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Transcript
Katherine Banwell:
Dr. Gray, for cancers that don’t have a regular screening test, like ovarian cancer, what can women do to stay vigilant?
Dr. Heidi Gray:
Yeah, that’s an important question. So, as you alluded to, ovarian cancer, which is one of our most kind of threatening cancers, it’s very hard to detect at an early stage. And we don’t have a reliable screening method to detect either precancer or pre-ovarian cancer, or even early-stage ovarian cancer.
The two most common methods we use are a blood test, called a CA 125 – okay – which is what we call a tumor marker that can be elevated in ovarian cancers. And then the other tool we use is pelvic ultrasounds, which look at the gynecologic organs, particularly the uterus, the tubes, and the ovaries. These tools we use in a screening method for patients who do have a higher known risk of ovarian cancer. So, as I talked about before, patients who have the BRCA1 or 2 mutation or have a strong family history of either breast or ovarian cancer.
So, we don’t use them in just the general population because actually, some pretty large studies have found that even when we applied it to patients who didn’t have a higher risk of genetic – of ovarian cancer – to a general population, that we didn’t detect cancer at an earlier stage, which is super frustrating.
Katherine Banwell:
Mm-hmm.
Dr. Heidi Gray:
There’s a lot of interest now in looking at blood-based tests to look for screening of precancer, particularly with something called ctDNA, which is detecting either tumors or markers of cancer in the blood well before you would detect them on an image or have symptoms from it. The technology is still being developed, so we don’t really know how to apply it yet, because there sometimes can be what we call falsely positive results – where a result comes back as positive, but it isn’t truly a risk – or falsely negative – where a patient is reassured that they don’t have a risk when they might.
So, but I think that it’s really an exciting time because I do think that we will be coming to a point where we will be able to screen folks at much earlier stages for a variety of different cancers.
Katherine Banwell:
What early warning signs or symptoms should women never ignore?
Dr. Heidi Gray:
Mmm, yeah, very important. So, I would say one of the most important symptoms is bleeding after menopause in women. So, menopause is when your periods stop, and it usually happens around age 50 to 52 for most women. After that time, when periods stop and the bleeding has stopped, any bleeding that comes after that really needs to be paid attention to and should not be kind of ignored or thought of, “Well, this will pass.” So, we really encourage anytime women after menopause have had bleeding or spotting, or discharge that doesn’t go away to please seek out their provider.
Because when that does happen, we do recommend testing, such as a pelvic ultrasound, looking at the uterus, tubes, and ovaries. In addition, sometimes requires a biopsy or a sampling of the uterus.
So, bleeding is definitely one of the most important things. And then, I think, for ovarian cancer, patients who develop ovarian cancer do develop symptoms. I think there’s a lot of misinformation out there that patients who develop ovarian cancer would never have symptoms, and all of that. I think what we know about the symptoms is that they can be a little more subtle. And patients do need to be aware that things like, for example, bloating, which is kind of that sensation of kind of full intestines – everyone experiences bloating every once in a while – but abnormal bloating would be having that sensation over a period of two weeks – 10 days to two weeks – that doesn’t abate.
That would definitely be something that should trigger a visit to a provider to get more testing. In addition, changes to your bladder or how you void or urinate – not just like a one-time irritation, but over time, if you’re finding how you urinate or how your bladder is behaving – can be a subtle sign of ovarian cancer.
Katherine Banwell:
Are well-woman exams necessary to keep up post-menopause?
Dr. Heidi Gray:
Oh, yes. That’s such a great question. Absolutely. I think a lot of women engage with their providers during kind of the childbearing years because they’re having periods, sometimes having pregnancies. And so, there’s a lot more interaction with the medical community. And then sometimes after menopause, a lot of women are like, “Why do I need to go see my doctor? I feel fine, I’m not having any symptoms.” But it’s actually really important.
We know that the vast majority of cancers happen to women in the post-menopause state. So, women in their late 50s to 60s. And so, it actually is a really critical time to keep engaged with your providers. And going into well-women exams, talking about symptoms, having a physical exam, a pelvic exam, and really to make sure that you’re getting the care and potential screening that you need.
Katherine Banwell:
Yeah. If women feel something isn’t right after testing results come back normal, how can they discuss their feeling – probably an intuitive feeling – with their doctor, and then encourage further testing?
Dr. Heidi Gray:
Yeah, that’s also an important question. So, it can be really frustrating sometimes when you feel like something’s not going well or you have some symptoms that are maybe more vague, and you see your provider. And they do some testing and say, “Oh, the blood test looks fine, your exam is fine.”
So, I would really encourage patients to be advocates. I really listen to patients. It’s really important. You know your own body more, by far, than anyone else. And if you feel like something’s changing, you’re not right, ask for a second opinion. Ask about – are there any additional testing? “I’ve never had an ultrasound. How do I know, or –” be an advocate for yourself. I think sometimes busy practitioners don’t always – and if they’re only seeing you once a year, they only see you for a small sliver. So, I think important to be an advocate. And if you’re continuing to have symptoms and you feel like you’re not being listened to, seek out another opinion, and just be a strong advocate for yourself.