The challenges of fighting gynecological cancers

PBS journalist Gwen Ifill passed away Monday after a battle with endometrial cancer. Do gynecological cancers receive the attention they deserve? Hari Sreenivasan talks to Dr. Angela Marshall of the Black Women's Health Imperative and Dr. Karen Lu of the MD Anderson Cancer Center to discuss what’s being done to diagnose and treat these cancers.

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    Next: the battle against cancer, specifically, gynecological cancers.

    Gwen died on Monday at the age of 61, after her fight with endometrial cancer, also referred to as uterine cancer. It is one of several gynecological cancers women face that sometimes get less attention.

    More than 50,000 women in the U.S. are diagnosed with uterine cancer each year, and more than 9,300 die from it. Ovarian cancer is better known. About 20,000 women are diagnosed each year, and more than 14,000 die from it annually.

    Cervical cancer's death rate has dropped dramatically. Roughly 12,000 are diagnosed with it annually. More than 4,000 die from it.

    We're not focused on Gwen's particular case tonight, but we wanted to take this moment to look at the latest efforts to diagnose and treat these cancers.

    Dr. Karen Lu is chair of gynecologic oncology at MD Anderson Cancer Center in Houston. And Dr. Angela Marshall is an adviser to the Black Women's Health Imperative. She is a women's health specialist in Maryland.

    Dr. Lu, now that we have set the table a little bit, let's add a little context to this. In relation to other cancers, how prevalent are these?

  • DR. KAREN LU, MD Anderson Cancer Center:

    So, all together, as you said, almost 100,000 women this year will be diagnosed with a gynecologic cancer. And, importantly, with uterine cancer, it's on the rise.


    And put that in perspective. Compared to — you know, there's a horrible reality in the cancer marketplace that some cancers get more attention than others, and then the more attention they get, the more research funding they get as well.

    So, how do these cancers compete and fare when we think about all the other cancers that are out there?


    There definitely is less attention, even though there's such a high number of women with these cancers.

    And I think the breast cancer community has done a fantastic job about demystifying and being open about talking about breast cancer, about risk factors, about what early signs are.

    And I think, when we're talking about gynecologic cancers — so that's cancer of the uterus, the cervix, and the ovaries — we're a little bit more maybe perhaps embarrassed to talk about it. And that — that goes towards individual women and the impact that that may have in terms of them thinking about symptoms that they may have, and also kind of on a broader scale in terms of really garnering interest and increasing research funding for the diseases.


    Dr. Marshall, I have heard them described as below-the-belt cancers. Is there a stigma attached with discussing this openly, compared to, say, breast cancer which, societally, we seem to have no problem talking about?

  • DR. ANGELA MARSHALL, Black Women’s Health Imperative:

    I think there is.

    But I think, more importantly, I think this is a good time to talk about the importance of women and self-care. And by self-care, I mean the importance of getting screening tests. And screening tests are tests that we do when people are having no symptoms.

    So, when we do mammograms, we're screening for breast cancer in women who have not symptoms. However, for uterine and for ovarian cancer, we don't have adequate screening tests for those. So those are tests that rely on women reporting symptoms before we do any kind of workup.

    And so I think it's important to get the word out. I think education is extremely important. People need to know what the symptoms are, and they need to know what tests to be requesting from their health care providers.


    Dr. Lu, is there a gap in women seeing symptoms, but not necessarily reporting them, or not even knowing that they are symptoms?


    I think there's two gaps.

    I think there's a gap where women don't know that there are early symptoms of these cancers, and so don't recognize them. And then there's also a gap when they report these symptoms. Sometimes, they can be nonspecific. And certainly, with ovarian cancer, women will present with bloating or their bellies will be bigger, very nonspecific pain.

    And, sometimes, physicians will dismiss these symptoms and not fully work up and think about ovarian cancer or other gynecologic cancers as a cause.


    Dr. Marshall, I see you nodding your head in agreement here. Is this also the case? And does it disproportionately affect women of color or in the African-American community?


    It does.

    And I think, specifically for African-American women, it's important to have health care providers that we trust, because there's historically been some mistrust in the African-American community.

    It's also important to have good access to health care. And it's important for to us have access to health insurance plans that aren't high deductibles. You know, some women are forced with making a decision to put food on the table vs. paying for expensive diagnostic testing. And so, sometimes, it boils down to an economic issue.


    So, sometimes, it's the infrastructure that's influencing whether or not they get the care.




    Dr. Lu, if a patient gets one of these diagnoses, what should they start thinking about, and how should they look at this?


    That's a great question.

    You know, there's so much information available on the Internet, and we say that's good and bad. But I do, overall, think it's important for women to arm themselves with information when they go seek health care.

    I think the second thing is to really seek a specialist. There are — we are specialists, gynecologic oncologists, who focus on treating these cancers. And it's really important that women who are diagnosed with uterine cancer, ovarian cancer, cervix cancer have a specialist who can take care of them.


    Dr. Marshall, what about those cases where, if you don't have the expertise of a Dr. Lu, you don't live in Houston, you don't live near a major cancer center or medical center, how hard is it for someone to lobby, basically, for themselves, or advocate to try to get that extra level of care and expertise?


    I think it starts with having a health care provider that you trust.

    And, so often, we don't, especially among African-Americans. And so I think your primary care doctor is a great resource, and I think you should be an advocate for yourself, and help — have them help you with the referrals to the specialists.


    Dr. Lu, where does the research stand in all this, considering — especially even including pharmaceutical companies, because they're crucial in the treatment part?



    Research is really important. And it's a great time now. There's a lot of exciting research going on. So, I like to think about it, for early-stage cancers, we're really focusing on minimizing treatment in some ways. So, we're seeing younger women who are diagnosed with uterine cancer.

    Uterine cancer is very tightly linked to obesity. So, as we see an obesity epidemic, we're seeing more and more younger women, women in their 40s, sometimes even in their 30s, with uterine cancer. So, we're thinking about, can we think about treatment where's we can preserve the uterus?

    Even with cervix cancer, we're thinking about, are there options for women to be able to have the option of childbearing? So, that's for early-stage.

    For later-stage cancers, there's a lot of emphasis on understanding the very basic molecular kind of DNA genes that contribute to the cancer cells. Once we understand that, we're able to bring in some of these new targeted therapies, immunotherapy.

    So, it's an exciting time, but it requires — it requires resources. It requires women to be open to clinical trials. And I really want to stress that, because I think that, if we're going to make advances — and we need to, especially for women who have advanced-stage disease — we're going to really need to encourage women to participate in clinical trials.


    Dr Karen Lu, Dr. Angela Marshall, thank you for what might be the first of many conversations on this topic. Thank you very much.


    Thank you.

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