Why did you choose this specialty?
When I was introduced to gynecologic oncology as a subspecialty, I was intrigued with the diversity of care. It crossed and integrated so many fields of medicine and touched such a variety of women that it seemed to be the right fit for me.
Is there a recent development in your field that you’re especially excited about?
The molecular aspect of cancer is very exciting. We are finding the genes that contribute to, or are responsible for, causation of cancers. And when we find these genetic defects, we can then tailor medicines to modify these problems. These developments contribute to the growing field of personalized medicine. The first gene that was identified to cause cancer was the BRCA gene that is accountable for a large portion of the tubo-ovarian cancers and breast cancers. By continuing this type of research and development, we will have more actionable targets and can add biologics to our chemotherapy regimens—and we can improve cancer and survival outcomes.
What’s the biggest misconception that patients have about what you do?
A lot of people are not aware that cancer is becoming much more of a manageable disease. We are able to treat and put into remission a large portion of these women’s tumors, and for other women, it can be a chronic disease with a very high quality of life.
What can women do to prevent gynecologic cancers?
We actually have a way to [prevent] cervical, vaginal and vulvar cancers, as 90 percent of them are HPV (human papillomavirus) related and we have the HPV vaccination. There is a lot more data now showing that we will also be preventing a significant number of head and neck cancers. This vaccine can prevent cancers in both men and women, so we should vaccinate all our children. There is also data to support vaccinations in adults who have not received this vaccination yet.
Another way to prevent cancers is removal of the fallopian tubes at the time of surgical sterilization or hysterectomy: We think that the most aggressive type of tubo-ovarian cancers originates from the end of the fallopian tube. And the Pap test for cervical cancer has saved thousands of lives. We are now performing HPV testing along with, or as a replacement for, the Pap test as a means of identifying women with precancer of the cervix. We are then able to treat the precancer before it progresses to cancer.
A way to increase detection for early-stage uterine cancer is to respect and know your body: most uterine cancers present with postmenopausal bleeding, which is not normal. When it happens, an ultrasound and biopsy of the lining of the uterus is recommended. We may be able to diagnose these cancers sooner.
Is there a patient behavior that you wish you could change?
A lot of women are afraid to talk about their bodies and what an abnormal symptom is. I want people to know that we can mention our concerns to friends and to medical providers. We are also afraid to focus on ourselves, and this may be because we are used to taking care of so many other people. We have to slow down and realize that we can and should take care of ourselves. I also have a lot of women who, after they are diagnosed, are afraid of being a burden on their family. I try to tell them that this is the time they can receive some of the love that they extended previously, and it is OK to accept help.