Gynecologic Cancer Risks and Prevention: Expert Q & A

MUSIC PLAYING] And coming up, Dr. Kathryn Mills and Dr. John Moroney will discuss gynecologic cancer symptoms, risks, and prevention tips. We'll also hear from a patient who is diagnosed with cervical cancer and recently completed primary therapy. And as always, we'll take your questions live. That's coming up right now on At the Forefront Live.

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And we want to remind our viewers that today's program is not designed to take the place of a visit with your physician. And let's start off with each of our doctors introducing themselves and telling us a little bit about what each of you do here at UChicago Medicine. And Dr. Mills, you're to my immediate left, so we'll start with you first.

Hi, thank you so much for having me. My name is Kathryn Mills, and I am an assistant professor in the Department of Obstetrics and Gynecology. I specifically focus on gynecologic cancer, which means that I take care of patients who have cancers that have developed from the female reproductive organs.

And Dr. Moroney?

Hi, thank you for having me on your show. My name is John Moroney. I'm an associate professor in gynecologic oncology, which essentially means that I am responsible for taking care of the surgical needs for women with ovarian, cervical, endometrial cancers and then performing a lot of the medical therapies.

Great. And we want to remind our viewers that we'll be taking your questions live on the air, so just type them in the comments section and we'll get to as many as possible for the next half hour. Dr. Moroney, we're going to start with you. And the first question is just what are the different cancer risks that women face and how likely is it that an individual woman will face one of these diagnoses in their life?

Well, fortunately, gynecologic cancers are less common than many of the other what we call solid tumors that a person can encounter over a lifetime. One we see the most frequently is endometrial cancer, which will affect about 1 in 35 women over the course of a lifetime. That's a much more common and threatening diagnosis for women who are overweight. So women who are significantly overweight will have sometimes doubling or tripling of that risk.

Ovarian cancer, on the other hand, is significantly less common, although it's talked about in a more threatening way. The lifetime risk for ovarian cancer is about 1 in 70. So relatively uncommon. Unfortunately, in our practice, it doesn't feel that way.

Breast cancer, even though it's not a disease that a gynecologic oncologist treats routinely, is actually quite common. I think it's always important to stress its existence. And that's one in eight or one in nine women. Cervical cancers are pretty infrequent, especially in the United States. Unfortunately, not so uncommon in less developed countries. There really isn't a one in number for that, but it's pretty rare. Unfortunately, we do see that on a regular basis, as well.

And then there is actually the thing called vulvar cancer, which many people wouldn't even know exists. It's essentially skin cancer arising from the vulva. That's something we see as, well.

You know, Dr. Mills, some of the numbers and statistics that Dr. Moroney just quoted are frightening. And so obviously, as the old saying goes, a bit of cliche, obviously, but an ounce of prevention worth a pound of cure. So what symptoms or physical changes should women be aware of that would be a good reason to make an appointment with a gynecologist or their family medicine physician just to be sure that they're OK?

Yeah, that's a great question. I think as Dr. Moroney has alluded to, there are a range of cancers that we do take care of in this area, but kind of the most general important things to watch for would be bloating or feeling like your clothes are tighter than they used to be. Feeling like you're trying to eat, and every time you eat, you just get old faster than you're used to. Having new nausea vomiting that doesn't go away.

Really important to pay attention to your bladder and bowel function. As many women know, from time to time, urinary tract infections and things are common, but if your bladder is just not recovering like it used to or you're having a lot of constipation. And then lastly, pelvic pain is important. We all get aches and pains in life, but if these pains become persistent or they get worse, these are important signals to watch for. And probably most importantly for endometrial cancer in particular, patients who have already gone through menopause, if you start noticing having spotting or bleeding again, it should be a signal immediately to present to a gynecologist or your primary care provider.

And of course, I would imagine it's always just it's important to be aware of your body and be in tune with your body and just any changes that happen, but along those lines, too, it's also important to get checkups and have a regular visit with your gynecologist with your family physician just to kind of keep on top of things like this. How often do people need to see a gynecologist? And either one of you can take that one.

Well, most commonly, we generally say that patients should check in with somebody-- be it a gynecologist, a family medicine doctor, or somebody who performs a pelvic exam, about once a year. But then as needed, individualized care, of course. We see patients more frequently for acute questions, as well.

So we had the opportunity just recently to do an interview in the last couple of days with a patient. Her name is Bilqis. And she was fantastic. She's so positive. And she talked to us about staying positive throughout her journey with cancer. And we're going to start with that clip, and then we'll discuss Bilqis and her attitude here in a minute.

It's very necessary. Nothing in your life, whether it's something like a diagnosis or a scrape meet-- you can't be negative, because then the negative thoughts come in. Then you want to do negative things towards other people. And you heal not quicker-- you heal slower, because your mind is connected to your body, of course.

And if your mind is negative and you're not thinking positively, it hinders you. It hinders your appetite, it hinders your mental ability, and even your physical abilities, because you don't want to do anything. You don't want to be around people. And I feel like people help you-- whether it's your friends your co-workers or your family.

Very positive attitude. She was a lot of fun during the interview, just a super, super nice person. And a positive attitude is important, but she also talked to-- we're going to see this clip in just a moment-- but I wanted to see, Dr. Moroney, if you can comment on this. Are there things that women can do to prevent gynecologic cancer? And she mentioned the HPV vaccine when we spoke with her. Could you talk a little bit about that?

Sure. I think that in order to try and get a grip on all the things that a person's supposed to do to avoid cancer in general or women with gynecologic cancers, we'd probably start with just focusing on diseases, specifically. In cervix cancer, no question-- the HPV vaccine has been actually just revolutionary in terms of its ability to prevent cervical cancer. And then even its precursor, which gets the word "cervical dysplasia" or "precancer," we strongly recommend that moms and dads follow the recommendations for HPV vaccination for children starting somewhere between ages 11 and essentially, their teenage years.

Apart from that, regular screening, just as Dr. Mills was talking about, is actually a pretty important way of staying ahead of any problem as it evolves. Apart from that, when you think about things like endometrial cancer and ovarian cancer, preventing those diseases has more to do with just a healthy lifestyle, the same way we're supposed to live a healthy lifestyle to prevent cardiovascular disease, heart attack, strokes-- things like that. So what that includes is a healthy diet, which is a hard thing for a lot of us as Americans. And then weight control and being physically active.

So John, let's go ahead and play the clip with Bilqis when she talks about the HPV vaccine and how important it is in her mind.

Look at your family history. That would be the first thing, because like I said, that's what prompted me to do it with my daughter. And I'm also going to do with my boys, too. Look at your family history first, because that's the most important thing. And then the fact that there are so many things going on in the world that we have no control over-- this is something that we can't have a little bit of control over. It's such an easy thing that's spreadable. And our children, they're having fun with their friends, and drinking after each Other, and that's one way that the virus can be contracted-- if they were drinking after each other and things of that nature.

I don't want to have to deal with something later on in life with my children and then be beating myself up as a parent because it's something that I could have prevented, you know what I mean? It's not something that I will recommend for anyone. So that's my main thing-- family history and how you feel about your children. Mine are my world, so there's nothing that I won't do. If I have any control over it, I'm going to do it, documentary.

And I think we would all agree that we do want to obviously take care our children. The HPV vaccine is an easy way to help prevent. So Dr. Mills, if you can't talk to us a little bit about COVID precautions that are being taken, because this is something that comes up on a fairly regular basis. We see this on social media. People are maybe a little bit worried about coming to the hospital. We do a couple of things here that I don't know if you can discuss, but the video visits. But also, we're very careful when people do come into the facility, you're probably actually safer here than you would be basically anywhere else. Could you talk about that a little bit?

Sure. I think that the concerns from the public regarding coming to the hospital are valid and warranted. So I think our department and others have tried to really allow accessibility through video visits. To facilitate ways for patients to get in contact with their doctor or to make an appointment to see a doctor, to get the ball rolling on the care that they need.

And then secondly, sometimes, unfortunately, patients can't do a telehealth visit or we need to see them in person for an exam. And when patients come here to be seen in the office, I think most of my patients have vocalized how safe they feel here. Everybody is wearing a mask. Everybody is appropriately distanced. The rooms are clean and sanitized between patients so the risk of transmission is as low as it possibly could be. And I think overall, the biggest message is that if something is going on or you're worried that something is going on, please don't use COVID-19 as a reason not to seek care and to also have a delay in care when your doctor is ready and able to care for you.

Yeah, we really want to stress that-- and I've heard some comments from some of our emergency room doctors even about people who have been delaying or not getting care that they desperately need particularly in a situation like that and with ED, because they're afraid of COVID. And it's such a safe place. This is actually, again, probably safer than a lot of places that you're going anyway. So we certainly would encourage folks to come and get treatment if they need it.

Can' we talk a little bit about the care plan that is involved with somebody that gets a gynecologic cancer? And Dr. Moroney, we hear this from other physicians from time to time, but there really is a team effort that happens with this. A plan is put together that's an individualized plan for that patient. Can you kind of walk us through the steps and tell us why that is so important?

Sure. A new diagnosis of an ovarian cancer or an endometrial cancer requires a lot of planning. And in some situations, fortunately, the problem can be solved almost exclusively with surgery. But the surgeries tend to be pretty complex. So there are situations sometimes where a person needs surgical effort that crosses different disciplines.

So one of the great things about working in an academic medical center like this is that recognizing that we all have limits, we are able to very, very easily cross those disciplines to be able to get support from other types of specialists that the patient needs. Particularly in ovarian cancer, that's the case where the surgeries can be extremely complex and long. And so you want to have a A, but also, a plan C, D, and E for that situation. That's something that I appreciate the most. We're very much working at a place like this.

And Dr. Mills, could you talk to us about your role in that team treatment and how that works? Because I understand there are meetings, there are groups of physicians and caregivers that will get together and discuss specific care for those patients. It's kind of interesting to me

Sure. So I think in general, most of us meet a patient and their family in either the office or via telehealth as we're doing now, and sort of make the introduction, the first steps. Then it kind of depends on the treatment that the patient requires or needs.

I know one thing that I think is great about university here is we have such a collaborative group of physicians. And any time a particularly complex or difficult case arises, we have a weekly meeting where we present our complicated cases and can discuss these patients amongst our group. And then also beyond with medical oncologists who specialize in gynecologic cancers as well as radiation oncologists, radiologists to help us understand extensive disease on imaging. And I think this is something that can really help us to offer just top of the line care to our patients.

And I know our patients are very happy with these care teams and how this works. In fact, we spoke with Bilqis, and we asked her about that. And let's go and play that clip.

But I had a great team-- have a great team, because they're still with me. Dr. Moroney, the gynecological thing, they're very good. He especially showed me and talk me through everything, every question that I had. I'm a visual learner, so it's hard for me to learn with you just speaking to me. So I told him that. He asks, he's like, would it be OK if I draw you picture? I'm like, yes, that is perfect. Please draw me a picture. And so he did that and he showed me where my mass was, and how it affected everything else within my body. And I still have this picture to this day.

Dr. Hasan and her team, they were up all aces. I dealt with them more, because I was going through radiation for so long. And they did the same thing. Constant communication, extension numbers. I spoke with Dr. Hasan at length while she was at home with her children and I was at home with mine about foods to eat. And we had a back and forth about food she shouldn't feed our kids. So it was kind of funny. But they were really good.

I love that, because again, I think it shows how that teamwork works with the patients. It also shows what wonderful folks you all are, because I think that's it's very important in a cancer journey or any kind of a journey with some kind of physical disorder. It's tough on the patient. And there's a lot of stuff that's being thrown at them, so communication is certainly key.

We have a question from a viewer about smoking. Can smoking be related to gynecologic cancer? And does stopping smoking helping to reduce the risks-- I think smoking can be related to lots of bad things, but I'll let either one of you jump in on that one.

Yes. Smoking is bad.

So how about how about stopping smoking, though? I know with your lungs, it obviously makes a pretty immediate impact, but will that help you down the road as far as avoiding gynecologic cancers?

It does. There is some, I think, debunked historic information to suggest that smoking can decrease of a woman's risk for endometrial cancer. But across the board, if you name something related to a health risk that you don't want, smoking will increase it. And along the same lines, stopping smoking-- as difficult as it is, is absolutely worth it. As I understand it, it takes the average smoker seven to nine times before being successful, and that's just you know easier said than done. So absolutely worth it. Lots and lots of science supports the idea that it leads to a better life apart from the cost savings.

And Dr. Mills, kind of along the same lines, obviously, stopping smoking or not smoking in the first place is the best thing to do, but can you talk just a little bit about diet and exercise? Because we hear again and again that obesity can be a risk factor in a whole slew of disease states, including some gynecologic cancers.

Yeah, I think this is a really important topic, as well. I think just to start with endometrial cancer, for example, the most common types of gender endometrial cancer are in fact, very strongly related to carrying extra weight. And the risk of developing this cancer increases as your obesity rate goes up. So if you actually look over time, as we've seen the American population gaining more weight, the incidence of a endometrial cancer has gone up. So I think anytime you can work on having a healthy weight this will help decrease your risk of developing endometrial cancer. In addition, there is some mixed data about the risk of ovarian cancer and obesity. But it is possible that there may be a link, though that data is less clear.

I have another question about prevention and screening. And in particular, can we talk a little bit about BRCA gene? We hear about that oftentimes with breast cancer patients. I learned a little bit yesterday on the program about prostate cancer also with the BRCA gene. Is that something you look for and are there genetic tests that patients can take to see what their predisposition is?

Sure. BRCA genes, some people call it the B-R-C-A-- and BRCA is the same thing. Basically, increases a person's lifetime risk for breast or ovarian cancer, melanoma, prostate cancer, pancreatic cancer, and a number of other diseases. So it affects both men and women. Screening for the possibility that a newly diagnosed cancer is related to heredity is absolutely a standard for most cancer practices, including ours. So we do that for both [INAUDIBLE] BRCA as well as this thing that gets some press called Lynch syndrome, which is essentially a similar but different problem that predisposes women to endometrial cancer. And of course, women and men to developing colon cancer, gastric cancer, and ovarian cancer, among others.

One thing I noted that Bilqis mentioned was the idea that your family history matters. And I certainly would echo what she's saying. That is more important for some diseases than others. It doesn't, we found, seem to have all that much connection to cervical cancer, but it's certainly something we pay a lot of attention to with respect to endometrial and ovarian cancer.

You know, it's interesting, speaking of Bilqis, obviously, the cancer battle is a difficult one, and great attitude, come through it like a champ and. She has one more clip that I'd like to see if we can play. And this was some good news that she had recently. John, if we can roll that one, that'd be great.

I am cancer-free officially. No more mass. There's nothing in my lymph nodes at all. So I'm very, very happy. Me and my family, very happy. My daughter, in fact, she just took me out this past weekend for a celebration and she paid for it. She's 12. She's 12. And we went bowling and to Applebee's, so we had a party.

That is my favorite clip of the entire show right there. Her 12-year-old daughter took her out and paid for it. I mean, how can you beat that? That's really, really awesome. Couple more questions that are coming in, one going back to the weight topic. And again, I certainly understand this one. Jaclyn asked, well, how much extra weight-- 20, 30 pounds? I know it's probably kind of hard to narrow that down, but Dr. Mills, if you can give us some thoughts there.

Sure, so I think there is less data as this suggests an exact number of pounds per person that might be more risky. But I do think the data is more clear in patients who have a BMI of greater than 30 who actually meet that obesity level definition. Patients who are in the overweight category are probably less clear how much that affects their risk of endometrial cancer development, but obesity is also related to other things that are important, including heart health, our joint and bone health, just overall function. Other risks-- some cancers like colon cancer. So I think it's hard for me to tell you exactly how many pounds to lose, but if you're hitting that BMI category of 30 or above, it's worth talking to your doctor about strategies that might work best for you to help lose some weight.

So Dr. Moroney, we have another question from a viewer asking what kind of genetic screening services are available. How does someone go about having that done?

Well, from a non-cancer patient standpoint, just a thorough discussion with your primary care physician is probably the place to start. All primary care physicians you know are versed in the different types of family histories that should trigger a special concern. And then when you combine that with the routine screening that we recommend for women, that's the best place to start.

Sounds good. We only have a couple of minutes left, but I want to hit just real quickly on clinical trials, because that's a big part of what we do here at UChicago Medicine. I think we have the largest portfolio of clinical trials in the Midwest, I am told. So can you talk to us a little bit about clinical trials in general, what they are, and why they're so important, in particular in the world of cancer treatment? And either one of you can take this one.

We are very involved with clinical trials. We really believe that they may provide an opportunity for women with gynecologic cancers to do the best that they can do. It sounds a little bit odd to say it that way, but we recognize that as much as we can be hopeful about enabling someone to get through a diagnosis and be cured, not enough women are cured. And we recognize the only way to fix that shortcoming is to provide more improved therapies-- hopefully, therapies that require less sacrifice and fewer side effects. So clinical trials are the way to do that. We're very, very active and have a large portfolio of different types of both surgical as well as medical therapies, many of which these days are less toxic than a lot of the chemotherapies we traditionally have used over the years.

And Dr. Mills, and kind of as our parting comment. Do you have any information or just a thought that you would want to share with maybe a woman who's been diagnosed? Because obviously, I think the first reaction is one of fear, but there is hope.


Yeah, it's understandable and expected. I think the majority of patients when they receive this diagnosis are extremely fearful. But I do want to offer that all is not lost. Certainly, myself and my partners are here for you the whole way. I think the beauty of doing oncology is that we offer both the medical and surgical treatment arms of your therapy, so I think we develop a special relationship with our patients. And I think because of that, we can help patients to cope with these diagnoses. And I think we also offer that to their families because it is important to remember that caregivers and family members who support our patients are also being affected by this diagnosis.


So I usually tell my patients in the office it feels devastating, but all is not lost. We have options for you. And in some cases, as Dr. Moroney alluded to earlier, things can be completely dealt with surgically and you know we just go on and follow you long term. And that's always our goal.


Well, we are out of time. You two were fantastic and shared a lot of great information with our audience. So thank you to both of you. And thank you to our viewers for your great questions. Please remember to check out our Facebook page for our scheduled programs coming up in the future. And if you want more information about UChicago Medicine, take a look at our website at uchicagomedicine.org. If you need an appointment, you can give us a call at 888-824-0200. And you can schedule your video visit also by going to the website. Thanks again for being with us today and I hope you have a great week.


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