OVARIAN CANCER AWARENESS MONTH

Encore: November 16, 2022

Every year nearly 20,000 American women are diagnosed with ovarian cancer, and the disease ranks fifth in cancer deaths among women.  In honor of Ovarian Cancer Awareness Month, we are joined by Dr. Ashley Haggerty, a Gynecologic Oncologist and expert in ovarian cancer, to discuss:  the symptoms to look out for, the risk factors that make some women more likely to develop the disease than others, and the incredible progress that has been made in terms of treatment options.

Aired: September 27, 2022

TRANSCRIPT

> GOOD EVENING, AND WELCOME TO 'METROFOCUS.'

I'M JACK FORD.

SEPTEMBER IS OVARIAN CANCER AWARENESS MONTH.

ACCORDING TO STATISTICS FROM THE AMERICAN CANCER SOCIETY, IT'S ESTIMATE THAT THIS YEAR, APPROXIMATELY 20,000 WOMEN WILL BE DIAGNOSED WITH OVARIAN CANCER AND APPROXIMATELY 1,000 WOMEN WILL DIE FROM THE DISEASE.

DESPITE THESE TROUBLING NUMBERS PROGRESS IS BEING MADE ON THE DIAGNOSTIC AND TREATMENT FRONTS, WHICH MAKES IT EVEN MORE ESSENTIAL FOR WOMEN TO BE AWARE OF RISK FACTORS, SYMPTOMS, AND AVAILABLE TREATMENT OPTIONS.

JOINING US NOW TO HELP WITH THIS AWARENESS IS DR. ASHLEY HAGGERTY, SITE DIRECTOR, AT HACKEN SAC RIVERVIEW MEDICAL CENTER, AND I SHOULD ALSO NOTE IS ALSO MY DAUGHTER.

DR. HAGGERTY, WELCOME.

THANKS FOR JOINING US HERE AT 'METROFOCUS.'

THANK YOU, I'M HAPPY TO BE HERE.

ALL RIGHT, SO LET'S START OFF WITH SOME OF THE BASICS HERE.

WHAT SHOULD WOMEN BE AWARE OF IN TERM OF FACTORS FOR OVARIAN CANCER?

THE FEW MOST IMPORTANT RISK FACTORS FOR OVARIAN CANCER DOES TEND TO BE AGE, THE MOST COMMON TYPE OF OVARIAN CANCER IS EXPERIENCED BY WOMEN WHO ARE POST MEN PAUSE LE IN THEIR 50s, 60s, AND OTHER FACTORS LIKE BREAST CANCER, PROSTATE CANCER, COLON CANCER, MELANOMA.

30% OF CANCERS WILL BE HEREDITARY.

LET'S LOOK AT SYMPTOMS.

AS WE SAID IN THE BEGINNING, AWARENESS IS ESSENTIAL.

WHAT SORT OF SYMPTOMS SHOULD BE RAISING FLAGS FOR WOMEN?

ABSOLUTELY.

SO, THIS SYMPTOMS THAT ARE OF CONCERN WITH SYMPTOMS THAT ARE NOT GETTING BETTER OR GETTING WORSE.

SYMPTOMS LIKE ABDOMINAL BLOATING, CONSTIPATION OR CHANGES TO YOUR BOWL HABITS, NAUSEA, VOMITING, PELVIC PAIN, EVEN CHEST PAIN OR SHORTNESS OF BREATH.

AND MANY OF THESE SYMPTOMS HAVE BEEN GOING ON WITH WOMEN FOR A LONG TIME AND HAVE BEEN PURSUING OTHER TREATMENT OPTIONS.

IF THOSE SYMPTOMS DON'T APPROVE, FURTHER TREATMENT AND WORKUP IS NEEDED TO MAKE SURE IT IS NOT OVARIAN CANCER THAT IS CAUSING THOSE SYMPTOMS.

FROM YOUR PERSPECTIVE THEN IN TERM OF ATTEMPTING TO DIAGNOSE THESE, WHAT SORT OF BARRIERS DOES THE -- LET'S GO TO, CONFUSION WITH OTHER TYPE OF SITUATIONS THAT COULD MANIFEST THESE SAME SYMPTOMS?

YEAH, AND AS YOU CAN IMAGINE, MANY PEOPLE EXPERIENCE BLOATING AFTER EATING AND CONSTIPATION, AND NOT ALL HAVE OVARIAN CANCER.

BUT SYMPTOMS THAT ARE CONSISTENT, MAYBE A PATIENT NOT UNCOMMON FOR US TO SEE IN THE OFFICE HAS ALREADY SEEN A G.I.

DOCTOR OR THEIR PRIMARY CARE DOCTOR, OR HAD WORKUP OR OTHER MEDICATIONS TO TRY TO MAKE THOSE SYMPTOMS APPROVE, AND IF THEY DO NOT, THIS IS WHERE THE AWARENESS OF OVARIAN CANCER IS IMPORTANT.

I'VE ACTUALLY SEEN YOU SAY THIS, AND THAT IS ABOUT WOMEN BEING THEIR OWN ADVOCATES, THEIR OWN CHAMPIONS IN TERMS OF THEIR HEALTH CARE.

WHAT DO YOU MEAN BY THAT AND HOW DOES THAT APPLY TO THIS QUESTION OF SYMPTOMS?

THE HISTORIC ASSUMPTION IS THAT OVARIAN CANCER WAS A SILENT KILLER THAT MOST PEOPLE STARTED WITH A VERY ADVANCED STAGE AND HAD NO SYMPTOM, BUT ACTUALLY WE'RE JUST NOT LISTENING FOR THOSE SYMPTOMS.

WHEN YOU HEAR PATIENTS DESCRIBE THEIR JOURNEY BEFORE THEY GET TO A GYNECOLOGIC ONCOLOGIST THEY HAVE BEEN HAVING SYMPTOMS FOR A PERIOD OF TIME AND WERE UNAWARE THEY COULD BE RELATED TO CANCER OR DIDN'T ADVOCATE FOR THEMSELVES TO KEEP FINDING A DIFFERENT REASON WHEN THEIR TREATMENTS WEREN'T IMPROVING THEIR SYMPTOMS.

OR EVEN AS SIMPLE AS GETTING IMAGES LIKE A CAT SCAN TO LOOK AT WHAT'S HAPPENING IN THE ABDOMEN.

WHAT DO YOU SAY THE WOMEN ABOUT WHAT THEY SHOULD DO IF THEY'RE EXPERIENCING THESE SYMPTOMS AND THEY'RE JUST NOT GOING AWAY?

WE KNOW ALL OVARIAN CANCER PATIENTS ARE BEST TREATED WHEN THEY'RE SEEN BY A GYNECOLOGIC ONCOLOGIST AND MAKING SURE YOU PURSUED WORKUP, ESPECIALLY IMAGING.

IMAGING IS GOING TO RAISE OUR CONCERN THAT THERE IS SOMETHING THAT LOOKS LIKE AN OVARIAN CANCER HAPPENING.

MOST PATIENTS DO NOT ALREADY HAVE A DIAGNOSE OF OVARIAN CANCER WHEN THEY SEE US, THEY HAVE IMAGING FINDINGS THAT ARE CONCERNING FOR OVARIAN CANCER.

WE KNOW THAT NOT EVERYBODY IN THE UNITED STATES HAS GOOD ACCESS TO GYNECOLOGIC ONCOLOGISTS.

THANKFULLY HERE IN THE METRO NORTHEAST WE DO, AND IT'S REALLY IMPORTANT YOU SEE AN ONCOLOGIST WHEN THERE'S CONCERN FOR OVARIAN CANSER.

ARE THERE SPECIFIC SCREENING TESTS THAT CAN LEAD TO THIS DIAGNOSIS?

UNFORTUNATELY NOT YET.

THERE WERE SEVERAL STUDIES THAT TRIED TO LOOK AT GENERAL POPULATION SCREENING TO SEE IF A COMBINATION OF THINGS LIKE ULTRASOUNDS AND BLOOD WORK WITH TUMOR MARKERS COULD IDENTIFY EARLY CANCER MARKERS AND MORE IMPORTANTLY, CHANGE THE SURVIVAL.

UNFORTUNATELY IN THE GENERAL POPULATION THOSE TRIAL DID NOT SHOW IMPROVEMENT IN DOING GENERAL SURVEILLANCE FOR WOMEN WITH CANCER.

THAT'S DIFFERENT THAN WOMEN KNOWN WHO HAVE A GENETIC RISK TO CANCER.

THERE MAY BE A ROLE FOR SURVEILLANCE IN THOSE PATIENTS.

BUT RIGHT NOW, THE PROGRESS THAT IS REALLY BEING FOCUSED ON IN RESEARCH FOR OVARIAN CANCER IS WORKING ON EARLY DETECTION.

SO, WE'VE TALKED ABOUT RISK FACTORS, SYMPTOMS.

NOW LET'S TALK ABOUT THE TREATMENT OPTIONS AVAILABLE FOR WOMEN WHO ARE EXPERIENCING OVARIAN CANCER.

SO, HERE'S WHAT I SAY WHEN PEOPLE SEE ME IN THE OFFICE WITH A PRESUMED OR KNOWN DIAGNOSIS OF OVARIAN CANCER.

UNFORTUNATELY, ONLY ABOUT 20% A PEOPLE PRESENT AT AN EARLY STAGE.

THE VAST MAJORITY OF PATIENTS PRESENT AT LEAST AT A STAGE 3C OR 4.

THAT DOES NOT MEAN IT'S NOT TREATABLE OR CURABLE.

THAT IS COMMONLY WHAT WE SEE FOR PRESENTATION.

TREATMENT IS THEN USUALLY A COMBINATION OF BOTH SURGERY TO REMOVE ALL OF THE LARGE AMOUNT OF TUMOR THAT CAN DID SEEN AND FELT, AND THEN CHEMOTHERAPY.

USUALLY INTRAVENOUS FOLLOWED BY MAINTENANCE CHEMOTHERAPY.

WE HEAR OFTEN TIMES IN YOUR FIELD, IN THE CANCER FIELD AND CANCER TREATMENT, ABOUT THE EMERGENCE OF IMMUNOTHERAPY.

GIVE ME A QUICK EXPLANATION OF WHAT THAT IS, AND IS THAT HELPFUL?

IMMUNOTHERAPY IS USING YOUR OWN BODY'S IMMUNE SYSTEM SO FIGHT CANCER CELLS.

CANCER CELLS ARE VERY SMART, AND THEY HAVE CREATED WAYS TO AVOID YOUR BODY'S IMMUNE SYSTEM BY ATTACKING THEM AND KEEPING THEM UNDER CONTROL.

UNFORTUNATELY, THE SHORT ANSWER FOR IMMUNOTHERAPY FOR OVARIAN CANCER IS, NOT YET, ALTHOUGH THERE IS SIGNIFICANT EFFORT BEING MADE WITH CLINICAL TRIALS TO LOOK AT OPTIONS FOR IMMUNOTHERAPY.

WHERE WE HAVE MADE TREMENDOUS PROGRESS IS TARGETED THERAPY IN OVARIAN CANCER.

WHAT DOES THAT MEAN?

TARGETS THERAPY, SIMILAR TO IMMUNOTHERAPY, IS TAKING ADVANTAGE OF MUTATIONS WITHIN THE TUMOR AND USING THOSE SPECIFIC MUTATIONS WITH DRUGS THAT TARGET THAT.

THE GREATEST SUCCESS STORY THAT WE HAVE HAD IN OVARIAN CANCER OVER THE LAST SEVERAL DECADES IS A CLASSIC DRUG CALLED PART INHIBITERS.

THEY'RE AN ORAL DRUG GIVEN TO PATIENTS AFTER THEY'VE COMPLETED THEIR INITIAL CHEMOTHERAPY.

THAT CHEMOTHERAPY TENDS TO GO OVER ABOUT 18 WEEKS OF TREATMENT.

THE STUDIES OVER THE LAST SEVERAL YEARS HAVE DRAMATICALLY IMPROVED PEOPLE'S OUTCOMES WITH OVARIAN CANCER AND HAVE IMPROVED THE TIME IT TAKES FOR OVARIAN CANSER TO -- BY YEARS RATHER THAN MONTHS AND IN SOME PATIENTS MAY BE PUSHING TOWARDS A CURE.

WHAT ABOUT THE ROLE OF GENETIC TESTING AND THE ROLE THAT CAN PLAY WITH REGARD TO CARE AND TREATMENT OF OVARIAN CANCERS?

GENETIC TESTING SO IMPORTANT IN OVARIAN CANCER.

THE NATIONAL GUIDELINES SAY ALL WOMEN WITH AN OVARIAN CANCER DIAGNOSIS SHOULD BE AT LEAST OFFERED GENETIC TESTING.

WE KNOW RECENT STUIES IN THE U.S. SHOW ONLY 30% OF PEOPLE HAVE UNDERGONE GENETIC TESTING.

WHEN YOU TALK ABOUT GENETIC TESTING EXPLAIN WHAT IT MEANS AND PICK UP YOUR THOUGHT FROM THERE.

SURE.

GENERAL IT, TESTING IS TESTING OF SOMEONE'S OWN HEREDITARY GENES THAT CAN BE PASSED ON TO FAMILY MEMBERS THAT CARRY A MUTATION CALLED A PATHOLOGIC VARIANT THAT PUTS THEM AT GREATER RISK FOR OVARIAN CANCER.

WE SEE THESE HEREDITARY SYNDROMES WITH THINGS LIKE OVARIAN CANCER AND BREAST CANCER WITH A GENE AND A GENETIC FAMILY CALLED BRACHA.

IT'S INCREDIBLY IMPORTANT FOR PATIENTS TO KNOW IF THEY HAVE A GENETIC MUTATION THAT HAS PUT THEM AT RISK OF GETTING THIS CANCER.

BUT THOSE GENETIC MUTATIONS HELP US PICK WHICH TYPE OF THE PART INHIBITER TO GIVE TO PATIENTS SOME THIS INFORMATION IS REALLY IMPORTANT IN THE SETTING OF A NEWLY DIAGNOSED CANCER.

BUT THESE GENES CAN BE HEREDITARY AND A 50/50 CHANCE SOME ALL MALE AND FEMALE FAMILY MEMBERS ARE AT A 50/50 CHANCE OF INHERITING THESE, AND THESE GENES, AS I MENTIONED, CAN PUT YOU AS RISK OF CANCERS BUT THERE ARE SCREENING OPTIONS AVAILABLE IF YOU KNOW YOU HAVE THIS GENETIC MUTATION.

CHANGES YOUR SCREENING RECOMMENDATION.

AND THERE'S EVEN A ROLE FOR RISK REDUCING SURGERY, FOR INSTANCE, TO REMOVE THE OVARIES AND FALLOPIAN TUBES, BECAUSE WE THINK OVARIAN CANCER STARTS IN THE FALLOPIAN TUBES, TO PREVENT GETTING CANCER FOR SOMEONE WHO'S AT A KNOWN INCREASED RISK.

WHAT SHOULD WOMEN WHO HAVE BEEN DIAGNOSED KNOW AND BE AWARE OF ABOUT THE PROSPECT OF CLINICAL TRIALS?

I THINK PEOPLE DON'T OVERALL HAVE A GREAT UNDERSTANDING ABOUT CLINICAL TRIALS.

YOU KNOW, YESTERDAY'S CLINICAL TRIAL IS TODAY'S STANDARD OF CARE.

THAT'S HOW WE MAKE THESE ADVANCES IN TREATMENT.

THAT IS HOW THESE WOMEN HAVE HAD AMAZING OUTCOME ON PART INHIBTERS.

THEY WERE ON A CLINICAL TRIAL.

MANY PEOPLE FEEL LIKE CLINICAL TRIALS ARE ONLY AN OPTION WHEN YOU'RE ADVANCED STAGE, WHEN THERE'S NO OTHER OPTIONS AVAILABLE.

THAT'S NOT THE BEST CLINICAL TRIAL.

MIGHT BE FOR SOME PATIENT BUS MANY ARE DESIGNED TO BE USED EARLY IN YOUR CANCER DIAGNOSIS AND TREATMENT COURSE.

AND SO I FEEL VERY STRONGLY THAT EVERYONE SHOULD BE AWARE OF THE ABILITY TO PARTICIPATE IN A CLINICAL TRIAL AND TO SEEK OUT CLINICAL TRIALS WHEN THEY'RE DIAGNOSED WITH A CANCER.

SO, SAYING I'M GOING LOOK FOR A CLINICAL TRIAL OR TALKING TO OUR PHYSICIAN ABOUT IT DOESN'T MEAN YOU'VE REACHED A POINT WHERE THERE'S TO PROSPECTS FOR YOU?

NOT AT ALL.

MANY TIMES THE CLINICAL TRIAL'S DESIGNED USING A STANDARD OF CARE CHEMOTHERAPY OPTION AND ADDING SOMETHING ON TOP OF IT THAT USUALLY HAVE INCREDIBLY STRONG SCIENCE BEHIND TO IT SAY WE THINK THIS COMBINATION WILL NOW MAKE THESE DRUGS WORK BETTER.

WE REALLY HAVE CHANGED HOW WE'RE DESIGNING THESE CLINICAL TRIALS AND IT GETS BACK TO THE CONCEPT OF A TARGETED THERAPY.

WE USED TO TREAT OVARIAN CANCER ONLY OR COLON CANCER ONLY, AND NOW WE'RE LOOKING AT THESE MUTATIONS IN THE CANCER, WE'RE LOOKING AT THE IMMUNOLOGY OF THE CANCER AND LUMPING AM OF THESE CANCERS TOGETHER WHEN THEY HAVE SIMILAR MUTATIONS AND USING ONE DRUG THAT TARGETS THAT SPECIFIC MUTATION.

LAST QUESTION FOR YOU.

I GOT ABOUT A MINUTE AND A HALF OR SO HERE.

FROM YOUR PERSPECTIVE, AND YOU'VE GIVEN US A SENSE OF PROGRESS THAT'S BEEN MADE, BUT FROM YOUR PERSPECTIVE, ARE YOU -- AGAIN, LET'S GO BACK TO THE TROUBING NUMBERS WE TALKED ABOUT IN THE BEGINNING.

ARE YOU OPTIMISTIC ABOUT THE PROGRESS THAT'S BEING MADE IN.

I'M VERY OPTIMISTIC.

THE LANDSCAPE OF OVARIAN CANCER TODAY IN 2022 IS DRAMATICALLY DIFFERENT THAN IT WAS THREE YEARS AGO, FIVE YEARS AND CERTAINLY 10 TO 15 YEARS AGO.

THERE IS NOW A FOCUS, AN AWARENESS, AN ADVOCACY FOR GYNECOLOGIC CANCERS AND OVARIAN CANCER IN PARTICULAR, TO REALLY MOVE THE SCIENCE FORWARD AND WORK ON NOT JUST BETTER TREATMENT OPTIONS ESPECIALLY IN THE RECURRENT SETTING BUT AS I MENTIONED EARLIER, TRYING TO FIND THOSE EARLY SKRENING AND THOSE EARLY DIAGNOSIS OPTIONS FOR PARENTS TO REALLY SCREEN THE STORY AND TRAJECTORY OF THE OVARIAN CANCER.

WE STARTED THIS CONVERSATION TALKING ABOUT SEPTEMBER BEING OVARIAN CANCER AWARENESS MONTH.

CLEARLY IT'S IMPORTANT IT CARRY THROUGH THE ENTIRE CALENDAR YEAR FOR WOMEN TO BE THE OWN CHAMPIONS OF THEIR HEALTH CARE.

DR. ASHLEY HAGGERTY, THE SITE DIRECTOR OF GYNECOLOGIC ONCOLOGY AT HACKEN SAC RIVERVIEW HEALTH.

THANK YOU FOR HELPING US UNDERSTAND ALL THIS, AND WE'LL TALK AGAIN SOON.

YOU TAKE CARE.

YOU THIS FOR HAVING ME.

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