- The word "cancer" invokes fear in almost anyone who hears it.

According to the American Cancer Society, approximately 33,000 deaths in women from some form of gynecologic cancer occur each year, affecting various parts of a woman's reproductive system.

Some forms are very preventable, while others are deadly.

According to the U.S. Department of Health and Human Services, Hispanic women are 40% more likely to be diagnosed with cervical cancer than non-Hispanic women.

On this episode, we'll bring awareness to gynecologic cancers and infections that could lead to them.

We'll speak with experts in the fields of sexual health and take a humorous look at discussing this delicate subject and spend some time with a patient who survived gynecologic cancer.

Welcome to A Su Salud - Cheers to Good Health.

I'm your host, Genesis Ortega.

We're broadcasting from inside the PPL Public Media Center in Bethlehem, Pennsylvania.

My first guest is Dr. Ashley Graul, a gynecologic oncologist from the St. Luke's University Health Network.

Thank you, Doctor, for joining us today.

- Thank you so much for having me.

- Let's jump right in with the forms of gynecologic cancers.

What are they?

- So anything that involves the female reproductive tract, which can be your cervix, your uterus, your fallopian tubes, your ovaries, and even the external vulva or vagina are considered a GYN cancer that I deal with.

- Now, at least one of these forms of cancer is preventable.

So let's talk about that.

What is that, and how can it be prevented?

- So, cervical cancer is our most studied, in terms of prevention, and that's because we know that most cervical cancers come from the HPV infection that can be prevented by vaccination, which can be offered as early as 12 years of age, and even till the age of 45.

And by receiving that vaccine, it drastically reduces the risk of developing cervical cancer.

- Is it more so just the lack of research that other cancers aren't preventable?

- Yes, in a sense, because unfortunately, we do not know the mainstay of the reason why some people develop ovarian cancers and uterine cancers.

There are some of those that are developed from mutational burdens, or things that are followed in your family's germline or bloodline, basically.

But for the most part, in the majority of those other cancers, we don't yet know kind of the underlying cause as what research is looking into and to why we can try and prevent.

- Now, with that being said, are there any symptoms that women can be on the lookout for, or any red flags to say something's wrong?

- Absolutely.

Absolutely.

So, anything in terms of... For cervical and uterine cancer, any sort of abnormal vaginal bleeding, abnormal vaginal discharge, pelvic pain, irregular menses or periods, in between bleeding from your periods, bleeding after intercourse, any of those things should be brought up to your GYN's attention and can be red flags for issues with the cervix or the uterus.

The problem with ovarian cancer is that that is inside the belly, and so it does not always cause symptoms until they're either large enough or in areas that can cause symptoms.

However, the symptoms that tend to be reported are things like GI upset, abdominal pain or bloating, changes in bowel movements, difficulties with urination, anything that persists outside of a week or even two weeks that seems new to you should be something that you bring up with either your GYN or your primary care doctor to have looked into further.

- Now, Doctor, does family history play a role at all when contracting a gynecologic cancer?

- Absolutely.

So there is definitely a role for genetics and family history, predominantly in the ovarian cancer and even some uterine cancers.

They do follow in some families.

And if you are at an increased risk, you can have a blood test that says if you yourself are at an increased risk in your family, and if that is the case, then there are things that we can do to help reduce your risk.

- Hispanic women are at 40% higher risk of contracting cervical cancer.

So does socioeconomic factors play into that at all?

Do we know?

- Unfortunately, yes.

I do think that they do.

And there has been a lot of retrospective or studies that we look back in time that tell us that that does play a role.

Now, why it plays a role, we have not quite found that answer, whether it's socioeconomic status, race, income, location, those types of things are all things that have been attributable to increased rates of cervical cancer, that also can play a role into access.

So, if they don't have access to the correct doctors or inform their doctors on their annual visits, or don't attend annual visits, that definitely can increase your risk.

- Now, gynecologists also recommend regular pap smears.

So, talk to me about how that plays a role in prevention.

- Absolutely, so Pap smears are very important, and almost all cervical cancers can be caught early, if not before they become cancer, if Pap smears and annual exams are done on a yearly basis.

Now, Pap smears are actually only completed starting at the age of 21, and they're only performed every 3-5 years, depending on your age and your history of abnormal Pap smears.

However, an exam should still be completed every year, because visual things would obviously prompt a workup prior to another Pap smear.

- Now ovarian cancer, I believe, is the deadliest of the gynecologic cancers, and that one, again, early prevention is not so much there.

But what's the prognosis, really, for women who are diagnosed with it?

How does that look like for most women?

- Ovarian cancer comes in a wide variety of types, and depending on the certain types, there can be more deadly or less aggressive types of ovarian cancers.

But the overall prognosis really depends on how early we catch it.

If it is caught when it's only confined to the ovary, the overall survival, which we term as the five-year overall survival, is 80-90%.

However, if we find the cancer when it tends to be more spread or in distant areas in the abdomen, the overall survival tends to lower closer to 50-60%.

- Now, let's talk about treatment.

Hysterectomy, is that an option, when it comes to these cancers?

- Yes, for almost all of these cancers, the upfront treatment would be a surgical intervention, which would include a hysterectomy and removal of any of the disease that's in the abdomen at the time of surgery.

- Any other forms of treatment?

- Absolutely.

So, depending on the form of cancer, whether it is cervical, which tends to be based on radiation therapy, or uterine cancer, which can be a combination of radiation or chemotherapy, versus ovarian cancer, which predominantly is chemotherapy in treatment.

- Now, I want to touch upon HPV.

You mentioned it earlier, and that is one of the most prevalent sexually-transmitted diseases that can also be responsible for certain forms of cancer.

Can you elaborate on which ones?

- Yes.

So, HPV, there are many forms of HPV, and it is sexually transmitted, and unfortunately, most men do not know that they carry or harbor this.

And many women also have this... What we say is an infection, but without any symptoms, they're unaware that they have this.

The different variants of HPV can either lead to things like genital warts or low-grade lesions that do not become cancer, or different variants of the HPV virus can actually lead to cervical cancer, as well as things like vaginal or vulvar cancer.

So, by receiving that vaccine and decreasing your risk of getting nine of the most common HPV variants, you can decrease your risk of getting any of those conditions.

- Now, I find that interesting because, for much of the conversation, we've been talking about women, and you say that men aren't as aware that they can also contract HPV.

So, what does that look like, if a man does get that?

- So, most of the HPV infections in men, there are some that can cause genital warts, in which case they would be aware that they had this.

However, some of the higher-risk HPV infections, they do not know that they have, and so that is how it does get transmitted.

And again, why it's so important to have those Pap smears test for this.

Fortunately, most women who are healthy do not have any other risk factors are able to clear the HPV infection and to decrease their own risk, and get rid of the infection just by your immune system.

However, it unfortunately has passed in that way.

- What advice do you have for people who might not have had this in mind?

You know, what do you say to your patients when it comes to maintaining good health?

- Absolutely, I honestly believe if you have one good doctor that you follow, whether it be an OBGYN or a primary care doctor, is really to just speak up and really know what your body is about, and things that are different.

Unfortunately, with the GYN cancers, you have to be aware that there is something different in order to diagnose these things.

And so, really speaking up to your own health, maintaining a healthy lifestyle, those are all things that can help in aiding surveillance, as well as treatment.

- Thank you so much, Doctor.

We appreciate your time.

- Thank you.

- We're speaking with our next guest about STDs and STIs.

Her most recent book, Strange Bedfellows, is a humorous and scientific approach to addressing the embarrassing and uncomfortable subject of sexually-transmitted diseases and infections.

Dr.

In Park, thanks for joining us today.

- I'm excited to be here.

Thanks.

- Dr. Park, let's take a minute to talk about your field of work.

How did you come to choose this specialty?

- Well, you know, I actually started off in college as one of those peer educators that went to frat houses and dorms, and demonstrated how to use a condom with a plastic penis.

So, I got my start early.

And from there, I actually started working directly with students and counseling them after they were receiving an STI diagnosis, or before they had their first Pap test for testing for cervical cancer.

- So, I knew from then I wanted to go into medicine.

And then, since then, I've been in the field of sexual health in some form or another from those early days.

- Now, taking a dark subject and putting a funny spin on it is no easy feat.

And yet, you did it.

So, how did you happen to choose this approach?

- Well, you know, the thing is, Genesis, that, you know, it's a lot easier to have sex than to talk about it, and especially those least intended consequences such as STIs.

So, I knew that people had an aversion or, sort of, like, you know, an ick factor when they think about STIs.

And I said, "I wanted to do something that would make "people more interested and turn towards the subject "with fascination and wonder instead of with fear."

And so, I thought maybe using humor and storytelling could help me achieve that goal.

- What is your primary message or the key takeaways from your book that you wish to convey to our viewers?

- So, I want to normalize the fact that everybody gets a sexually-transmitted infection who has sex.

So, if you get one, then congratulations, you are a human being, and that's all it means.

CDC actually, just a month-and-a-half ago, released new data saying that one in five Americans actually has an STI.

So, we should not be shaming each other for something that happens to almost all of us at some point in our lives.

- And it's something that might be more prevalent in the Latino community.

Have you done any research on that, too?

- Yeah, absolutely.

We know that both infections such as chlamydia and gonorrhea are more common among Latinos than among white Americans.

And then, when we talk about HIV, we know that Latino MSM also have a greater risk of HIV over one's lifetime than white MSM, so men who have sex with men.

And so, it just means that folks in the Latino community should be aware and they should take steps to protect themselves, just knowing that these might be more common in their community.

- Why do you think it's more common?

Is there any reasons why that is?

- I think there's quite a few reasons, but one I think might be lack of access to health care, could be one factor.

The other is that I think, you know, there are not so many clinics out there that might be offering really culturally competent services and folks might feel intimidated sometimes to go in and ask for an STD test.

So, I think language barriers can play a role.

But, even for folks who are born here in the US, where English is their first language, I think can feel intimidated.

Just culturally, me being Asian, it's the same thing.

Like, we don't talk about sex.

We certainly don't talk about STDs.

So, I wonder if cultural factors can play a role.

So, when you take everything all put together, you know, it can mean that that folks in the Latino community are more at risk.

- You recently did an interview with NPR.

You explained a relationship between super gonorrhea and Covid-19.

Can you take a moment to discuss that with us now?

- Sure.

Early on in the pandemic, I don't know if you remember, Genesis, but President Trump sort of came out and said, you know, maybe hydroxychloroquine and azithromycin, which is an antibiotic that is commonly used to treat STIs, might be effective against Covid-19.

So, it turns out neither one of those were true, but a lot of people started using azithromycin for any respiratory infection that they might have.

And that antibiotic is one of the antibiotics that we used to use to treat gonorrhea.

And then, in December 2020, CDC actually had to issue new recommendations saying we can't use that antibiotic anymore because gonorrhea has developed too much antibiotic resistance to it.

So, when we have an antibiotic being used a lot in the community, other bacteria that are being exposed to that antibiotic can actually be pushed to develop antibiotic resistance when there's too much of that antibiotic around.

So, with gonorrhea, we have, unfortunately, we're down to one antibiotic left in the US to be able to treat it.

And so, if we lose that antibiotic, then we are going to be in trouble, in terms of not having a lot more options to treat gonorrhea.

- Have there been any conversations as to finding another antibiotic?

- There's a few.

So, there's three actually in clinical trials.

And, as we now know from the clinical trials with Covid-19, those trials can move quickly.

Unfortunately for antibiotic development, nothing is moving at warp speed.

But we do have some antibiotics in those last stages of the clinical trials, but they're not quite ready for prime time yet.

- Let's talk about STDs and their relationship to gynecological cancers.

When we talk about condoms, is that the safest form of prevention?

- You mean, in terms of preventing the viruses that could cause gynecologic cancers?

Yes.

But the thing is, Genesis, is that that virus is called HPV, and that is the one virus that we are all going to get if we are sexually active.

And it is the virus that can cause cervical cancer, and it can also cause cancers of the mouth and throat, as well as of the anus.

So, it is the one thing that we can't screen for for women.

They can actually get a Pap smear or an HPV test, or sometimes both, and condoms can protect.

But the thing is, it's a skin infection.

And so condoms only cover the penis, or now we have internal condoms that can be worn inside the vagina, but you can't cover your entire body or your entire lower region with latex.

And so, you can still get HPV if you rub up against somebody, even if there's no penetration involved.

So, condoms help, but they are not 100%.

- What about men?

Are they just as susceptible to get this sort of cancer as women are?

- Unfortunately, women really get the short end of the stick here.

Men can get changes on the skin of the penis and pre-cancers and cancers, but they're very rare in the US.

And cervical cancer is becoming more rare because we have a great vaccine.

But women, unfortunately, do suffer, you know, sort of, more risk for cancers in the genital tract.

But when it comes to cancers of the mouth and throat, men are actually much more likely to get those cancers related to HPV than women are.

- Dr. Park, are there any other forms of prevention that you can recommend to our viewers?

- So, I mentioned the internal condom, which they used to call the "female condom", which can be worn inside the vagina or the rectum, and then, as well as the old-fashioned latex condom, or, you know, they make them with polyurethane, which worn over the penis.

And then, of course, we have STI vaccines.

So, we have the HPV vaccine, which is highly effective against nine types of HPV infection, including the ones that are most commonly associated with cancers.

And then, right now, they're not ready yet, but there are folks working on these devices called multipurpose prevention technologies, so they would be like a vaginal ring made out of plastic that would have medicine that would prevent HIV, pregnancy, and perhaps several STIs, as well.

So, stay tuned for that.

Now, what age should people get the vaccine for HPV?

- So, people can get it as early as nine.

But the recommendation nationally is to start vaccinating folks at 11 and 12.

And that is because, Genesis, you want to get that vaccine before you have any kind of sexual contact.

And we do know that people start exploring, you know, in their teens, even before they actually have sex.

And those, like, exploration, rubbing up against someone without your clothes on is enough to sometimes catch HPV.

So giving the vaccine early, you know, is better.

After you've already been exposed, it doesn't actually have any benefit.

- A lot of really good information.

We're running out of time.

But I want to close on this note, Dr. Park.

Is there any other advice that you have for our viewers when maintaining a good, sexual, healthy life?

- I want everyone to understand that STIs are going to happen to you, and to go out and get tested.

That is the empowering thing that you can do to take charge of your sexual health.

And for parents, you know please have these conversations with your kid.

I know it is really hard, because I am a parent myself, but I just wanted to point folks to a website that I like called TalkWithYourKids.org, because it actually gives you sample messages and a timeline for when to talk about certain topics.

So, I think sexual health and instilling strong sexual health starts early, when folks are in their preteen and teen years.

- It's great to know that resource is available.

TalkWithYourKids.org.

Thank you so much, Dr. Park, for being with us today.

I appreciate your insight.

- Thank you for having me on.

- My next guest is Pam Richetta, a longtime Lehigh Valley resident who lives here with her husband, John.

She loves her family, her rescue dogs, and gardening around the house.

But she's also a cancer survivor, an ovarian cancer survivor.

Thanks, Pam, for joining me today.

- You're welcome.

You're welcome.

- To start out, I'm just going to ask you if you could share your story with us.

- It hasn't been a terrible, terrible journey like some people would imagine cancer would be.

It sounds kind of weird, but it probably was one of the best things that's ever happened to me in my life, really.

- Tell me why?

Why was it the best thing to ever happen to you?

- Well, it grounded me.

It made me more aware of things that are around me that I was overlooking or taking for granted.

It really defined my spirituality, which I always had, but not to the degree that I developed it while I had cancer, because you need something to believe in.

And so, for me, I believed in God first, my doctor second, and then, myself third.

And that has what probably has made the journey not so devastating, as some people might think it would be.

- So, Pam, how did it make you feel to receive the news that you were diagnosed with ovarian cancer?

- First, I was diagnosed with breast cancer, so that happened at the end of May.

And on June 5th, I had a lumpectomy.

So after that, I thought I was kind of home free, you know what I mean?

How many people get cancer twice in two months?

So...

It was a month later that my husband discovered a lump on my stomach that was the size of a grapefruit, and fortunately, I had an appointment with the gynecologist that Monday, and I went to see her, and she really was alarmed and said, "You have a mass," and immediately sent me to St. Luke's to get a C.T.

scan right away.

So, I had that done at noon.

And, as I was driving home in the car, she called me and told me that it was ovarian cancer.

My initial reaction, because I was driving in the car, I pulled over.

My initial reaction wasn't so much that I was scared for me.

I had to call my husband and tell him.

I really didn't know how I was going to say to him that I had ovarian cancer when we had just dodged a bullet with breast cancer.

So, maybe because I was more concerned about him, or I was in shock, I really didn't get the whole picture until I got home and actually had a phone call saying that "you have an "appointment on Thursday for an MRI.

"You have an appointment on Tuesday with Dr.

Taylor."

All of these things happened all at one time.

It kind of, like, overwhelmed me in a good way.

I was so busy figuring out all the things I had to do that I wasn't really so scared about ovarian cancer because, after all, I had just finished getting breast cancer.

It didn't it didn't register right then, you know?

- Now, I know initially you said that you felt worried for your husband, but as you went through the course of treatment, how did it impact you and your family?

It happened quickly.

Dr. Taylor... And we had a meeting, John and I, and Dr. Taylor, and he told me that I was going to have surgery the following Thursday.

And then, I said, "Well, that's OK. "That's all good, I just don't want to have chemotherapy.

"I just don't.

My father had it and I saw him go through it," and he said, "Well, when was that?"

And I said, "Well, 1984."

And he said, "Well, you know, we've had advances since then.

"And if you want me to save your life, you're going to have "to have chemotherapy."

So, that was a no-brainer.

You know, he set everything up and I had an implant...

I had them implant a port into my chest so that they could do the chemotherapy.

And it just started.

All of a sudden, on August 23rd, I started getting chemotherapy, and it happened every three weeks.

My daughter and son-in-law and grandson live about an hour-and-a-half away.

They fortunately did not get to see all the drama that associated getting chemo, like losing my hair and all of that stuff.

It wasn't as horrible as some people will give you the impression that it is, because you have so many people, if you're lucky enough to go to St. Luke's, who care for you and watch over for you.

So, the worrying about it was not up to me.

They took care of everything for me at the infusion center, I was treated so beautifully.

It was not a horrible thing at all.

I can't remember getting sick.

I remember being terribly tired.

I remember having cravings for things like, silly things, like jelly donuts.

I hate jelly donuts, but I crave them.

I loved hot dogs from Dairy Queen.

I never eat a hot dog.

It was the weirdest thing, but it was not as horrible as people would think it is, because you're kept busy between blood work every week, chemotherapy every three weeks.

And I had the blessing of not having to work anymore.

So, I got to rest.

I had my husband and my wonderful, wonderful friends who were always there for me, and I bought a lot of wigs.

So, I had a whole bunch of different hairstyles.

It really was not as bad as people would think it is.

But I have to thank St. Luke's for that, because they really did a wonderful job taking care of me.

- And you know what?

What you're saying goes hand-in-hand and in-line with conversations that I've had with other cancer survivors.

My dad right now is going through chemo.

And, you know, a support system has been great for him.

But he also has cravings, you know, and... You know, carrot cake.

So, what thoughts would you like to share with our viewers about your experience overall?

- If you're fortunate, you get an awareness of how wonderful Life is and how precious it is.

I think, like I said before, for me, it was the best thing that has ever happened to me in my whole life, because I became so aware of the gift of life.

Cancer has not defined me.

It has not made me... it has not controlled my life.

It was something that's in the past, it was something that made me a better person, a more patient person.

It has just not been what a lot of people would expect from it.

It really hasn't.

- Now, you've been through breast cancer, and also ovarian cancer.

And right now, there could be some women that are going through that same journey.

So, what is some advice that you would have for those ladies that are just in the middle of it right now?

- Believe in God first, or a higher power, believe in your doctors.

If you start second-guessing your doctors or thinking that you should go on websites and find better alternatives, don't do that.

You have to trust your doctor more than anything.

If your doctor tells you to do something, that's what you need to do.

There's no second-guessing.

There's nobody better in the whole universe that's going to tell you what's right for you than your doctor.

- Well, thank you, Pam, for joining us today and sharing your story with us.

- You're welcome.

It was a real pleasure.

It really was.

Thanks a lot for letting me do this.

- Of course.

I want to thank our St. Luke's University Health Network expert Ashley Graul and our other guests, doctor and author Ina Park and Pam Richetta for joining us today.

And thank you for tuning in.

We look forward to seeing you again soon.

If there's a medical subject you'd like for us to cover, send me a message on social media.

You can find me on Facebook and Instagram.

Plus, you can tune in to hear more of my reporting on 91.3 FM, WLVR News, your local NPR News source all day, every day.

I'm Genesis Ortega, and from all of us here at Lehigh Valley Public Media, stay safe, be healthy, and cheers to your health.