoselaws, maybe obtaining some of
those policies beforehand. Sothey feel like they've done at
least as much as they can do tocontrol that part of it. Um,
but Gina does provideprotection for employment and ,
um, health insurancediscrimination. So under that
(16:03):
part of it , um, it would notbe deemed a preexisting
condition for people who have ,um, no personal diagnosis, but
just have a, a genetic testresult that shows a mutation
putting them at increased riskfor cancer.
Speaker 2 (16:18):
Can you explain if insurance covers genetic
testing and then in the caseswhere it doesn't, what are the
other options available to gettested?
Speaker 4 (16:27):
Yeah, so most insurance companies do cover
the cost of genetic testing,particularly when people are
meeting their insurancecriteria for genetic testing.
So some of those risk factorswe talked about earlier, like
family history of ovariancancer or young onset cancers,
or all factors that are lookedat in terms of deciding about
coverage. Now for thoseindividuals who might not meet
(16:47):
those criteria , um, or arejust interested in pursuing
genetic testing to understandtheir risks , and they might
have no information about theirfamily history, there are more
affordable ways nowadays to payfor the test out of pocket ,
some of which costing around$250. And so healthcare
providers can help navigatethose decisions and help
(17:08):
determine if insurance coveragewould be , um, available or
whether those out-of-pocketoptions might be ones that a
patient might want to pursue.
But it's a lot less than thethousands of dollars for
testing that we used to hearabout many years ago.
Speaker 2 (17:22):
What do you think about , um, the age, you know,
is there sort of a , a point intime before which you wouldn't
encourage someone to gettested?
Speaker 3 (17:33):
Yes . So , uh, our general philosophy for, for
instance, BRCA one and BRC twois that particularly if there's
a known mutation in the family, uh, we suggest that women be
tested at 25 because that'swhen we start breast MRI
screening. But we do not testchildren , um, for BRA one and
(17:53):
two mutations. And the reasonfor that is because at this
time that's, there's noactionable utility for it.
Meaning we don't do anythingdifferent in children who would
have BRA one or two mutations,and therefore there's no reason
to know, and this is an adultonset condition. So there is a
concept of autonomy thatindividual gets to make the
decision about when they wantto know that information. We
(18:16):
definitely have young women,you know, 18, 20 21, come in to
talk to us, and sometimes whenwe review that, we're not going
to do anything till 25. Theysay, thank you very much, I'll
see you in a few years. Andsometimes they do really want
to know this informationbecause they feel like they,
they feel like they alreadyhave the mutation, there was a
50% chance they don't. But weare very careful to review sort
(18:39):
of the pros and cons. Itdepends on the gene. So for
instance, RAD 51 C and D , therisks are later. So we don't
necessarily test , uh, as earlyand for Lynch syndrome. There,
there are are differentapproaches there because of the
colon cancer screening. And sothere's not sort of a one size
fits all approach. It dependson the gene. What I can tell
(18:59):
you though, that if, if it's abreast ovarian type of
situation , um, and no one's inthe family been tested, you
know, 25 is usually , uh, whenwe, we talk about it. And
Amanda, I don't know if youwanna say specific comments on
Lynch syndrome since you know,I'm outta my, over my skis .
.
Speaker 4 (19:16):
Yeah. So I, I think for , uh, you know , a syndrome
like Lynch syndrome or othercolon cancer type related
conditions where we seeincreased risk, also linked
with gynecologic risk , um, welook at the family history in
combination with the gene inparticular. So there are some
genes for Lynch syndrome whereyou can see people much younger
with colon cancer, where wewould start screening with
(19:38):
colonoscopy maybe as early as20 or 25, depending, especially
if we see someone in the familywho might have been diagnosed
in their late twenties or earlythirties with colon cancer. So
, um, we really, as part ofthat big risk assessment and,
you know, really wanna hithome, why knowing your family
history can be so important is, um, while the general
guidelines might say 20 to 25,we might alter that depending
(20:00):
on family history, if we reallysaw as a much younger case of
colon cancer and would need tostart even earlier than that to
, to be on the cautious side.
So , um, you know, it reallycan, can depend, but really in
generally try, you know, I Ireally have not tested many
kids, if at all , um, for anyof this, unless there was, you
know, a sort of an outlier in afamily history.
Speaker 3 (20:22):
And, and I wanted to make, you know, one other
important, important or two,two points that are quite
important. One is that, youknow, we mentioned individuals
of Ashkenazi Jewish ancestry,but we wanna be clear that ,
uh, uh, these gene mutationscan be seen in individuals of
any race and any ethnicity. Andwe're very conscious of the
fact that there's under testingin , um, in minority
(20:43):
populations. Uh, so we'rereally conscious about equity
and fairness and making surethat individuals know of all
races and ethnicity know thatif you have a family history,
you should, you should gettested. And the second issue is
that if you have a strongfamily history and testing is
negative, that doesn't meanyou're off the hook. Uh, we
still that your family historydrives things. Um, the , with
(21:06):
the , the one exception is ifthere's a known mutation in the
family and you don't have it,that's the one time where we're
really reassuring. But ifthere's a very strong family
history and there's negativegenetic testing, we still
change management and weincrease surveillance based on
the family history alone.
Speaker 2 (21:25):
Um, we're talking about testing then. Um, are all
tests created equal? I guess myfirst encounter with a a test
was 23 in May . Um, I thought Iwas seeing things when I got
the report back , um, but thenI followed up with my
gynecologist and retested. Um,what do you think about the
(21:47):
commercially available , um,consumer self-administered
tests?
Speaker 4 (21:52):
Um, you know, I think you said it , they're not
all genetic tests are , arecreated equal. And I think we
advise and really caution theuse of commercially available
tests that you might find atyour local pharmacy or on
Amazon , um, in terms ofguiding medical decisions and,
and learning about risk fordifferent diseases such as
cancer. Um, you know, they,they, they do a certain thing ,
(22:16):
um, but it's not maybe as, youknow, as comprehensive as the
type of testing that you , um,might receive when you see a
genetic counselor or a geneticprovider who's ordering a
clinically available genetictest. And I think where I
caution most is there are somany risk factors that go into
understanding someone'spersonalized risk. Part of that
(22:37):
is family history. Part of thatis results of genetic testing.
And so we have to look at allof that together. And those
direct to consumer type testsdon't really give us that full
comprehensive view from thegenetic test standpoint. And so
what I fear is that patientsmight utilize the results that
were negative through thiscommercially available to and
feel reassured when it mightnot have been the best or most
(23:00):
accurate test that they shouldhave received. And so they
might not be then getting thescreening that they need. They
might not even tell theirdoctor about their family
history 'cause they feel like Igot a negative genetic test and
I'm fine. Um, and so I think Icaution a little bit the use of
that. Um, and, you know, your ,your doctor did the , the right
thing and what definitely whatI would have recommended too .
Okay, let's, let's confirm thatthrough a clinical test. Let's
(23:23):
see if there's any additionaltesting that might be indicated
based on personal or familyhistory factors. Use all of
that together to make a plan asto what we need to do , um, in
terms of screening,understanding your risk and how
to communicate that to thefamily, whether the results
were positive or negative.
Speaker 3 (23:42):
And, and , and as Amanda pointed out, but this is
one that we really like todrive home , uh, 23 and me, for
instance, only test is test forthe three common found , what
we call founder mutations inthe Ashkenazi Jewish
population. So I literally havehad my own family members say I
had 23 and me test , and it wasnegative for B say one and two
(24:04):
mutations. And I'm like, that'sgreat. You're Italian. Uh ,
that didn't help you. Uh,you're not of Ashkenazi Jewish
descent. So, you know, I've hadextremely smart people not
understand what the test was.
So, so that's the key. I thinkno matter what, you have to
understand what test is beingsent and what information
you're getting at it. There arethese other tests that, that
(24:25):
Amanda will, I'm sure it'llcome up later, but there are
these things that we kind ofcall , uh, a company
facilitated test , consumerfacilitated test , where you
can actually reach out to acompany, say you want to be
tested, and they will find adoctor for you. And they are
more comprehensive tests, butthe downside of them then is
(24:47):
that it's completely taken outof your medical plan. Um, and
so, you know, the best way touse genetic testing information
is to embed it , uh, with therest of your medical
information and your medicalrecords. Um, you know, it's a
piece of information that'sreally valuable. So if you put
it outside of the medicalsystem, then we're not
(25:09):
optimizing the information.
Speaker 2 (25:12):
So we have a couple questions that have come in
from the audience. Um, one is,what does the physical testing
process look like? For example,is it a cheek swab, a blood
sample, or something else?
Speaker 4 (25:25):
Yeah, so we , um, can, can do the testing through
blood is probably the moretraditional way that we've done
them. Saliva is just the same,just as accurate. Um, some labs
will offer a cheek swab, butit's not as common as the
saliva based test where you'respitting into a tube. I always
tell patients it's notglamorous, but it'll get the
job done. Um, and so we can useeither type of an approach to
(25:49):
do genetic testing.
Speaker 2 (25:52):
Okay . Um, and one other really good question that
I think we should ask now is ,um, are there any lifestyle
habits or medications thatincrease an individual's risk
for developing gynecologiccancers?
Speaker 3 (26:07):
So we know that in general, things that can
decrease your risk of canceroverall are a healthy
lifestyle, includingmaintaining a healthy weight,
regular exercise , um, uh, uh,maintain a healthy weight , uh,
regular exercise, and , uh,minimizing your alcohol
consumption as well as notsmoking. So these are things
(26:27):
that we say over and over again, uh, but are really important.
And , uh, particularly exerciseis important and none of us get
enough of it, and we all haveto keep at it. Um, for ovarian
cancer in particular, birthcontrol pills , uh, oral
contraceptive pills have beenshown to decrease the risk of
ovarian cancer. Um, and so thisis an important thing. Having
(26:49):
children , um, can , uh,definitely impact certain
cancer types. Uh , but it's alittle bit complicated and also
it's not something that I wouldever prescribe to anyone. You
know, please have this manychildren by this age. Um, so
it's an association withoutnecessarily being , um,
particularly helpful to us. Youknow, what's interesting is
that there are things that aregreat about developed countries
(27:11):
like the United States that arejust terrific from the , the ,
the standpoint of , uh, uh,empowering women that can be
negative in terms of cancerrisk. So for instance, you
know, getting your periodearlier and having your period
late and having your kids late,that all increases your risk of
breast cancer. But those areall things that happen in the
(27:32):
developed countries becausewe're well nourished, so we get
our periods earlier, we'reeducated, so we have our
children later. And so, youknow, these are things that we
just have to balance out andand realize. But again, the
things that people have mostcontrol over are those , uh,
you know , um, uh, healthyweight, regular exercise,
minimize alcohol, don't smoke,and birth control pills can be
(27:53):
, uh, effective.
Speaker 2 (27:55):
How about sugar?
I've heard , um, eliminatesugar. Cancer loves sugar,
Speaker 3 (28:01):
It's been shown in mice. Um, I like chocolate.
Speaker 2 (28:04):
So I, I think with all of that we're just about
past our time. Um, I would putit back to the both of you. I,
I've so enjoyed speaking to youand hearing , um, uh, all of
this information and I'm, I'msure that our attendees have
done so as well. Is thereanything else that, that we
didn't cover that you think isreally important for everybody
(28:26):
to understand?
Speaker 3 (28:28):
Uh , well, I'll , I'll have , uh, one comment,
which is , uh, I don't know ifwe hit it hard enough, but I'm
gonna say it very precisely. Ifyou are diagnosed with ovarian
cancer, you should have hadgenetic testing for inherited
susceptibility. And if you havenot, you should get it and you
can ask your doctor. Butthere's lots of different ways
to do this. And so sort ofdon't relent it is an absolute
(28:52):
guideline , uh, that all peoplewith ovarian cancer should have
had this testing. Um, and , uh,and I'll , I'll let , uh,
again, Amanda talk about thereare specific things for uterine
cancer as well.
Speaker 4 (29:04):
Yeah, I mean, if it's a young onset uterine
cancer before age 50, even withno family history would be
indicated to do the test. Um,but I also would , uh, empower
the women who might have afamily history. So maybe if
that member of your family withovarian or uterine cancer is
deceased or unwilling to dotesting, it doesn't exclude
that individual from goingforward with the test
(29:25):
themselves.
Speaker 2 (29:26):
Well, thank you both so much for being here. Um, on
behalf of Tina's Wish , um, andmyself, thank you so much for
being here. Um, Amanda Ganekand Dr. Susan Domek . Um, and ,
uh, thank you so much.
Speaker 1 (29:48):
For more information about gynecologic health, visit
tina's wish.org/what to know .
That's tina's wish.org/wO-K-N-O-W. 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 Leslie's mug . I'm general
counsel at Gordon Brothers, andI'm also a member of the Tina's
Wish Boston GatheringCommittee. Three years ago, I
attended a Tina's Wish event inBoston. It was my first and
what I learned that eveningchanged my life as well as
those closest to me. I'drecently received a report
through the AncestralConnection Service 23 and me
(00:50):
that I had the BRCA two genemutation, and then my sister
received the same news with oneof our two brothers having had
prostate cancer. We all of asudden realized that we had
this secret family history thatwas unknown to us. And from
that Tina's wish panel, I wasgiven a roadmap for what to do
with that startling newinformation, which was
(01:10):
priceless to me and to myfamily. So I'm so excited to
moderate today's panel becauseit is personal to me. I'm
grateful to Tina's Wish, whosemission it is to find an early
detection mechanism for ovariancancer, for creating this
series so that one day allwomen will have the opportunity
to have a fighting chanceagainst this disease. And now
(01:33):
let's welcome our panelists.
First we have Dr. Susan Domek,medical oncologist and
executive director for theVassar Center for BRCA or BRCA
at Penn Medicine.
Speaker 3 (01:45):
Thanks so much for having me.
Speaker 2 (01:47):
Welcome and genetic counselor, Amanda Ganza from
Yale School of Medicine.
Speaker 3 (01:54):
Thank you so much for having me here today.
Speaker 2 (01:57):
Thanks to you both, Susan and Amanda. I'm really
excited to be here with both ofyou, and I'm thrilled that I
have the opportunity to be inthis conversation with you for
the next 30 minutes. So,without further ado, let's,
let's dig in. Um , we'll startwith probably the most burning
question for the attendees. Um, and we'll go first to , um,
(02:18):
Dr. Domek , what is a geneticmutation Exactly. And if I have
one, will I develop cancer?
Speaker 3 (02:26):
Yes. A genetic mutation or if you've seen a
recent path , uh, report, itwill be called a pathogenic
variant. Periodically, we liketo change the words just to
confuse everyone. Uh, no , thatwas, that was just a joke. Uh,
but , uh, those are synonymousterms, mutation or pathogenic
variant. And the different testreports will say things
(02:47):
differently, but both of themmean the same thing, which is,
as a reminder, the DNA is the,the blueprint, the instruction
manual for a cell. And based onwhat the DNA says, proteins are
made. And if there is amutation or an abnormal
variant, pathogenic variant ,um, in the DNA , then the
protein that is made is notfunctional. And either it can't
(03:11):
bind to things or it isn'texpressed at all. And because
that protein is not functional,that is what increases cancer
risk. So even if you have amutation , uh, that you're born
with, this increases your riskof cancer. But it does not mean
that you will get cancer, or aswe tend to say, genetics is not
destiny. But some of thesegenetic mutations increase your
(03:34):
risk by quite a , quite a greatdeal. And so it really depends
on the specific gene and thespecific mutation, what your
cancer risks may be. And it'svery important to be informed
and to talk to people who knowthe details to get the best
information.
Speaker 2 (03:50):
So, so what are the different mutations that one
can have ?
Speaker 3 (03:55):
Right. So there are genes that everybody has. So
for instance, all of us haveBRC one and B RCA A two genes.
The normal function of thesegenes and these proteins in the
cell is to help repair your DNA. So actually BRC one and BRC
two are good for the cell. Butif you have a mutation in one
(04:15):
of these genes that leads tothe protein not working, that's
what causes problems. Somutations in BRA one and BCA
two increase your risk ofbreast cancer with lifetime
risks of up to 70%. Theyincrease your risk of ovarian
cancer. Those risks are higherfor BA one mutations than for
BA two mutations. But for BAone, those risks are as high as
(04:37):
45%. These, the mutations inthese genes also increase the
risk of male breast cancer,prostate cancer, and pancreatic
cancer, particularly for BRCtwo. But those aren't the only
genes. Those are the ones thatpeople tend to know the most
about because of Angelina Jolieand just a lot of discussion in
the media. But there areothers. And so there's a
(04:58):
syndrome called Lynch syndrome.
And Lynch syndrome isassociated with mutations in,
in , in multiple genes. Andthis is associated with a high
risk of colon cancer, but alsoendometrial cancer or uterine
cancer, which is relevant forour discussion today. And other
cancers. Um, there aremutations in genes such as RAD
51 C , RAD 50 1D and B brip .
(05:21):
And these , um, increase yourrisk of ovarian cancer, but
more like in the 10% range,which is still significantly
higher , uh, given thedifficulty with ovarian cancer.
And there are other , uh, uh,mutations in , in rare genes
that probably we won't get intotoday. Uh, but there's a range
of genes and a range of risk .
And that's why it's important ,uh, to know exactly what you're
(05:42):
being tested for and exactlywhat the implications are when
these mutations are found.
Speaker 2 (05:49):
So , um, let's unpack. There's so much to
unpack in, in all of thatinformation. I think I found in
my journey, one of the , um,points of misunderstanding is
that men cannot inherit thosegenes. Um, can you, can you
tell us what the truth isbehind that statement?
Speaker 3 (06:10):
Absolutely. And I'm sure Amanda's gonna touch on
this , uh, uh, additionally ,um, when she's talking about
the role of counselors, forwhatever reason , um, women,
men and their physicians oftenreally look to the mother side
of the family when we'retalking about, if you will,
female cancers. Um, but whenyou take a step back, if you
line up all the BRA onemutation carriers in the world,
(06:32):
half of them will be men. Okay? And half of the time when we
find an individual who has aBRC one or two mutation, she
has inherited that mutationfrom her father. In addition,
there are risks to men. Um ,those, these risks are
different and they're not assignificant , uh, meaning in
terms of an absolute number,but they matter quite a bit.
(06:53):
And particularly for BRC too ,there's a significantly
increased risk for male breastcancer with a lifetime risk of
up to 10%. That might not soundlike very much, but the
baseline risk in the populationis 0.1%. So you get the idea,
this is a massive elevation ofrisk. There is an increased
risk of prostate cancer, andthis is the type of prostate
(07:14):
cancer that's aggressive. Or aswe say, it's the type of cancer
that you die of, not that youdie with. It's not benign
prostate cancer. And again,this increased risk of , uh,
pancreatic cancer, which we'vetalked about, which affects ,
uh, both men and women. Uh , sothese risks are significant.
And in addition, if one has aBRC one or two mutation,
(07:35):
there's a 50% chance that thatcould be passed along to each
individual child. Uh, so thisis really important, not only
for the man, but also for theirfamily.
Speaker 2 (07:47):
Well , thank you for that. And you touched on the
role of a genetic counselor.
For me in my journey that wasso important. Um, I , I don't
think that I was fully awarethat that function existed,
that that source of helpexisted. So, Amanda, tell us
what , um, is the role of agenetic counselor?
Speaker 4 (08:08):
Absolutely. And that's probably the the first
question I always ask patientswhen they walk through the
door, you know, this isprobably the first time you
ever heard of a geneticcounselor, and you have no idea
what you're about toexperience. So let me just give
you a quick recap. Butbasically how I start every
time I meet with a new patient.
So I see my role and myfunction in patient care is
really , um, helping patientsto provide 'em with education,
(08:31):
to guide and support them.
Through this journey oflearning about inherited cancer
risks and pursuing genetictesting, I'm really there to
help translate those technicalgenetic terms in a friendly and
understandable way so thatpatients walk away
understanding this is my risk,and this is what it's gonna
mean for me, for my children,for my family. And that they
(08:56):
can then communicate thateasily because they understand
it , um, from our conversations, um, so that their family
members can and themselves usethat information as an
opportunity to , um, go after.
And , uh, you know, futurescreening and cancer prevention
strategies and planning, all ofthat information can really be
(09:16):
, um, obtained once , uh,really once that , uh, patient
has a true understanding ofwhat genetics mean and whether
, uh, mutation and how doesthis impact myself and my
family. And I'm really there tohelp alongside the patient,
walk them through that process.
Um, I also see myself as , uh,there to help identify
(09:37):
resources. So patient advocacygroups and other families that
I can get them in touch with,that they can talk to and, you
know, can be there for them as,you know, going through with
them or having gone through itbefore to give them some advice
or to go through some researchopportunities that they might
be eligible for, that theymight not have been aware of
otherwise. So I sort of seemyself in that way too, to open
(09:59):
other doors that they might nothave realized were even there.
Speaker 2 (10:04):
Um , and that was my experience too. Um, so how do
people determine if they andtheir family are at high risk
for cancer? And if they wouldbenefit from , uh, a specific
assessment, a geneticsevaluation, and then a risk
assessment?
Speaker 4 (10:22):
Yeah, so I, I always tell patients , uh, ask your
family first. The, the reallyimportant step in the beginning
is gathering as much details aspossible. And in some families,
that's not possible. People areadopted or they've lost touch
with family. Um , but , uh, youknow, I try to get some people
to do some homework before theycome into their first visit
because as much detailedinformation that we have about
(10:45):
the types of cancers in thefamily who was affected, how
old were they when they werediagnosed, are all important
information that we use toprovide an accurate risk
assessment for an individual.
Um, so kind of doing thathomework in advance really
helps us understand who's gonnabe best suited for a genetics
evaluation. Um, and for mostpeople, I would say, if you are
(11:08):
concerned about your risk forcancer, meeting with a cancer
genetic specialist is a reallythe best first step. Have us
look at someone's personal andfamily history in detail,
really give them a good idea.
Is this something we need to beworried about or not? Um, and
in general, the families thatare kind of higher risk for us
for a hereditary cancer riskare those where we're starting
(11:30):
to see the same or relatedtypes of cancers on the same
side of the family, like breastand ovarian cancer clustering
together. Um, young onsetcancers like breast cancer
before the age of 50. Um, morerare cancers like ovarian
cancer or pancreatic cancer,regardless of kind of what a ,
what are the family history orthe age in which they were
(11:51):
diagnosed. And even in someindividuals with certain
ancestral backgrounds such asAshkenazi, Jewish ancestry,
also have a higher risk. Sowhen we start to see some of
those patterns in someone'sfamily history, those are the
people who we really say wouldbenefit the most. And even
people who might not hit allthose highlights, they still
might be , uh, you know, kindof worth meeting with a
(12:13):
counselor and a geneticsprofessional to really have a
better understanding of whattheir risk might look like.
Speaker 2 (12:19):
Dr. Domek, what percentage of gynecologic
cancer patients have a geneticmutation?
Speaker 3 (12:26):
Yeah , it , it, a little bit depends on how you
count , uh, to, to, to behonest. And , uh, we always
have these conversations thatif you test for more genes, you
find more stuff, whether or notit's related to the cancer at
hand. But to give some sort ofrough estimates , uh, for
ovarian cancer, it's in therange of about 15%. Uh, when
we're talking about , uh,uterine cancer, it's probably
(12:49):
more in the 3% range. Uh ,cervical cancer is not , uh,
closely is not known to beassociated with inherited
cancer susceptibility. Uh, itis more strongly linked to , to
HBV and environmental , uh,causes. Um, and , uh, and so it
is really important, as youknow, Amanda has, has , uh,
(13:10):
outlined to know the details ofa person's family and personal
history, because ovariancancer, when I'm talking about
ovarian cancer here, I'm, I'mtalking really about epithelial
ovarian cancer, sort of, if youwill, the , uh, the , the more
common cancer. But there aresome rare ovarian cancer types
that are associated with othergene mutations. And so that's
(13:31):
why as part of this , um, uh,assessment , um, that a lot of
information will be obtained,I'm sure we're gonna talk about
later, you know, about the factthat, you know, in the
Ashkenazi Jewish community, onein 40 individuals of Ashkenazi
Jewish descent does have amutation in VRC one or two .
And so that is one of thesituations where , um, we
(13:53):
remain , uh, that familyhistory may not be the most
important thing as ethnicity.
Um, it's all , it's stillimportant. It's still more
likely that if you have afamily history and you're
Ashkenazi Jewish , uh, that ,uh, you have a mutation. Well,
Speaker 2 (14:07):
Let's talk about insurance , um, and how that
plays into it because it isvery relevant. Mm-hmm
putting the word out andencouraging people to go get
tested, particularly when you,like I have had a diagnosis ,
um, should people be concernedif they , um, you know, for
(14:28):
example, are young, don't yethave their own personal
insurance, they'll then have apreexisting condition. Um, what
do you think about that andwhat can you advise people to
do?
Speaker 4 (14:39):
Yeah, so there are , um, discrimination laws that
are in place both federally andStatewise, that provide some
level of protection fromdiscrimination based on results
of genetic testing. One of thelarger federal laws is called
the Genetic InformationNon-Discrimination Act, or GINA
for short. Um, there's awonderful website , um, that
(15:00):
you can go to as well to learnmore information , um, about
Gina and what it protections itprovides, but also protections
that it doesn't provide. It'snot a perfect law. Um, I think
where it falls short is reallywhen it comes to , um, life
insurance, long-term care ordisability insurance. That's
really where Gina does notprovide protection a , against
(15:22):
results of genetic testing. Um, as well as those individuals
who might be looking to servein the active military results
of genetic testing can be usedto decide about fitness or
eligibility for the military.
So though that's really whereGina , um, I think doesn't
always provide the bestprotection. And so for patients
who might be worried about thator concerned about that prior
(15:43):
to genetic testing, it might beworth them kind of learning a
little bit more about thoselaws, maybe obtaining some of
those policies beforehand. Sothey feel like they've done at
least as much as they can do tocontrol that part of it. Um,
but Gina does provideprotection for employment and ,
um, health insurancediscrimination. So under that
(16:03):
part of it , um, it would notbe deemed a preexisting
condition for people who have ,um, no personal diagnosis, but
just have a, a genetic testresult that shows a mutation
putting them at increased riskfor cancer.
Speaker 2 (16:18):
Can you explain if insurance covers genetic
testing and then in the caseswhere it doesn't, what are the
other options available to gettested?
Speaker 4 (16:27):
Yeah, so most insurance companies do cover
the cost of genetic testing,particularly when people are
meeting their insurancecriteria for genetic testing.
So some of those risk factorswe talked about earlier, like
family history of ovariancancer or young onset cancers,
or all factors that are lookedat in terms of deciding about
coverage. Now for thoseindividuals who might not meet
(16:47):
those criteria , um, or arejust interested in pursuing
genetic testing to understandtheir risks , and they might
have no information about theirfamily history, there are more
affordable ways nowadays to payfor the test out of pocket ,
some of which costing around$250. And so healthcare
providers can help navigatethose decisions and help
(17:08):
determine if insurance coveragewould be , um, available or
whether those out-of-pocketoptions might be ones that a
patient might want to pursue.
But it's a lot less than thethousands of dollars for
testing that we used to hearabout many years ago.
Speaker 2 (17:22):
What do you think about , um, the age, you know,
is there sort of a , a point intime before which you wouldn't
encourage someone to gettested?
Speaker 3 (17:33):
Yes . So , uh, our general philosophy for, for
instance, BRCA one and BRC twois that particularly if there's
a known mutation in the family, uh, we suggest that women be
tested at 25 because that'swhen we start breast MRI
screening. But we do not testchildren , um, for BRA one and
(17:53):
two mutations. And the reasonfor that is because at this
time that's, there's noactionable utility for it.
Meaning we don't do anythingdifferent in children who would
have BRA one or two mutations,and therefore there's no reason
to know, and this is an adultonset condition. So there is a
concept of autonomy thatindividual gets to make the
decision about when they wantto know that information. We
(18:16):
definitely have young women,you know, 18, 20 21, come in to
talk to us, and sometimes whenwe review that, we're not going
to do anything till 25. Theysay, thank you very much, I'll
see you in a few years. Andsometimes they do really want
to know this informationbecause they feel like they,
they feel like they alreadyhave the mutation, there was a
50% chance they don't. But weare very careful to review sort
(18:39):
of the pros and cons. Itdepends on the gene. So for
instance, RAD 51 C and D , therisks are later. So we don't
necessarily test , uh, as earlyand for Lynch syndrome. There,
there are are differentapproaches there because of the
colon cancer screening. And sothere's not sort of a one size
fits all approach. It dependson the gene. What I can tell
(18:59):
you though, that if, if it's abreast ovarian type of
situation , um, and no one's inthe family been tested, you
know, 25 is usually , uh, whenwe, we talk about it. And
Amanda, I don't know if youwanna say specific comments on
Lynch syndrome since you know,I'm outta my, over my skis .
Speaker 4 (19:16):
Yeah. So I, I think for , uh, you know , a syndrome
like Lynch syndrome or othercolon cancer type related
conditions where we seeincreased risk, also linked
with gynecologic risk , um, welook at the family history in
combination with the gene inparticular. So there are some
genes for Lynch syndrome whereyou can see people much younger
with colon cancer, where wewould start screening with
(19:38):
colonoscopy maybe as early as20 or 25, depending, especially
if we see someone in the familywho might have been diagnosed
in their late twenties or earlythirties with colon cancer. So
, um, we really, as part ofthat big risk assessment and,
you know, really wanna hithome, why knowing your family
history can be so important is, um, while the general
guidelines might say 20 to 25,we might alter that depending
(20:00):
on family history, if we reallysaw as a much younger case of
colon cancer and would need tostart even earlier than that to
, to be on the cautious side.
So , um, you know, it reallycan, can depend, but really in
generally try, you know, I Ireally have not tested many
kids, if at all , um, for anyof this, unless there was, you
know, a sort of an outlier in afamily history.
Speaker 3 (20:22):
And, and I wanted to make, you know, one other
important, important or two,two points that are quite
important. One is that, youknow, we mentioned individuals
of Ashkenazi Jewish ancestry,but we wanna be clear that ,
uh, uh, these gene mutationscan be seen in individuals of
any race and any ethnicity. Andwe're very conscious of the
fact that there's under testingin , um, in minority
(20:43):
populations. Uh, so we'rereally conscious about equity
and fairness and making surethat individuals know of all
races and ethnicity know thatif you have a family history,
you should, you should gettested. And the second issue is
that if you have a strongfamily history and testing is
negative, that doesn't meanyou're off the hook. Uh, we
still that your family historydrives things. Um, the , with
(21:06):
the , the one exception is ifthere's a known mutation in the
family and you don't have it,that's the one time where we're
really reassuring. But ifthere's a very strong family
history and there's negativegenetic testing, we still
change management and weincrease surveillance based on
the family history alone.
Speaker 2 (21:25):
Um, we're talking about testing then. Um, are all
tests created equal? I guess myfirst encounter with a a test
was 23 in May . Um, I thought Iwas seeing things when I got
the report back , um, but thenI followed up with my
gynecologist and retested. Um,what do you think about the
(21:47):
commercially available , um,consumer self-administered
tests?
Speaker 4 (21:52):
Um, you know, I think you said it , they're not
all genetic tests are , arecreated equal. And I think we
advise and really caution theuse of commercially available
tests that you might find atyour local pharmacy or on
Amazon , um, in terms ofguiding medical decisions and,
and learning about risk fordifferent diseases such as
cancer. Um, you know, they,they, they do a certain thing ,
(22:16):
um, but it's not maybe as, youknow, as comprehensive as the
type of testing that you , um,might receive when you see a
genetic counselor or a geneticprovider who's ordering a
clinically available genetictest. And I think where I
caution most is there are somany risk factors that go into
understanding someone'spersonalized risk. Part of that
(22:37):
is family history. Part of thatis results of genetic testing.
And so we have to look at allof that together. And those
direct to consumer type testsdon't really give us that full
comprehensive view from thegenetic test standpoint. And so
what I fear is that patientsmight utilize the results that
were negative through thiscommercially available to and
feel reassured when it mightnot have been the best or most
(23:00):
accurate test that they shouldhave received. And so they
might not be then getting thescreening that they need. They
might not even tell theirdoctor about their family
history 'cause they feel like Igot a negative genetic test and
I'm fine. Um, and so I think Icaution a little bit the use of
that. Um, and, you know, your ,your doctor did the , the right
thing and what definitely whatI would have recommended too .
Okay, let's, let's confirm thatthrough a clinical test. Let's
(23:23):
see if there's any additionaltesting that might be indicated
based on personal or familyhistory factors. Use all of
that together to make a plan asto what we need to do , um, in
terms of screening,understanding your risk and how
to communicate that to thefamily, whether the results
were positive or negative.
Speaker 3 (23:42):
And, and , and as Amanda pointed out, but this is
one that we really like todrive home , uh, 23 and me, for
instance, only test is test forthe three common found , what
we call founder mutations inthe Ashkenazi Jewish
population. So I literally havehad my own family members say I
had 23 and me test , and it wasnegative for B say one and two
(24:04):
mutations. And I'm like, that'sgreat. You're Italian. Uh ,
that didn't help you. Uh,you're not of Ashkenazi Jewish
descent. So, you know, I've hadextremely smart people not
understand what the test was.
So, so that's the key. I thinkno matter what, you have to
understand what test is beingsent and what information
you're getting at it. There arethese other tests that, that
(24:25):
Amanda will, I'm sure it'llcome up later, but there are
these things that we kind ofcall , uh, a company
facilitated test , consumerfacilitated test , where you
can actually reach out to acompany, say you want to be
tested, and they will find adoctor for you. And they are
more comprehensive tests, butthe downside of them then is
(24:47):
that it's completely taken outof your medical plan. Um, and
so, you know, the best way touse genetic testing information
is to embed it , uh, with therest of your medical
information and your medicalrecords. Um, you know, it's a
piece of information that'sreally valuable. So if you put
it outside of the medicalsystem, then we're not
(25:09):
optimizing the information.
Speaker 2 (25:12):
So we have a couple questions that have come in
from the audience. Um, one is,what does the physical testing
process look like? For example,is it a cheek swab, a blood
sample, or something else?
Speaker 4 (25:25):
Yeah, so we , um, can, can do the testing through
blood is probably the moretraditional way that we've done
them. Saliva is just the same,just as accurate. Um, some labs
will offer a cheek swab, butit's not as common as the
saliva based test where you'respitting into a tube. I always
tell patients it's notglamorous, but it'll get the
job done. Um, and so we can useeither type of an approach to
(25:49):
do genetic testing.
Speaker 2 (25:52):
Okay . Um, and one other really good question that
I think we should ask now is ,um, are there any lifestyle
habits or medications thatincrease an individual's risk
for developing gynecologiccancers?
Speaker 3 (26:07):
So we know that in general, things that can
decrease your risk of canceroverall are a healthy
lifestyle, includingmaintaining a healthy weight,
regular exercise , um, uh, uh,maintain a healthy weight , uh,
regular exercise, and , uh,minimizing your alcohol
consumption as well as notsmoking. So these are things
(26:27):
that we say over and over again, uh, but are really important.
And , uh, particularly exerciseis important and none of us get
enough of it, and we all haveto keep at it. Um, for ovarian
cancer in particular, birthcontrol pills , uh, oral
contraceptive pills have beenshown to decrease the risk of
ovarian cancer. Um, and so thisis an important thing. Having
(26:49):
children , um, can , uh,definitely impact certain
cancer types. Uh , but it's alittle bit complicated and also
it's not something that I wouldever prescribe to anyone. You
know, please have this manychildren by this age. Um, so
it's an association withoutnecessarily being , um,
particularly helpful to us. Youknow, what's interesting is
that there are things that aregreat about developed countries
(27:11):
like the United States that arejust terrific from the , the ,
the standpoint of , uh, uh,empowering women that can be
negative in terms of cancerrisk. So for instance, you
know, getting your periodearlier and having your period
late and having your kids late,that all increases your risk of
breast cancer. But those areall things that happen in the
(27:32):
developed countries becausewe're well nourished, so we get
our periods earlier, we'reeducated, so we have our
children later. And so, youknow, these are things that we
just have to balance out andand realize. But again, the
things that people have mostcontrol over are those , uh,
you know , um, uh, healthyweight, regular exercise,
minimize alcohol, don't smoke,and birth control pills can be
(27:53):
, uh, effective.
Speaker 2 (27:55):
How about sugar?
I've heard , um, eliminatesugar. Cancer loves sugar,
Speaker 3 (28:01):
It's been shown in mice. Um, I like chocolate.
Speaker 2 (28:04):
So I, I think with all of that we're just about
past our time. Um, I would putit back to the both of you. I,
I've so enjoyed speaking to youand hearing , um, uh, all of
this information and I'm, I'msure that our attendees have
done so as well. Is thereanything else that, that we
didn't cover that you think isreally important for everybody
(28:26):
to understand?
Speaker 3 (28:28):
Uh , well, I'll , I'll have , uh, one comment,
which is , uh, I don't know ifwe hit it hard enough, but I'm
gonna say it very precisely. Ifyou are diagnosed with ovarian
cancer, you should have hadgenetic testing for inherited
susceptibility. And if you havenot, you should get it and you
can ask your doctor. Butthere's lots of different ways
to do this. And so sort ofdon't relent it is an absolute
(28:52):
guideline , uh, that all peoplewith ovarian cancer should have
had this testing. Um, and , uh,and I'll , I'll let , uh,
again, Amanda talk about thereare specific things for uterine
cancer as well.
Speaker 4 (29:04):
Yeah, I mean, if it's a young onset uterine
cancer before age 50, even withno family history would be
indicated to do the test. Um,but I also would , uh, empower
the women who might have afamily history. So maybe if
that member of your family withovarian or uterine cancer is
deceased or unwilling to dotesting, it doesn't exclude
that individual from goingforward with the test
(29:25):
themselves.
Speaker 2 (29:26):
Well, thank you both so much for being here. Um, on
behalf of Tina's Wish , um, andmyself, thank you so much for
being here. Um, Amanda Ganekand Dr. Susan Domek . Um, and ,
uh, thank you so much.
Speaker 1 (29:48):
For more information about gynecologic health, visit
tina's wish.org/what to know .
That's tina's wish.org/wO-K-N-O-W. And like, follow or
subscribe wherever you listento your favorite podcasts.
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