Gynecologic Cancers: What Every Woman Needs To Know

Episode Summary

In this conversation, Dr. Troy Gatcliffe, a gynecologic oncologist, discusses the complexities of women's reproductive cancers, including their rising incidence, warning signs, and the importance of early detection. He emphasizes the need for awareness regarding symptoms often dismissed as menopause-related and the significance of regular screenings. The discussion also covers the role of genetics in cancer risk and proactive measures women can take to reduce their risk of gynecologic cancers. In this conversation, Dr. Gatcliffe discusses various aspects of women's health, focusing on misconceptions surrounding hysterectomy, the role of hormone replacement therapy, the impact of weight and estrogen on cancer risk, and the importance of lifestyle choices in cancer prevention. She emphasizes the need for women to advocate for their health, understand their bodies better, and prioritize self-care, especially in midlife.

Takeaways
- Gynecologic oncologists are experts in women's reproductive cancers.
- Endometrial cancer is on the rise, linked to obesity.
- Postmenopausal bleeding is a significant warning sign.
- Women often dismiss symptoms as normal menopause changes.
- Early detection of cancer significantly improves outcomes.
- Ovarian cancer symptoms can be vague and easily overlooked.
- Pap smears are only for cervical cancer screening.
- Genetic testing is crucial for women with a family history of cancer.
- Removing fallopian tubes can reduce ovarian cancer risk.
- Regular screenings are essential for women's health.  Patients often misunderstand the implications of a hysterectomy.
- Hysterectomy can be performed without removing ovaries.
- Doctors should educate patients about their bodies.
- Hormone replacement therapy has both risks and benefits.
- Obesity is linked to increased estrogen levels and cancer risk.
- Lifestyle choices significantly impact cancer prevention.
- HPV vaccination is crucial for both men and women.
- Women often delay seeking medical care for themselves.
- Self-advocacy is essential in healthcare.
- Women should prioritize their health and well-being. 

Chapters
00:00 Introduction to Gynecologic Oncology
07:15 Understanding Common Gynecologic Cancers
14:49 Recognizing Warning Signs and Symptoms
21:50 Screening Guidelines for Women
30:30 The Role of Genetics in Cancer Risk
34:21 Proactive Steps to Reduce Cancer Risk
37:39 Understanding Hysterectomy and Women's Health
44:30 Hormone Replacement Therapy: Risks and Benefits
49:33 The Impact of Weight and Estrogen on Cancer Risk
53:20 Lifestyle Choices and Cancer Prevention
61:26 Advocating for Women's Health in Midlife

Disclaimer

Breast Intentions is intended for informational and entertainment purposes only. The content shared on this podcast is not a substitute for professional medical advice, diagnosis, or treatment. Any views or opinions expressed by the hosts and guests are their own and do not necessarily reflect the views of any affiliated organizations. Always consult with a qualified healthcare provider for medical advice or concerns.

Resources & Mentions:

• Find Dr Troy Gatcliffe (https://doctors.umiamihealth.org/provider/troy-a-gatcliffe/2723228) 

• Follow us on Instagram and Facebook (@breastintentionspodcast ) 

Connect With Us: Have a topic or guest suggestion? Email us at breastintentionspodcast@gmail.com 

Transcript

SPEAKER_01 0:00

The thing about that warning bleed is that it typically comes early and it's it's a great warning sign and if everyone paid attention to it we'd probably catch a number of things earlier and people would be more in the realm of curability. The problem that we have is that you know when you dig down in the history, because you know the old adage from medical school is that it's all in the history, you know, it's all in the history. You've got to examine the patient, you can, you know, uh get all the fancy tests, but still so much comes from talking to the patient and really working through the history with her.

SPEAKER_03 0:45

Welcome to Breast Intentions, the podcast where we take off the bra of expectations and dive into honest, empowering conversations. We're your hosts, Nadine and Cynthia, two Canadian girls who swapped snow boots for flip-flops in the Cayman Islands. This is your space to feel seen, supported, and a little less alone. So grab a cup of coffee or a glass of champagne and get ready for your weekly handful of truth, wellness, and empowerment. Welcome back to Breast Intentions. Today we're joined by Dr. Troy Gatcliff to talk about the gynecologic cancers and warning signs too many women in midlife overlook or dismiss as just menopause. From ovarian cancer and hormone therapy to screening, prevention, and self-advocacy. This episode is filled with life-changing information every woman needs to hear.

SPEAKER_04 1:35

So on today's episode, we have Dr. Troy Gatcliffe. Welcome to the show.

SPEAKER_01 1:40

Thank you for having me.

SPEAKER_04 1:41

Thanks for coming. And you are a gynecologic oncologist.

SPEAKER_01 1:45

Yes.

SPEAKER_04 1:46

What is that?

SPEAKER_01 1:48

So a gynecologic oncologist is a comprehensive women's cancer surgeon. Okay. We consider ourselves the expert in women's reproductive cancers. So we perform both the surgeries required and administer and order the chemotherapy for those cancers. So women's reproductive tract cancers starting from the outside, going in, vulvar, vaginal, cervical, uterine, ovarian, fallopian tube cancers. And then there's one other little one that gets grouped with us, which is primary peritoneal cancer, because the lining of your abdomen, which is called the peritoneum, originates embryologically from the same place as your ovaries and fallopian tubes. So cancers that grow from the peritoneum are very similar and have the same um characteristics as ovarian and fallopian tube cancers. So we treat primary peritoneal as well.

SPEAKER_04 3:00

So um very different than a gynecologist. Or not very different.

SPEAKER_01 3:06

No, not very different. So we're all we're we're we all start training as obstetricians and gynecologists.

SPEAKER_04 3:12

Okay, so that's what you started as?

SPEAKER_01 3:13

Yeah. So I I went to um you know medical school and then chose to do OBGYN and uh did a residency in OBGYN and then figured out uh during my residency that I really enjoyed surgery more than obstetrics. Um and so that takes you down the path of the various surgical subspecialties in OBGYN. And uh and then I did uh an elective during my um residency in gynecologic oncology, where I went to a different institution and really got my fingers into what gynecologic oncology was, and I was like, yeah, this this could sustain me for my life. This this could this could keep me interested for for a career. Yeah, I liked I liked cancer, I liked um the the struggle that cancer patients go through, and I felt that I had never met cancer patients like that before in my career. Um and these women were like heroes to me, you know? So I was very drawn to that, and I was also very drawn to this unique um place that uh uh GYN oncology or gynecologic oncology has in the cancer world because we are uh the only uh surgical oncologists that also give our own chemotherapy. So it's a little bit of a niche specialty in that regard. Um other surgical oncologists like the person that's gonna perform your colon cancer or your breast cancer, they're gonna have to send that patient on to a medical oncologist should that patient require additional treatment, whereas we don't have to. So gynecologic oncologist, yeah. How come it's a it's a good question. I kind of actually know the answer. So the the specialty was really incepted and formalized in the late 60s, and my prior mentor was one of the guys that was around when that was being done. And so I was actually his last fellow. I graduated in 2010 from fellowship. And um, you know, he said that when they were sitting down and trying to figure out how to create the specialty because it obviously needed to be done, you know, GYN cancers needed to have their own world and their own sub-specialists and their own surgeons. He said, you know, it would be very wise for us at this point to co-opt the chemotherapy of our cancers into the specialty. And none of the other surgical specialties had done that for cancers. So it was a bit of a struggle. The medical oncologists, who are typically the folks that give chemotherapy, were not too, too happy with that, but they managed to do it. Okay, and uh and so we are we are the only surgical oncologists that are also trained to give chemotherapy.

SPEAKER_04 6:21

So then you also follow your patients through their whole journey. Yeah, which is great.

SPEAKER_01 6:27

The whole arc of their yeah, so it must be so rewarding. Yeah. The whole arc of their treatment and their hopefully long surveillance and into full remission and cure. Yeah.

SPEAKER_04 6:40

Wow. Very cool.

SPEAKER_03 6:42

That is cool.

SPEAKER_04 6:42

Yeah. So let me start with um the first question that I have for you is for women in midlife, what are the most common gynecologic cancers that you're seeing right now? And are those trends changing?

SPEAKER_01 6:57

Yeah, that's a great question. So most of the gynecologic cancers cluster around the postmenopause. But there is an increasing trend in the last, I would say, decade that we are seeing an uptick in endometrial cancers. So that's cancer of the lining of the womb. And that's heavily related to the epidemic of obesity. Along with a couple other factors, it's not just that, but endometrial cancer is one of the few cancers that continues to rise. And um we are really trying to study and figure out why that is happening. And one of the putative causes is the fact that um the world's getting heavier, the population's getting heavier, and we see more and more obesity. It is very much um a lifestyle cancer.

SPEAKER_06 7:58

Okay. Yeah.

SPEAKER_01 7:59

So is it? It is, yeah, endometrial cancer, most of it. Most of it, not all. Okay. Yeah. There's exceptions to everything.

SPEAKER_04 8:07

But yeah. And before it used to be uh women post-menopause.

SPEAKER_01 8:12

Yeah, it was post-menopausal, women postmenopausal. Yeah. Still is, it still is mostly preponderant in the postmenopausal group, but we're seeing younger and younger women with endometrial cancers, yeah.

SPEAKER_04 8:26

Okay. So then for women who are older that have the cancer, is that also um like lifestyle related or is it age related? It's lifestyle.

SPEAKER_01 8:38

It is lifestyle, a lot of lifestyle relatedness, yeah.

SPEAKER_04 8:42

We might have to get into a couple of those questions too. Yeah. Um, what are the symptoms that are often dismissed as just menopause that could actually be something more serious? And I think we were just talking about it before, which is the bleeding as well, right?

SPEAKER_01 8:56

Yeah, that's the that's the thing, is that folks um, you know, will sometimes think, well, they just had a, you know, they just had a bleed and it was just a period. Um but you know, we really try to educate our patients, especially the general OBGYS, that the textbook definition, the medical definition of menopause is the absence of menses for a year. Right. I think most people know that, but people kind of forget that. So, you know, a year and a half goes by and you have a bleed, that's not normal. That's a postmenopausal bleed. And that needs to be investigated. It doesn't mean you have cancer. Right, right, but it does mean that you um need to follow up with a physician, check the thickness of the lining, probably have a biopsy and figure out what's going on.

SPEAKER_04 9:48

So don't just chalk it up to oh, just a randomly.

SPEAKER_01 9:53

Yeah, just a randomly. Yeah, if you're still if you're still in that perimenopausal time where your periods are becoming irregular and it's been a few months and you're having on and off periods, and you know, but you know, the joke that I always say to my patients is that you know, your last period doesn't come with a flag, you know, I'm your last period.

SPEAKER_04 10:14

Right, yeah.

SPEAKER_01 10:15

You only know that in hindsight.

SPEAKER_04 10:16

Yeah, true.

SPEAKER_01 10:17

You know, but once you pass that one year mark, you know, and people forget, you know, life is busy. Yeah, yeah. Like, well, what was my last period? February or last February or last April? You know, but women are pretty in tuned with their bodies in a way that most men aren't.

SPEAKER_04 10:37

Yeah. And I I want to ask this because I think that there might be other people that may want to ask it as well. Is like, what do you consider like the bleed? Like, is it except like a spot or something?

SPEAKER_01 10:48

Yeah, so I actually gave a talk in uh in the HSAs, uh they had a the women's conference. We were there, yeah, yeah. And I talked about postmenopausal bleeding, and it can be anything. So it doesn't have to be like a bright red bleed, it doesn't have to be a period quantity bleed.

SPEAKER_06 11:08

Okay.

SPEAKER_01 11:08

You know, any postmenopausal woman that sees blood-like or even pink staining on a pad or a panty shield or a liner or anything, or on toilet tissue, that's not normal. It just it just means like you need to check it out.

SPEAKER_05 11:26

Yeah.

SPEAKER_01 11:27

Don't don't dismiss it. Okay. Far less like a real bleed.

SPEAKER_04 11:31

Okay.

SPEAKER_01 11:32

Yeah.

SPEAKER_04 11:32

Okay. And are there any other symptoms or of endometrial?

SPEAKER_01 11:38

Are we talking about specifically or we could, I guess, yeah.

SPEAKER_04 11:43

If that's maybe more of the common one that you see, I guess.

SPEAKER_01 11:46

Well, that's the one that we're seeing rising.

SPEAKER_04 11:49

Okay.

SPEAKER_01 11:50

So that's the one that like kind of we're focused on a lot.

SPEAKER_04 11:53

And the the bleeding would be related to the endometrial.

SPEAKER_01 11:55

Mm-hmm.

SPEAKER_04 11:56

Okay.

SPEAKER_01 11:56

Yeah. But, you know, the other cancers can also, specifically cervical cancer, can cause bleeding. Um, ovarian cancer, not so much, but vaginal cancer is very rare cancer, super rare. Even for us, we see it very, very rarely. Vulvar cancer. But bleeding on the whole in the postmenopause needs to be looked at. Okay. Needs to be investigated.

unknown 12:23

Okay.

SPEAKER_03 12:23

I think that's really good. I'm glad that you said that because I think I probably would just be like, oh, being a woman, yeah, it sucks. And I probably would kind of chalk it up or just ignore it and go about my day.

SPEAKER_05 12:37

Yeah.

SPEAKER_03 12:38

Even a year into it or a year and a half into it. Sure. Yeah.

SPEAKER_05 12:41

Yeah.

SPEAKER_03 12:42

So that's good.

SPEAKER_04 12:43

Yeah. I I do actually have an old client who it happened to her. And um, she did go and see a doctor. We're we're both from Canada. And where I think a lot of people also are like, I'm not gonna bother going in to see the doctor. One, I probably can in, can't get in to see the doctor. It's gonna be a long wait. Um, and then possibly getting dismissed or something like that. And um, she ended up, she worked for a hospital actually, and she ended up going in and she did have cancer.

SPEAKER_01 13:13

So endometrial.

SPEAKER_04 13:15

You know, I don't know exactly what it was, but I'll have to ask her now. Now that we're talking about it. Now that we know a bit more. Yeah. Um, if a woman could remember only one red flag symptom, what would you want it to be? I'm gonna guess it's probably the bleeding.

SPEAKER_01 13:32

It's the one we're talking about. Yeah, it really it really is. Um because you know, the thing about that warning bleed is that it typically comes early. Um and it's it's a great warning sign. And if everyone paid attention to it, we'd probably catch a number of things earlier, and people would be more in the realm of curability. The problem that we have is that you know uh when you dig down in the history, because you know, the old adage from medical school is that it's all in the history, you know, it's all in the history. You gotta examine the patient, you can, you know, uh get all the fancy tests, but still, so much comes from talking to the patient and really working through the history with her.

SPEAKER_04 14:22

Like history of family or history of the family.

SPEAKER_01 14:23

No, the history of the history of the complaint.

SPEAKER_04 14:26

Oh.

SPEAKER_01 14:26

So you know you're talking to the patient, and she's like, you know, what I've been having this bleeding. Okay, well, tell me about this bleeding. How long have you been having it? How heavy it is, when do you remember that it first began? She's like, you know. And you know, they sometimes have a partner or a husband or a daughter in the room, and they're like, you know, I think it was like six months ago. It's like, well, six months ago it was summer. Let's talk about last Christmas or last new year. Try to peg it to different times in the calendar. And she'd be like, Yeah, you know, you know, that's I was bleeding at Christmas. So I said, well, that's a year ago, you know?

SPEAKER_05 14:59

Right.

SPEAKER_01 14:59

And then sometimes patients will be very honest and be like, no, this happened once or twice two years ago, and I never followed up. So then you're like, oh, you know, so now you have someone who's had on and off bleeding for a number of years. And then the possibility that they, I'm not saying that they would, but the likelihood that they may have more advanced disease becomes really real. Yeah. As opposed to the patient who, you know, has a bleed and says, uh oh, this isn't this is not good. I'm gonna call my doctor and is in in a month, gets a biopsy in a month, gets a diagnosis, gets a surgery, right? Much higher likelihood that she's gonna be caught early.

SPEAKER_03 15:45

Okay. That's the that's I mean true for all cancer, I suppose, right? Is the earlier detection, the better. Yeah.

SPEAKER_01 15:53

100%. 100%. Yeah. I know that I looked further down in your questions and you were talking about the problem with some of our cancers is they don't have, and that's the thing about the red flag warning sign, the bleed, you know. Um, it's it's there, it's real. Um, we're not so lucky with like ovarian cancer, you know, very silent, um, very vague symptoms. Um, not often it doesn't have a primary red flag warning sign that people can pay attention to. Right.

SPEAKER_04 16:26

I believe that that's what Cass had was ovarian.

SPEAKER_03 16:29

I think I think that's where it started, right? Yeah.

SPEAKER_04 16:32

Yeah. Um, is there some symptoms where it's like stomach issues, like weird bloating, like lower abdominal.

SPEAKER_01 16:40

Yeah, that's ovarian. Yeah, that's ovarian. Or it could be a symptom of any of the advanced kind of collagen cancers, but that's kind of one of the main ones for ovarian.

unknown 16:52

Yeah.

SPEAKER_04 16:53

It could probably also be um colon, too, right?

SPEAKER_01 16:56

100%.

SPEAKER_03 16:57

Yeah.

SPEAKER_01 16:57

Yeah.

SPEAKER_03 16:58

It could also be just being, you know, being a woman and having, I don't know, like lots of that's the thing.

SPEAKER_01 17:04

It's like the thing is that I had a crappy meal last night, I feel bloated. You you women are, you see, women are so used to the course of their in the course of their life to understanding bloating symptoms, right? And where does bloating come from, right? Bloating comes from the fact that when you menstruate every month, a certain fraction of your menses ends up in your abdomen. This is not a fact that's actually known by a lot of people. But when you it doesn't all go out your cervix, it doesn't all go out your cervix, out your vagina, and into the world, right? Onto a pad or into a tampon. So there are three exit points from your uterus, the two fallopian tubes and your cervix. Now the cervix is the bigger highway, and so most of your menses comes out of, most of your menstrual flow comes out of your cervix and into the vagina and out. But a pretty decent portion ends up going retrograde through the fallopian tubes. It'll follow the same path as a sperm, okay? Okay, and it'll spill out the fallopian tube into the abdomen. And your abdomen is not a place that likes blood.

SPEAKER_05 18:23

No.

SPEAKER_01 18:24

So when blood hits your abdominal lining, the peritoneal lining, you get bloated and you get gassy, and you feel crampy, and you feel yucky, and your GI tract goes off, and you going to the bathroom doesn't feel great, and all of those symptoms that men have no concept of. None. Because but women get that, you know, nine, ten, twelve times in a year, so they're very used to it. So you have that built into your memory, your your genetics almost. So you take a 60-year-old woman, and you know, she's just like, oh, I just kind of feel gassy and bloated. Yeah. You know, like I had a bad taco. Yeah. Exactly. Exactly. Yeah. You know, but that's those are some of the very whispering signs, as we say, of of ovarian cancer. Wow.

SPEAKER_04 19:28

Wow. Okay.

SPEAKER_01 19:30

Okay.

SPEAKER_04 19:30

Okay.

SPEAKER_03 19:34

When I saw it, I didn't really did not know that. No. I didn't know that. I think I just thought like everything was inflamed. And that's what I thought.

SPEAKER_01 19:43

Everything is inflamed too, but it but it has a lot to do with retrograde menstruation. Yeah. So we when we do surgeries on women for other things, young women for like a fibroid or a cyst, and they happen to be on their menses, and we put a camera inside their belly, you know, you can see it.

SPEAKER_05 20:01

Why?

SPEAKER_01 20:02

Yeah.

SPEAKER_04 20:03

This is so crazy. Where does it go?

unknown 20:06

Yeah.

SPEAKER_01 20:06

It gets absorbed.

SPEAKER_04 20:08

It does.

SPEAKER_01 20:08

Yeah, it just gets absorbed. It doesn't get the blood breaks down.

SPEAKER_04 20:12

Like it doesn't come out in your stool, and all of a sudden you see blood. No.

SPEAKER_01 20:16

No. Yeah. The blood will break down, decompose, and it'll get absorbed by the lining of your abdomen. Yeah.

SPEAKER_04 20:23

Okay. Wow. It's a wild. It is. It's very interesting.

SPEAKER_01 20:28

We should change the podcast to wild gynecology for this.

SPEAKER_04 20:34

We could probably do a really cool episode on that.

SPEAKER_03 20:37

Yeah. Yeah. Wow. Now that's I'm way too old to just be learning that. Yeah.

SPEAKER_04 20:47

Oh, okay. So this is a question that I do want to ask because I think that a lot of people would want to know as well. Is women who are in their 40s and 50s, what should they actually be prioritizing when it comes to screenings? I'm guessing they're pap smears, which aren't even like yearly anymore. Anymore, yeah. Like what's your thoughts on that?

SPEAKER_01 21:09

So I think from an epidemiological standpoint and from a population perspective, I get where the task forces that look at these guidelines and create them. I get where they're coming from. And I think that the guidelines are built around uh women who follow up and women who are really health literate and have good access to healthcare. The problem is that not everybody has good access to healthcare. Not everybody has really high health literacy, and not everybody follows up. And have phenomenal access to care. But um sometimes don't follow up. And you know, life is busy. Um as I've learned, taking care of women for my life, women are the primary caregivers of every family, including the husband. So they're taking care of everybody and often not taking care of themselves. This is something that we know really well, you know. So there's there's sometimes some self-neglect, and you know, um two, three years have gone by and somebody hasn't gotten a pap smear. Now, if you're in a mutually monogamous relationship, you have a long history of normal pap smears, you have no concerns for any high-risk behaviors, and that could be a whole podcast.

SPEAKER_04 22:51

High risk behaviors. What do you mean by that?

SPEAKER_01 22:53

High risk behaviors. So high-risk behaviors for cervical cancer for pap smears are the fact that you are in a mutually monogamous relationship. So you don't have any other partners, and your partner doesn't have any other partners. So as soon as there is a thought that that may not be the case, you now have a high-risk situation.

SPEAKER_04 23:18

Oh, okay.

SPEAKER_01 23:20

So that person is now exposed potentially to HPV in a way that she was not expecting or knowing. And, you know, um, men have affairs, but women have affairs too. And so um, you know, I always say to my patients, I said, you know, um, do you are you do you feel like you're in a mutually monogamous relationship? And if the patient says yes, I feel secure and comfortable with that, you have a long history of pap smears, okay, great. I'll see you in three years for a pap smear.

SPEAKER_06 23:55

Okay.

SPEAKER_01 23:55

But, you know, if that's not the case, or something's happened, or there's been a question of infidelity, or the patient herself has had an outside um infidelity or to to whatever relationship, or even if there's no infidelity, she just has multiple partners, like it could be single, and yeah. Somebody who's single and dating, yeah. Then that person needs um to be followed more closely, you know?

SPEAKER_04 24:22

That's good to know. Yeah.

SPEAKER_01 24:24

So the at with the advent of HPV testing, where we're dirt, where we're headed is that HPV testing is gonna become the mainstay. It already is, but we're you know, the world is transitioning to that, where the the presence of the virus is more predictive of what may happen with that individual patient than the actual smear itself.

SPEAKER_04 24:48

And that one's also silent too, right?

SPEAKER_01 24:52

Yeah, cervix cancer is is can be kind of silent in the very early stages when it is treatable with surgery, which is really only in the very early stages.

SPEAKER_06 25:04

Okay.

SPEAKER_01 25:05

Um uh it can be quite quite silent. Okay. So, like, you know, for example, I I I um I tell uh older women, older patients, you know, sometimes um spouses pass or people get divorced or separated, people date anew. Then to me, that woman is like an 18-year-old. Yeah, even if she's 68. Right. Because now she's kind of back in the exposure realm where she could be being exposed to the virus again. You know, maybe after a long life of monogamy, for whatever reason that relationship has come to an end, and now she's found a new partner or has a new love. And uh now that's a different level of exposure.

SPEAKER_04 25:56

Okay. Oh, that's actually one of my other questions is about pap smears. So then are pap smears enough, or do they miss certain cancers that women assume they're protected from?

SPEAKER_01 26:09

Yeah, so that's a great question. So I think women think that like a pap smear is a global cancer screen.

SPEAKER_03 26:20

Yeah.

SPEAKER_01 26:20

And it's only a screen for cervix cancer.

SPEAKER_03 26:24

I didn't know that either. No. Did you know that?

SPEAKER_01 26:26

Only a screen for cervix cancer. So a pap smear as it is now collects cells from the outside of the cervix and it's one of medicine's most revered screening tests. It's been around for decades. Yeah. Um, and it's highly effective, it's really easy to do, it's low cost, it's the perfect screening test, except for the fact that you know you have to come into a doctor's office and you know, put yourself in stirrups and have a speculum placed in your vagina, but not even so now, because now that we have HPV, you can self-collect in the privacy of your home.

SPEAKER_05 27:08

Really?

SPEAKER_01 27:09

Yeah, you can self-collect your specimen, especially the HPV specimen. But back to the pap smear, the pap smear and the whole HPV thing is really just for cervix. It's not for ovarian, it's not for fallopian tube, it's not for uterine cancer, it's not designed to be a screening test, so it's not a global gynecologic screening test. So I think women think, you know, I've I've gone for my PAP, I'm good.

SPEAKER_05 27:37

Yeah, so for sure.

SPEAKER_01 27:39

So women with ovarian cancer all the time will be like they come in, I I had my PAP. Yeah. I was like, I know you had your PAP and your cervix is perfect. Yeah, right. It's great.

SPEAKER_04 27:50

But so what can you do? Like what else can you do?

SPEAKER_01 27:54

For what?

SPEAKER_04 27:55

Like to say for the screen for like ovarian and stuff.

SPEAKER_01 27:58

Yeah, so we are we medicine are working really hard on that. Um, how to come up with uh an effective population-based, cost-effective screening test. So then it's for ovarian, we don't have one yet.

SPEAKER_04 28:16

So then is it fair to say that it's kind of left up to the patient to convey how they're feeling or their symptoms to you?

SPEAKER_01 28:26

Well, it no, because that kind of puts it on the patients, and this is like a thing that we deal with, you know, with with ovarian cancer a lot, where patients get into a situation where they get into like self-blame.

SPEAKER_03 28:39

And like, how Why didn't I catch this sooner? Why didn't I know something was wrong with me?

SPEAKER_01 28:44

Yeah, 70, 80% of ovarian cancers are diagnosed at stage three, advanced, like widely disseminated in the abdomen.

SPEAKER_06 28:53

Right.

SPEAKER_01 28:54

And patients will be like, I don't understand how I got here. I don't understand how I missed this. And I'm like, well, that's you and most women. Okay. So it's not uh like the patient missed it. It's the fact that the the cancer is a silent whisperer. Yeah. Doesn't have that warning sign like the bleed.

SPEAKER_04 29:19

Right.

SPEAKER_03 29:20

Yeah, it's very sad. It is. It's it's you know, you hope that there's something that you can be like, well, everybody just do this, yeah, and then you'll catch it.

SPEAKER_01 29:30

Yeah, but it's like well, I think lower down we're gonna get uh some top some questions about prevention. Oh, okay, great. And like we have a whole new drum that we're beating with that. And so we'll we'll get to that, I guess, when we get there. We'll circle back on ovarian. Yeah, because there's a there's a big new light on the horizon. Good. Yeah.

SPEAKER_04 29:51

Good. Okay. What about um genetics?

SPEAKER_01 29:56

So uh do genetics play a role and should women consider getting genetic testing or yeah, so um I think the time will come really soon where probably we'll all be tested for a lot of genetic things just because the cost will become so low, but we're not there yet. So still we need our genetic counselor colleagues and all of their expertise to help us delineate who are the people to test.

SPEAKER_05 30:29

Okay.

SPEAKER_01 30:29

Because we can't just test the whole population because it would be too expensive. Right. And we're not there yet, but we're gonna get there.

SPEAKER_05 30:36

Okay, okay.

SPEAKER_01 30:37

Um, but uh the most important thing is obviously family history. So we're talking about history, the history of the complaint, the history of the symptom, but family history and your genetic history is super important. And um, you know, if there is a clustering of cancers in your family, then you want to go to a genetic counselor. Very easy to get referred by any primary care physician, and let a genetic counselor do your family's pedigree. And sometimes, you know, people have cancers in their family, but they're not clustering around genes. Yeah. You know, like you have an uncle with pancreas and a dad who had lung and an aunt who had endoservix, for example. Those don't, you know, match.

SPEAKER_06 31:28

Okay.

SPEAKER_01 31:28

But what we do know is that breast and ovarian cluster. So about 25% of the population, around about there, have cancers that are genetically driven in breast and ovary. And now we have more than just the big two BRCA1 and two, we have about eight genes that we know about, and we're discovering more as the years go by that lead to an increased chance of developing breast and ovarian cancer. So if you have a clustering of breast in your family, in particular breast under the age of 50 or premenopausal breast cancer, and ovarian, which tends to cluster in the postmenopausal patients, but you have those clusterings, that family needs a pedigree and they need to be tested. Similarly to endometrial cancers and ovarian cancers cluster along with colon cancers in a syndrome called Lynch syndrome.

SPEAKER_04 32:30

I've heard of that.

SPEAKER_01 32:30

So Lynch syndrome, the two big cancers in Lynch syndrome are colon and endometrial. So a bunch of colon in the family and a couple of endometrials here and there, and maybe an ovarian. That family needs a pedigree, they need to be tested. So there are some cancers that cluster in gynecologic cancer. Um breast, colon, endometrial, ovary, those are all the ones. The common misconception, for example, is um patient will come in and say, you know, my mom had cervical cancer too. So this must be genetic. But of course, like we've been talking about, cervical cancer is caused by a virus that's sexually transmitted.

SPEAKER_06 33:15

Right.

SPEAKER_01 33:16

So if you have a family member, even a first-degree relative that had cervical cancer, that's just chance. It has nothing to do with genes. But you see, patients will see that as maybe a genetic connection.

SPEAKER_04 33:31

Oh, okay. Very interesting. Yeah. Um, let's go over to like proactive steps and uh different things that women can do to help reduce their cancer risk.

SPEAKER_01 33:46

Sure. So we talked about some of them. Yeah, we talked about some of them. So I think um I think screening for cervix, really big, really important. Um, we talked about the relaxed guidelines, but if you're young and you're dating and you have multiple partners in a year, or you're older and you're dating and you have multiple partners in a year, you probably need to continue getting PAPS mirrors annually. So, screening, really important. Um the the thing that we're moving to with ovarian cancer, which is really huge, and there are some big international studies going on that I think will result in the next few years that'll probably really change the paradigm, is that we now know, not now, for a good while now, number of years, that really and truly most ovarian cancers actually begin in the fallopian tube.

SPEAKER_06 34:45

Okay.

SPEAKER_01 34:45

So what we've been calling ovarian cancer for generations are actually really fallopian tube cancers. So some really elegant studies over a decade ago realized that there are some precursor lesions that develop in the fallopian tube uh that then turn into cancer cancerous cells that then drop onto the ovary, and we think we thought that they came from the ovary itself, but they actually come from the tube. The good news is that um your tubes don't do anything except help you reproduce. They don't provide support for your pelvis, they don't prov make hormones. So once you are certain that you have completed childbearing or that you no longer want future fertility, we're now moving really heavily to what's what we call opportunistic sap injectomy. Meaning that anybody in any surgical specialty ends up in uh the abdomen of a young woman who has declared, she obviously has to you have to know that, and that's a key thing because we can't have patients feeling that doctors are just gonna go in and rip out their tubes. Right. But once the patient has been counseled, and what we're trying to do is get all of our surgical colleagues, general surgeons, colorectal surgeons, not just gynecologists, everybody to bind to the fact that if you have a patient that states that they do not desire future fertility, andor has completed childbearing, andor has their tubes tied, like a segment of the tube removed, and you're in her abdomen for some other reason, take out the rest of the tubes. So we think that we will have a really significant decrease in ovarian cancer, which is one of our rarer cancers, but one of our cancers that we don't have the screening test for or a great screening test for, so it's caught often late. We could really have an impact if we remove the fallopian tubes.

SPEAKER_03 36:58

We can just remove the tubes without taking the ovary, without Yeah.

SPEAKER_01 37:03

So, you know, explaining the anatomy to women is um to my patients is something I do all the time. And um, you know, even in clinic this afternoon, you know, I had a patient that had avoided a hysterectomy for years because she thought that her hormones came from her uterus, but they don't, right? So your tubes, your ovaries, and your uterus are very separate organs and they can be dealt with surgically separately. So having a hysterectomy, removing the uterus because of, say, bleeding or fibroids, um, doesn't mean that you automatically have to lose your ovaries as well.

SPEAKER_04 37:44

Is that considered a partial hysterectomy?

SPEAKER_01 37:46

So that's a great word. That's that's the that's the misconception. So what doctors call a partial hysterectomy is when the cervix is left behind, which is a part of the uterus. The cervix and the uterus have two different names, but they are kind of one organ, one unit.

SPEAKER_06 38:05

Okay.

SPEAKER_01 38:07

But patients think that a partial hysterectomy is where the ovaries are left behind. Yes. So the medical terms, the the medical terms for the surgeons are total versus partial, which is where a piece of the uterus is left behind.

SPEAKER_02 38:22

Okay.

SPEAKER_01 38:22

Meaning the cervix. But hysterectomy is often done with removal of the tubes and or ovaries as well. And that part of the procedure has a totally different name.

SPEAKER_03 38:36

Oh.

SPEAKER_01 38:36

And it has a totally, it's not, it's not hysterectomy.

SPEAKER_03 38:39

Right, right, right.

SPEAKER_01 38:40

So you know it's ouperectomy.

SPEAKER_03 38:43

I had I had a right oopherectomy, side. Yeah, yeah. A right oopherectomy. Right, and the tube on that side. Yeah.

SPEAKER_01 38:52

So you had a right salpingoofrectomy, and it was done without removing your uterus.

SPEAKER_05 38:57

Yeah.

SPEAKER_01 38:57

Yeah. So salpingoofrectomy or salpingectomy or oofrectomy are all different pieces of the puzzle. So you don't have to, you know, you can go into a woman's abdomen, not touch her uterus. Say there's nothing wrong with her uterus. Why are you gonna take her uterus off for? Nothing's wrong with it. You know, classic set, say 42-year-old woman, three kids, no plans for more, she's done. She may even have had her tubes tied, where a small segment of the tube was removed to interrupt the tube. But the rest of the tube, most importantly, the fimbria, which is the end of the tube that sits on the ovary that picks up the egg that brings the sperm and egg together, um, that's the part that we really want to take out. So the fimbria can be left behind after somebody's tied their tubes. Say now that 42-year-old woman ends up with uh an appendicitis and she's in the hospital and she has tubes are tied. Then what we want is to evolve to the point where the general surgeon who's going in to take out her appendix knows in the future that the very best thing to do for this woman is fix her appendix. But while you're there, super simple. Just go chip chip, take off both of the tubes and get them out the patient because that could save her from a future ovarian cancer. So opportunistic sap injectomy.

SPEAKER_04 40:27

Yeah, I see. I can imagine, because it's not something that's happening a lot right now. No, I can imagine though, there's gonna have to be so much education around it because a woman's gonna be like, Yeah, I don't know what you're doing, and I I don't consent to that. Don't take it to learning more about it.

SPEAKER_01 40:47

Yeah. But you know, I mean, look, we're all patients at some point, and you have to just trust the physician, the surgeon that's taking care of you. And I think, you know, our job is to educate. You know, I tell the med students that I teach every day in Miami that you know, the word doctor is Latin for teacher. So doctors are teachers. Um, and our goal is to teach our patients about their bodies. And remember that patients, unless they're doctors too, medical doctors, don't know. No, you know, they they don't know. You can't assume that, you know, even the most highly educated patient understands that her tubes don't make hormones, that her uterus doesn't make hormones, that if you take out her uterus, you could leave her ovaries behind. You can't assume these things.

SPEAKER_03 41:38

And honestly, like I don't think we talk about women's bodies, or at least haven't in the past, like enough. Like we're women, we don't even know this. Yeah, like it's just all like we just assume it's all connected and nobody tells us different. Why would we go? We're not gonna go research it ourselves unless there was a reason for it, unless we were looking looking something up at Google.

SPEAKER_01 42:00

Well, that's the reason that you know, it's the reason that um breast is not only is breast the big female cancer, but you know, breasts are on the outside.

SPEAKER_05 42:08

Right.

SPEAKER_01 42:08

They can be seen, yeah, they can be examined. Women have a very personal relationship with their breasts because it's part of their outer structures, it's part of their body image, you know, it's part of who they are. You know, it's like it's uh your arm or your nose, you know. Yeah, but people don't have a great understanding of what's going on in their pelvis.

SPEAKER_03 42:31

Definitely.

SPEAKER_01 42:32

Yeah, they don't understand like tubes, ovaries.

SPEAKER_03 42:34

Yeah, we know that we, we as women, like we know they're there. They have a job and they do what they're meant to do. But as far as, yeah, I'm learning a lot.

SPEAKER_01 42:45

Tons of women, tons of women ask me that ask me, for example, um, that if they have a hysterectomy, um what'll happen to their vagina? Okay, right, because lots of women have hysterectomies and you know obviously want to go on to be continually and normally sexually active. And you have to show them diagrams and bring out a uh and say, well, nothing's gonna change about your vagina.

SPEAKER_06 43:13

Right.

SPEAKER_01 43:13

And for intercourse, what you need is your vagina, right? So people say, Well, is it gonna get shorter? Are you gonna close it? Is it gonna change? Um, and the answer is with a normal hysterectomy, no, you know.

SPEAKER_04 43:30

You wouldn't even know.

SPEAKER_01 43:31

Yeah, yeah. You wouldn't even know, there'd be no difference. Right.

SPEAKER_04 43:34

Yeah. Okay. Okay.

SPEAKER_03 43:37

This is very interesting. Um, so we're talking about midlife women, we're talking about hormone replacement therapy. Um, a lot of us are taking it or considering taking it. Does HRT incre increase cancer risk, or is that like misunderstood?

SPEAKER_01 43:54

I think it is misunderstood, and the scientific answer is. It increases the cancer risk for certain cancers. But that that increased risk, even though by multiples sounds, you know, sounds a lot. For example, you know, if you said to somebody, you know, that if you take HRT, you would double or triple your rate of endometrial cancer, it sounds like whoa, wow. But the actual statistical number, the true rate of increase is really small, relatively speaking.

SPEAKER_06 44:33

Okay.

SPEAKER_01 44:34

So, you know, I was trained by the very same uh guy that uh I was talking about that was around when the um specialty was being accepted, Philip De Saia. Um and he was a great believer in hormone replacement therapy for women. Back then, back would not just back then, because this is only 16 years ago I left fellowship. Oh yeah, okay. So yeah, so he, you know, he people would come from far and wide to um get hormone replacement therapy from him. And I think once you counsel people and you educate them on what the risks are, um there's a certain cohort of people for whom taking hormones in the post-menopause is really life-changing. I think what's I think where we are right now is that there are a number of people that are taking hormones because it's just the thing to do.

SPEAKER_06 45:29

Right.

SPEAKER_01 45:29

And everybody wants to feel better, live longer, and not go through menopause or not have to deal with those symptoms. But I think that what I would counsel, what I still counsel my patients to do, and even the female members of my family, is you know, see how menopause feels to you. And you can tackle various aspects of the symptoms that you have in various ways that may not increase your risk as much. Now, if you're having a terrible, terrible menopause and it's a really, really rough ride, and you're very, very symptomatic and you're very miserable, then you're probably a great person to take hormones. Of course, provided that you don't have any contraindications to taking hormones, like you're a smoker, or you have hormone receptive positive breast cancer, or other things that could be really important. But let's just take your average woman who's gonna go into menopause at you know 49, 50, 51. I kind of try to encourage folks to kind of like see what it's gonna be like and not just be like, well, you know, I'm perimenopause, so I'm gonna start taking hormones, you know. I'm like, okay, well, that's not unreasonable, but but but how do you know that it's gonna be terrible?

SPEAKER_03 46:58

Yeah.

SPEAKER_01 46:58

Now, you know, as a man, I'm never gonna have the symptoms and I'm never gonna understand them. But I've counseled and spoken to so many women who go through menopause that there's just the hugest breath, just like of humanity. There's just this wide range of experiences. And I think that everybody automatically focuses on the you know, the kind of like the crazy, sleep-deprived, you know, uh upset, anxious woman who's having terrible hot flashes and has a dry vagina and has no libido and her whole world has gone upside down. Well, that's a lot of people. That is a lot of people. Yeah, 100%. Um, but there are a lot of people that don't have that experience as well. Right, yeah, that may have some of the symptoms. So what are your symptoms? You know, what do you need the HRT for? For example, if you're if your main complaint is vaginal dryness, one of the most common complaints, you don't need to take systemic HRT to take care of that. You could actually take vaginal hormones, right? Which don't have the systemic risks. So if someone comes in and says, you know, I have a couple hot flashes, I'm okay. I don't wake up at night, I'm not like there, you know, with the air conditioner turned down, and my husband is like an ice cube and I'm in the bed, you know. Right. Uh, but you know, like the dry vagina doc, that's it's terrible. We have a fix for that. We can we can tackle that one symptom. We can tackle the libido, you know, on its own, you know. Um so it depends on what the symptoms are.

SPEAKER_03 48:48

Okay. Uh so we you did mention how weight gain can influence cancer. Um how do estrogen levels let's talk about all of these, I guess, how they influence can influence cancer, like estrogen levels, weight gain, metabolic health, um, in midlife specifically. Um how is it influencing cancer risk?

SPEAKER_01 49:14

So I think that a number a number of of cancers are linked to obesity. Um, as we've talked about pretty a lot in the beginning, um, endometrial cancer is, um, ovarian cancer also is. Um so having just having a higher having a higher BMI leads to, in a woman, leads to increased estrogen levels. Because what happens is that your your extra adipose tissue, the extra weight that you're carrying around is is adipose tissue. And adipose tissue, as I like to try to explain to my patients, acts like an ovary. So there is peripheral conversion of uh of hormones into estrogen. So in a very obese woman, she has higher levels of endogenous estrogen coming from the extra weight that she's carrying. And for example, the mechanism in endometrial cancer is that the way you don't get endometrial cancer when you're reproductive age is because you have both hormones. You have estrogen and progesterone. And the estrogen causes the lining to build, and the progesterone helps you to slough the lining and get rid of it, and then the whole cycle repeats, you know, every 28 to 35 days.

SPEAKER_06 50:36

Yeah.

SPEAKER_01 50:37

But if your ovaries have failed and they're no longer producing hormones, you don't have a source of estrogen. You don't have a source of progesterone. But if you're really heavy, you have increased levels of estrogen. So over time, not in the way that it happens in a monthly cycle as it would for a young reproductive age woman, but over years, your the lining of your uterus is being stimulated by that estrogen.

SPEAKER_05 51:04

Okay.

SPEAKER_01 51:05

And the lining is building up, and it's slowly building up over months to years, and you don't have the progesterone to slough it off and get rid of it. And then it stays there and it builds and it builds and then it transforms. So that's the mechanism for obesity and and uh endometrial cancer. So one of the things you can do is just really try your best to be to have a BMI that's under 30. And you know, we we we know now that BMI is not the be all and end all. You know, it's not, you know, we don't want to have people just, you know, if they have a BMI of 31, like, you know, they're failures, they're not, you know, but um, you know, it's still a good gauge of of of where you are, you know, um, weight-wise. So you want to try to move down to a more normal weight.

SPEAKER_04 52:02

It's a good way of explaining it as well, you know, to people to understand how that link is with weight and it's a few.

SPEAKER_03 52:11

Yeah, because I think I would have assumed, well, because a lot of times, I mean, in health, we talk about having a higher weight, and it's because you're you know eating unhealthy foods, and so maybe it's the unhealthy foods that contribute that contribute to the cancer.

SPEAKER_01 52:28

Yeah.

SPEAKER_03 52:28

But it's actually the weight itself.

SPEAKER_01 52:30

It's actually the adipose tissue itself. In an endometrial cancer mechanism, it's the actual weight itself that you're carrying that's creating more estrogen that your body does not need.

SPEAKER_03 52:41

Right. Wow, okay. Um, are there specific lifestyle habits you consistently see in patients that either increase or decrease risk?

SPEAKER_01 52:51

Um, lifestyle things. So um, for example, in cervix, um, the lack of understanding of the transmission of the HPV virus, the lack of understanding of protecting yourself. Um I guess when we talk about prevention, you know, I'm a huge advocate for the HPV vaccine.

SPEAKER_05 53:12

Okay.

SPEAKER_01 53:12

Um, but if you're gonna have you know sexual contact with a new partner and this is not someone that you've known terribly long and you don't know their sexual history, because you know, you don't fall in love with people and say, okay, you know, let me have that sexual history now, let's talk through, you know. Um, maybe you want to think about barrier um barrier methods, not necessarily for contraception.

SPEAKER_05 53:38

Yeah.

SPEAKER_01 53:39

Um, although that's what they're for, but they're really for protection against the virus. So folks who are careful and use barrier contraception have a lower risk of HPV transmission, um, that'll cut down their risk of cervical cancer. Um, folks that maintain, you know, uh or try to maintain a more normal BMI, or at least can, if they have gained a lot of weight, try to move their BMI back down to you know, something you know, under 30 or around 30. Because morbid obesity is defined as a BMI of over 40. And you know, we see folks in the office every day with a BMI of over 40.

SPEAKER_03 54:23

Right, okay, and 30, like I think I don't know this, but say a BMI of 30, that's not like a stick thin person. Not at all. It's not at all an average type, like even maybe a little on the not happy, on the not skinny side, like exactly.

SPEAKER_01 54:40

Yeah, yeah, yeah. Okay. Exactly.

SPEAKER_03 54:42

So because I don't want people to think like, oh, I have to be real thin or I have to lose all my weight. It's not like a BMI of 30 is it's very reasonable. Yeah, it's not it's not tiny, I guess, is what I'm trying to say.

SPEAKER_01 54:55

Yeah. I think that you know, in the Western world, because of the obesity of the epidemic of obesity, we've all become acculturated to seeing heaviness as normal. And it always strikes me when I travel and see different cultures, and I'm like, wow, everybody in the Western world is a little on the heavy side.

SPEAKER_05 55:14

Yeah.

SPEAKER_01 55:15

You know, because you go to Asia or you go to Europe or you, you know, go to other places, and you're like, on the whole, people here are a little not so heavy. Yeah. But in the Caribbean, you know, I'm a Caribbean man myself, so in the Caribbean, you know, when I when I've lost weed in the past, my mother says, What's wrong with you?

SPEAKER_05 55:35

Yeah, right.

SPEAKER_01 55:37

You can never win. Here you go.

SPEAKER_05 55:38

You can never win.

SPEAKER_04 55:39

What's wrong with you? You don't look bad. Right. Can I ask you a question about the HPV? Um, they're doing it, you can get the um uh vaccine, is that what it's called? Um, at school.

SPEAKER_05 55:51

Yeah.

SPEAKER_04 55:52

And so they're doing it at school. My son um goes to school and um they were giving them there. Is it a one-time it's two now? It's two.

SPEAKER_01 56:01

It's two. Um, it used to be more, um, but it's two shots.

SPEAKER_03 56:05

For life.

SPEAKER_01 56:06

Yeah.

SPEAKER_03 56:07

Um you can only do it when up to a certain age.

SPEAKER_01 56:09

I was just gonna say, like, can we do it?

SPEAKER_03 56:12

Oh, no way.

SPEAKER_01 56:13

Oh, I would give it to anybody. I would give it to anybody that um that you know, any woman of any age, and and and you know, you have to we have to vaccinate ban on women.

SPEAKER_05 56:25

It's not a it's not a woman.

SPEAKER_01 56:26

It's not a woman vaccine. Okay, it's not a woman vaccine. So all of my kids happen to get it in their pediatric vaccination schedule because I believe in it and you know it's offered now. And but we have a we have a real cultural barrier. Um, you know, and in the current uh political climate and in the current health climate, there's a lot of vaccine deniers and a lot of of that stuff going on. And um, that can be tough, that can be challenging. And and parents are um, you know, we're hoping that people will really come around to the fact that, yeah, you know, you're gonna get your smallpox and your measles mumps and your you know, tetanus booster, and yeah, when you get to 10 and 12 and you're gonna get your first HPD vaccine. Because you really want the vaccine, you really want the immunity there before um before human beings start to become sexually active. But to your point, um women come in all the time with cervical dysplasia or the precancerous lesions of cervical cancer, the precursor lesions of cervical cancer, and uh, you know, we treat them with you know removing the cancer with a procedure called a leak procedure or a LETS procedure. But you know, it was caused by one strain. There are nine strains that the vaccine protects you from. So unless we bother to go through some pretty expensive and not necessary testing, um an individual woman's dysplasia would have been caused by one strain, but she's gonna have immunity to that strain only. So the vaccine contains nine strains, and seven of them are the most common strains for cervical cancer, and you would want protection for the other seven for the rest of your life too. So even, you know, 28, 35 women, year old women, uh they're all eligible for the vaccine. And in fact, if a woman comes in and she says to me in her sexual history, you know, I'm 42 and I've never had intercourse, but I'm gonna get married and I'm gonna start having intercourse because that's her belief system and that's where she is. I'll be like, Have you got the vaccine? And she's like, No, I was like, you need the vaccine. Yeah. Because, you know, yes, this is what it protects you from.

SPEAKER_03 58:58

Okay. Yeah. That's interesting. I thought that it was only up to a certain age that you could get that and be protected.

SPEAKER_06 59:03

Yeah.

SPEAKER_03 59:04

So let me get I just want to make sure make sure I have this right. So HPV if is caused by sexual intercourse, like not caused by sex, I shouldn't say that. Yeah, uh, transmitted through sexual intercourse. And that's how you can not 100%. If you get HPV, do you get cancer?

SPEAKER_01 59:26

No, if you if you get HPV, you have the the the pre the you have the cause. But it doesn't mean you will develop it, right? There's a whole bunch of host factors. Okay. But but HPV is the cause. So if you get HPV, you're not gonna get cancer. But you might. But you might.

SPEAKER_03 59:46

Okay.

SPEAKER_01 59:47

Yeah.

SPEAKER_03 59:48

And we have we as women have no way of knowing if a guy has it.

SPEAKER_01 59:53

Correct.

SPEAKER_03 59:53

Does he know he has it?

SPEAKER_01 59:54

No.

SPEAKER_03 59:55

No.

SPEAKER_01 59:55

No.

SPEAKER_03 59:57

Because like, I mean, for my whole life, you use protection so you don't get S S T D. Like STDs, like you know, the big ones.

SPEAKER_01 1:00:07

Yeah.

SPEAKER_03 1:00:08

Not HPVs.

SPEAKER_01 1:00:09

HPV is an STD. That's it. Yes. It's just that simple. Like honoria, chlamydia, you know, everything. It's it's the same thing. HPVs and STD. And so cervical cancer is a sexually transmitted disease cancer.

SPEAKER_03 1:00:25

Oh. Wow. Okay.

SPEAKER_01 1:00:27

Yeah.

SPEAKER_03 1:00:28

That's good information. It is. Wow. Okay. Yeah.

SPEAKER_01 1:00:32

And we have a vaccine for it.

SPEAKER_03 1:00:34

Yeah.

SPEAKER_01 1:00:35

But we could eradicate this cancer from the human race if everybody had immunity. Right.

SPEAKER_03 1:00:42

Right.

SPEAKER_01 1:00:42

Yeah.

SPEAKER_03 1:00:43

Uh what's something you wish more women took took seriously sooner when it comes to their bodies?

SPEAKER_01 1:00:52

Wow, that's a that's a really good phenomenon. I think it would have to just be their their general overall health and weight. Um, because if you if you again, if we talk about the epidemic of obesity, and this is not a gynecologic thing, but this is just a thing that's just part of the Western world, part of our ready access to processed foods and bad diets. And we all are probably carrying around a little bit more weight than we should. But a whole lot of us are carrying around a lot more weight than we should. And the effect of that long-term, you know, into middle-age, getting into pre-diabetes, high cholesterol, hypertension, needing to be on a number of different drugs. I mean, if if if folks really could understand that it's not about exercise, you know, it's not about the gym. It's not about the gym. You know, it's not about the clothes and the gym and the working out and the trainer and the routine and the discipline and the waking up. It all has to do with what you put in your mouth. And I see, I it it just, you know, the the longer I live is the more I realize that that is really the mantra. And I struggle with it too. I'm struggling with it right now. I have a I'm I'm doing I started to try. This is my this is day three. This is to tell you how I'm like try always trying things. I'm doing intermittent fasting. Yeah. And there's pretty good science around it. And I'm not saying that that's the be all and end all, but we're all struggling with, you know, 20 to 50 to 60 pounds, you know, most people, you know. And um, I am too, you know, and uh I love to eat, you know. I work out and I try to be healthy and I try to exercise, but it's really not about that. It's really about what you put in your mouth. And if we really understood how bad our food supply is in terms of the number of process things that we put into our bodies, we could really change who we are biochemically, you know. So, you know, somebody I somebody said it in one of my uh friend chats the other day that if you're eating something that wasn't around, you know, 2,000 years ago, you know, you shouldn't be eating it.

SPEAKER_03 1:03:29

You know, yeah, yeah, you know, it's it's just that's something that can sit on a shelf for months and months and months and months.

SPEAKER_01 1:03:36

Yeah, and it's because our our diets and our weight have such a profound effect on our overall health, even our cancer risk, you know, that uh that for me, I think that's the thing that really glares at me in the Western world, personally.

SPEAKER_03 1:03:56

Do you see women delaying care? And if so, why do you think that happens?

SPEAKER_01 1:04:02

Because they take care of everybody else. Yeah, right. They're always last on the list. Yeah, they're always last on the list. But I think I think that you know, um newer generations, you know, the millennials and and the generations coming up. So I'm I'm I'm the first of the I'm Gen X. Oh my. Yeah. Are you Gen X? I'm Gen X.

SPEAKER_04 1:04:24

I'm 81, but I think I'm on the cusp of something.

SPEAKER_01 1:04:28

Yeah. So I was so I'm I'm Gen X. And um, but I think people are getting more into healthcare, more into self-care, yeah, and and being more careful about, you know, I think that yeah, the that the the mom who neglects herself hopefully is gonna be the the the paradigm that maybe we'll hopefully lose soon. Yeah. Um, but I I think that I think that that folks do really um get really busy with life and careers, you know? I agree. Yeah. Um and and sometimes just forget the the simple things that they can do to screen for diseases.

SPEAKER_03 1:05:10

Um how do you think women can better advocate for themselves if they feel dismissed by their doctor?

SPEAKER_01 1:05:15

Oh, dismissed by your doctor. Gosh, that's just a terrible thing. Um it happens a lot. It happens a lot. I know. It does really happen a lot, and so I think that then um then you go for another opinion, you know?

SPEAKER_04 1:05:30

Yeah, I think you know I people shouldn't be afraid to do that.

SPEAKER_01 1:05:35

No, I in fact I tell patients all the time because I very frequently tell people things that they really, really don't want to hear. Right. And I say, you know, um, if you don't like what I'm telling you, I understand why. And I would really suggest that you go and hear this or ask these questions of another provider. And you know, it doesn't matter to me that you don't come back to me.

SPEAKER_03 1:06:04

Yeah.

SPEAKER_01 1:06:05

But um, but if you end up hearing this again and again, then you gotta think that maybe the block is in you, you know? Yeah, but if you're being dismissed by your physician, you absolutely need to um get another opinion. And you know, a really good doctor um should not be affronted by that. You know, if a patient, if a patient wants another opinion. I agree. I think that that the era I do think that this is happening to the era of paternalistic medicine, you know, yes, doctor, yes, doctor, whatever you say. I mean, it's been long gone in OBGYN because the specialty is a majority of women now. Men are the minority. So I trained with mostly women. Um, I was one of the few men in my residency program, and in the world of OBGYN, the minority are men. But um I think with Google, which is now what, how old is Google? I mean, 30 years old or something. I mean, now with chat, with AI, with everything that patients can do, um, you know, if you don't like what a doctor is telling you, you know, go somewhere else. And um, what you have to be careful of is is that you don't doctor shop for the answer that you're looking for. Yeah, you're right. You don't doctor shop for the answer that you're looking for. But if you end up with a second opinion and you've basically heard the same thing, then you gotta kind of say, well, okay, so I gotta really take this in.

unknown 1:07:45

Yeah.

SPEAKER_06 1:07:45

Yeah.

SPEAKER_03 1:07:46

Agreed. Yeah, that's good advice. Um, if you could change one thing about how women approach their health in midlife, what would it be? I guess we've maybe already talked about that. Anything different?

SPEAKER_01 1:07:57

Um, in midlife, I would say um really and truly carve out time for yourself. Um, carve out time for yourself, continue to make your health a priority, um, you know, share responsibilities. Um the the thing in the modern age is that is that so many women um are not just the primary caregivers and the mothers and the and the wives, but they have full-on um you know, full-on careers and doing great things in the world. And men don't get that like that's that requires us to step up and share, you know. Um so if you have a spouse, you know, what I would say to the men is that if you have a spouse that that has a career that is as busy or busier than yours, then you really got to think of the relationship that you have, whether you have a family, kids, or parents or whatever, but whatever you're doing, it really has to become a completely shared thing. Yeah. Because how can you expect um your spouse, uh a wife who's at home, um who, unless she is at home and you've made a family decision that somebody's a homemaker and somebody's a breadwinner, but if you're both out in the world, then you both have to be breadwinners and you both have to be homemakers. And but yet it isn't really happening. It isn't really happening, you know, because there's still a huge weight of responsibility for everything that still falls on the woman, right? Which is which is just not commensurate with trying to also have a big career. So what happens is that, you know, it's back to the thing that we've talked about at least twice before, but then the woman is like, I'll get to my pap's smear, I'll get to this funky lump that I feel in my breasts, I'll get to it because I have them, I have him, I have the house, I have the dog, I have my sick parents, and I'm really trying to be a first-rate corporate lawyer.

SPEAKER_05 1:10:19

Yeah, right.

SPEAKER_01 1:10:20

Or a uh, you know, first-rate accountant. Yeah. So what goes down the tubes?

SPEAKER_03 1:10:25

Yeah, that's the last on the list for sure. Yeah. All right, that's the last of my questions. Is there anything else you have? No, I don't think so.

SPEAKER_04 1:10:34

Not for this episode. Not for this episode, but I do think that it would be great to um get you back and talk about a lot more because I think that there's so much more that we can talk about.

SPEAKER_01 1:10:44

Yeah, we could really focus in on um a couple of the things a little bit more anatomy. We could focus on anatomy, we could bring some charts. We could put some we could put some slides up in your in your in your podcast. Um But yeah, there's there's there's tons to talk about. This was like a very general health preventative, yeah epidemiologic kind of like overview discussion. But you know, we could talk for hours on on individual cancers.

SPEAKER_04 1:11:17

Oh, or even just you know, the the HPV and STDs and um all of that kind of stuff. Yeah, it doesn't end when you're in midlife. No. No. Well, we really appreciate this. Um if anyone wants to get a hold of you, like do you always say go and see your gynecologist first and then you get referred, or can people just so in in Cayman, um uh folks can book appointments with me directly.

SPEAKER_05 1:11:47

Okay.

SPEAKER_01 1:11:48

Um in the States to see a gynecologic oncologist usually requires a referral. Okay. But you know, this is a smaller place and um better access, and um Health City really is trying to make subspecialists accessible. Um sometimes I'll I'll you know get a patient coming in for something that really is not what I do or not what I want to be doing, and I'll say, you know, you really should see a general gynecologist, and you know, there's a whole group of amazing OBGYNs on this island. Okay, over 25 OBGYNs on an island for what 80,000 people. So there's no shortage of you know, ages, genders, races, locations to fit what you're looking for. Um, but I'm happy to see folks, and for people to get in touch with me, they can email me.

SPEAKER_04 1:12:47

Okay.

SPEAKER_01 1:12:48

Um, which is really simple. It's my first name.lastname at healthcity.ky. I'm always happy to uh get an email from a patient. Um, or you can just call the clinic and and and get an appointment.

SPEAKER_04 1:13:02

Um I was just gonna say as well, um our our podcast also reaches North America. Oh, yeah. Um, so if anyone is do you have to be within the Florida area to see you?

SPEAKER_01 1:13:15

Or no, anybody can come from anywhere.

SPEAKER_04 1:13:17

Anywhere.

SPEAKER_01 1:13:18

Yeah, anyone can come from anywhere. I mean, gynecologic oncology is a pretty small specialty. Um, there's not a lot of us in the in the specialty across the country. So, but but we are um in most states um and in in most big cities, but you know, someone can come and see a gynecologic oncologist anywhere.

SPEAKER_03 1:13:37

Perfect.

unknown 1:13:38

Yeah.

SPEAKER_03 1:13:39

Okay, this was great. Thank you for thank you for this. Thank you. My pleasure. Thanks for joining us on Prest Intentions. We hope you felt seen, supported, and maybe had a few laughs along the way. Don't forget to share, subscribe, rate, and review us. Your support keeps the conversation alive. Follow us on social media for more insights, behind the scenes fun, and updates on future episodes. Got a topic you want us to dive into? We'd love to hear from you. Remember, life's too short for bad bras, toxic relationships, and kale you don't actually like. So until next time, stay bold and keep your best intentions exactly where they belong. Front and center. Now go crush midlife, or at least today's to do list. Cheers!