What to Know Down Below™
Welcome to What to Know Down Below™ by Tina’s Wish! We’re here to empower you with the knowledge and tools you need to advocate for your own gynecologic health.
Knowledge is power, and we encourage everyone to join us in learning more about what you need to know, down below!
What to Know Down Below™
Beneath the Surface: Ovarian Cancer Risk Factors and How to Reduce Your Risk
Hosted by comedian and 2x ovarian cancer survivor, Karen Mills, and featuring Dr. Gizelka David-West, Gynecologic Oncologist at Northwell Health and lead singer of the band N.E.D.
Welcome to What To Know Down Below by Tina's Wish. We're here to empower you with the knowledge and tools you need to advocate for your own gynecologic health. Knowledge is power, and we encourage everyone to join us in learning more about what you need to know down below.
Speaker 2:Hi everyone. My name is Karen Mills, and I've been a nationally touring comedian for over 25 years, and am a two-time ovarian cancer survivor. I'm here with Dr. Gazelka , David West, gynecologic oncologist and lead singer of the band , NED, for the next installment of our ovarian cancer 1 0 1 series. Today we'll be talking about what puts someone at a higher risk for ovarian cancer and the steps you can take to reduce that risk . Risk . You know , um, for me it really wasn't even on my radar. And , uh, and I had, you know, I had no idea that I was at risk for ovarian cancer. In fact, I didn't even think I was at risk for cancer. I mean, it's not my history. Um, no one in my family. I mean, we've had, I have , I had an uncle with skin cancer and I had , uh, an aunt with , uh, breast cancer. But, you know, I have a big family. Nobody else has ever had any cancer risk and , um, cancer , uh, occurrences. So I really never even considered that because I put so much stock in genetics and I learned quickly that , um, that you can still have a high risk for , um, for ovarian cancer. And I'm sure other cancers as well, whether or not you're , it's your family history or not. Is that correct, doctor?
Speaker 3:Correct. Yeah. So , um, family history definitely plays a major role in it. Um, but , um, there can be , um, some genetic predisposition that maybe doesn't come up until the person , um, presenting with the cancer. You know, you could be the first one in the family, right?
Speaker 2:Yes. That's what I was thinking. You know, I I I just feel like I thought, well, it couldn't be that, you know, because my mom had a , um, had a, had a benign tumor years ago, so I immediately, when, when they said I had a tumor , uh, I thought , there's no way. It's just like she had, it's a fibro , just like she had. And, and so I was shocked mm-hmm <affirmative> . Because my family, we, you know, we don't get cancer. We eat gravy and biscuits for 50 years, clog our arteries and have strokes. So that's what we do.
Speaker 3:That's what you were preventing , that's what you were trying to focus on prevention for , right? Yep . Not cancer , but you're , but you're absolutely right. And those are the more common things, you know, know if you, the number one killer of women heart disease, you know, this is, these are the things that , um, uh, are kind of it , we were reminded of and being told of, you know, protect your heart and eat healthy exercise. Um, so yeah, ovarian cancer may not be on your radar at all. And the general population risk for ovarian cancer is quite low. It's at around 1.4%. So, you know, it's really not something that really is that common, but when it does come up, it is deadly, and it's important to know what risk factors there are .
Speaker 2:And I also , um, I have not been married. I've not had children. And does that also up my risk? I've, I've heard that it does.
Speaker 3:Yes. Well, the not having kids part, but the not being married part doesn't , <laugh> might increase your risk 'cause of stress and stuff. Who knows , <laugh>
Speaker 2:Takes some stress down. Yeah .
Speaker 3:That might be , that might balance things out for you. But , um, but yes, you , you highlighted on some of the risk factors that you had personally and that are risk factors, non-child bearing or not ever having children. Um , other risk factors are, let's say , um, use use of fertility drugs or maybe a history of infertility can be a risk factor. Hormone replacement therapy can be a risk factor. Um, age older. The age you are, the higher the risk of any cancer development. Um, and then , um, obesity. Obesity has, is a , in chronic inflammation state, chronic inflammation, chronic stress in the body is a risk for cancer in general. And then we, and then we go, go to the history, the family history that we touched on, right? So family history is a big one. You know, there may not be a genetic marker, but if there's a strong family history that can clue you into are you somebody at risk? And then there is a patient , uh, population , uh, the Ashkenazi Jewish population , um, in the world are significantly higher risk for ovarian cancer.
Speaker 2:Isn't that interesting that one group of people have such a higher risk, but what about , um, the BRCA gene ? Like if you have , um, breast cancer, but you haven't had any , uh, ovarian cancer, say in your family, but you carry that gene, then that is a , puts you at a higher risk, correct?
Speaker 3:Yeah, absolutely. So we can talk about that, right? So , um, this is where kind of knowing your risk , knowing family history may then lead you to a genetics counselor, somebody who will counsel you and tell you what are, how high percentage risks you may have given your family history , um, and then recommend genetic testing. And the genetic testing is where we find genes such as the BRCA gene. So BRCA one and BRCA two are the most commonly associated with breast and ovarian cancer. There are others, we won't go into all those details, but BRCA one and two are the most common , um, with , um, up to 40% risk with the BRCA one and the , and up to 20% risk with BRCA two. And that's risk for ovarian cancer with those genes.
Speaker 2:This is like , uh, with Angelina Jolie , you know, she had that gene and so she had the mastectomy, she had ovaries removed. I mean, is that something that is recommended?
Speaker 3:Yep . So our governing bodies do have guidelines that we follow , um, regarding these genetic , um, mutations. And so , um, as we talked about in our first episode, screening and early detection, there's no good tests or screening for the general population. But once we know you are high risk with one of these high risk gene mutations, then we do have a protocol we do have for the younger patients , um, who are not ready to pro perform these risk reducing surgeries. There are certain screenings that we do with pelvic ultrasound and that ca 1 25 that we mentioned, and that trend of those tests will clue us in to is there something early evolving? Is there something more advanced, evolving? And so it's not a perfect test at all, but it gives us something to follow these high risk patients with. Um, then in the patients who are ready for risk reducing surgery, we do recommend the tubes and ovaries get removed. And so that's a procedure called a bilateral cell pingle ectomy.
Speaker 2:I thought so .
Speaker 3:Huh?
Speaker 2:I thought that's what it was called.
Speaker 3:Yeah . Great <laugh> , but removal of tubes and ovaries is good enough. Right? <laugh> . So , um, and so our guidelines state that by age 35, or when you're done with childbearing and you harbor a BRCA one or two mutation, the recommendation is to remove the tubes and ovaries to prevent ovarian cancer.
Speaker 2:Well , um, and age wise is, is most , uh, ovarian cancer, does most of that occur , uh, at menopause or perimenopause, or is there I have heard of people getting it really young. Mm-hmm
Speaker 3:<affirmative>. Yeah . So , um, uh, for the general population , um, the patients who present as spontaneous, spontaneous ovarian cancer, no genetic risk. We tend to see it in the age sixties and up, that's the most common age group. Um, when you harbor a genetic mutation like BRCA one, it's a lot earlier, 35, 40 years old, or in your forties, you can develop ovarian cancer for BRCA two, it's a little bit more in like the eight in the fifties , um, age range, fifties to sixties. And so when we make these guidelines recommending these risk reducing surgeries, 35, age 35 is kind of the number we use , but it's really geared towards those BRCA one patients because they are so much higher risk, up to 40% risk of developing ovarian cancer at that earlier age bracket, BRCA two carriers. They , um, we , you know, you can kind of push that age limit along a bit because we know if they're gonna get ovarian cancer, it's more likely to happen in the fifties age bracket. Um, but age does, it does make a difference.
Speaker 2:I was 54 when I was first diagnosed. Yeah . And , uh, you know, I know that estrogen is also so important for your heart and other things, and, but you can't really take much estrogen beyond, I mean, after ovarian cancer. Right.
Speaker 3:So I will say it , it , it gets into a little bit more granular discussion, but it's all kind of dependent on the type of ovarian cancer that you had, the cell type, if there was hormone receptors on it or not. There's some young women, let's say they had an ovarian cancer in their thirties and they had to have ovaries removed, which puts you into menopause definitively. Right? That's why it's a very big deal for young women to have these risk reducing surgeries, right? You're gonna go into menopause. So it's, it's hard pill to swallow ovarian cancer, super high risk, or the reality of menopause at 35. I , so it's very hard. Um, and so again, depending on what type of cells were found at the ovarian cancer, and if you're young , um, it's a conversation with your doctor, weigh risks , benefits, and we have put patients on estrogen after ovarian cancer diagnosis that they're very young and if they were the right candidate, right? Because like you said, heart health, bone health, mental health, you know , these are things that are estrogen is so important for,
Speaker 2:I am on a very low dose mm-hmm <affirmative> . But, you know, because of my, of heart health, basically. Yeah .
Speaker 3:Right. And then again, likely your cancer cell type was not driven by estrogen. So you're , um, likely, you know, a good candidate for that. And it makes sense.
Speaker 2:How , uh, how important , uh, do you feel diet is in all of this?
Speaker 3:Um, so I wish I had more education on diet and nutrition in our training, but as, as I go through my , um, career now I learn more and more. And , uh, we work with excellent nutritionists who do a lot of cancer nutrition counseling. Uh, but my general rule of thumb with patients is eat the rainbow, meaning high , um, high protein, more vegetable protein , um, colorful vegetables and fruits, things that are, have more nutritional value, right? The bland or the plate , the less nutrition that you're seeing on that plate. Um, and I think , um, trying to minimize inflammation. Right? Um, and so the types of things that you eat, what is causing inflammation? Um, low sugar is better than high sugar, right? Low fat is better than high fat. These just like the basic tenants and principles and then getting into nitty gritties of the diet. Um, I leave that to the professionals,
Speaker 2:Right? <laugh> ? Well , I , uh, I, and this is just something I feel personally, I , I haven't had a professional say this to me necessarily, but I've been a, a road comic for, you know, 29 years. And I , um, early on particularly, I ate a lot of fast food 'cause it was cheap. And at that time, I, that's what I could afford. And , um, and as a result, I just feel like everything jacked up with hormones and everything else. I just feel like that it contributed. I just, I just do ,
Speaker 3:You can't deny that there's gotta be a link. There's gotta be some correlation. It's , um, we don't, just to do the study to test fast food and ovarian cancer, you need a lot of people <laugh>. I don't think anybody would sign up for that study either,
Speaker 2:<laugh> . Oh , that's true. Um, but , uh, and I also , uh, was recently , um, diagnosed with an autoimmune that my understanding is occurs a lot with ovarian cancer patients.
Speaker 3:Mm-hmm <affirmative> .
Speaker 2:Mm-hmm <affirmative> . So is that something you , uh, you have to deal with with your patients a lot? Or, or you do you see that very often? Yeah,
Speaker 3:So , um, I've seen it a , a handful of times. I will say it's , um, uh, the times I've seen it was at onset of the disease, right? Like at presentation, they, it coupled with some kind of autoimmune condition. And when we treated the disease that autoimmune condition subsided mm-hmm <affirmative> . Um , but then it can also be something that may come up as a consequence of the treatment that you get certain, certain chemotherapies or maintenance therapies can create these autoimmune conditions. And then we see that later on, like these, well , when we have long-term survivors, you kind of end up seeing a lot of these , um, these sort of things pop up that you wouldn't expect.
Speaker 2:And, and once you , uh, you go through the hysterectomy and everything, I mean, is is hormone replacement an option? Not an option.
Speaker 3:So that's a great question. So , um, so I would say the easy answer is yes, it's an option. It's, it's just requires a conversation and evaluation of risk assessment. So let's just talk about the BRCA mutation carriers, for example. Um, let's say this patient has had the mastectomy, right? Um, so they have risk reduction for breast cancer, and now they've want to proceed with their total hysterectomy and , um, tubes and ovaries out. Um, that patient, if they're premenopausal, yes, they can , um, get on some hormone replacement therapy. And in that case, because the uterus has been removed, they can just have estrogen alone. And estrogen alone is much safer than estrogen plus progesterone when you're doing hormone replacement. Um, lower risk of , um, side effects or , or blood clot risk or cancer risk when you just have the one with the estrogen. Um, there are some patients who maybe still have their breasts or the BRCA patients who have a diagnosis of breast cancer already, they unfortunately cannot get the hormone replacement, especially if their breast cancer was hormone positive, right? So it really, it's a discussion. It's an figuring out, you know, your risk category. If the uterus was left in, then you have to do progesterone with the estrogen, because now estrogen alone on the uterus is a risk for uterus cancer. So lots of conversation, lots of , um, really looking at the patient as a whole to then figure out really what's the benefit we can achieve with this hormone replacement? What's the risk? And I always tell patients it's an up and down that we wanna make sure the the benefit is higher and the risk is lower.
Speaker 2:And it's really something you need to , uh, a personal , um, yeah . Situation with your doctor that you have to
Speaker 3:Absolutely, absolutely. There's some women who they just are afraid of the idea of hormone replacement. And so then I discuss alternatives. It's important to know that there are non-hormonal options for the symptoms that , um, patients can and will experience with menopause.
Speaker 2:So is it fair to say that the majority of people diagnosed with ovarian cancer do not even have a genetic variant?
Speaker 3:Correct. Yeah. So I listened to a podcast sometime ago about kind of genetics and how we're so focused on genetics and cancer, and the person speaking was like, well, you know what? Not e majority of cancers are not even related to genetics. So we've gotta think about the environment, we've gotta think about other things. And he was right. Really only about 25% of ovarian cancer is genetically linked . So we're dealing with 75% of our population that we don't know why they are getting ovarian cancer. Um, I think we focus so much on genetics because we can do something about it, right? We can help prevent this deadly disease with intervention. Or if you're diagnosed with ovarian cancer and have these genetic mutations, we know that certain medicines will work better for you. Right? So this is why there's so much focus and attention because we have things that we can do to help that population. So why not? If knowledge is power, if you know more, you can get more information that could help you get it, go out there and seek , seek it out. Um, uh, meet with a genetics counselor , um, and if you are a candidate for genetic testing, then you will get tested. And it's a very easy process.
Speaker 2:And what other ways are there to, for a person to reduce the , uh, her risk, their risk of , uh, of ovarian cancer?
Speaker 3:Right. So , um, um, believe it or not, even though we were talking about hormones and the good and bad <laugh> , hormonal birth control is actually a preventative mechanism, right? So hormonal birth control, when you're young, you go on birth control pills, it puts your ovaries in this quiescent suppressed state, right? And one of the theories of ovarian cancer is that this constant ovulation and , um, um, division of cells division and breakdown of cells at that, at the , in these ovaries can be , uh, priming an environment where cells can get out of control, right? They can, they're overacting or they're rapidly dividing. Mutations can occur. The checkpoints that our DNA have may miss a mutation. And then that's, that's it. That's what turns into cancer. So birth control puts your ovaries in a suppressed state, and really, I think , um, 10 years of birth control , um, really is a dramatic decrease in the ovarian cancer risk. So that's one. And then preventative surgery that we talked a lot about. Um, you know, I have many patients who come to me with a strong family history. Their mother had ovarian cancer mm-hmm <affirmative> . Um, but she was genetic tested negative. The patient is genetic testing ne negative, but now she's approaching menopause and is , and says, you know what? I just want these ovaries out. I don't wanna risk it . My mom was 52 and I am 49. Let's just take them out. Right? So preventative surgery is definitely the recommendation for the patients with BRCA mutations, but then a strong family history can also be a reason to have a preventative surgery.
Speaker 2:And, and how do you find a genetic counselor if you feel like you need one and what , what exactly do they do?
Speaker 3:Sure. So , um, speaking with your primary care doctor or with your gynecologist , um, really any of your doctors could , um, plug you in. Um , I work at the cancer center here with Northwell, and so we have the genetics counselors built into our practice. And so it's very easy for us to just , um, send a referral, but it's really a referral through your doctor . And , um, they do a very comprehensive review of your family tree and really , um, assess your risk categories, right? And if you don't really meet criteria, could you pay out of pocket for genetic testing? Sure, you can, you can do whatever you want. Um , but if you wanted your insurance to cover it, that had , you have to meet a certain criteria to then get it covered and then get the testing.
Speaker 2:Okay. Well , um, you know, it's so, so much great information, you know, any other remarks you have regarding this topic before we move on?
Speaker 3:I think , uh, kind of the take home or the reminder here, I think it's a big one, is family history or just knowing your own personal history, right? Knowing what in your personal history puts you at risk and keeping that at the forefront of your discussions with your doctors. If you have certain risk factors that we have mentioned and you start having these vague symptoms that we discussed , bring that to your doctor and say, listen, I have this family history, or I've never had kids, you know, I, I've had fertility drug treatment, now I'm having bloating, I'm having pelvic pressure, I'm having these urinary symptoms. What's going on? Could this be ovarian cancer? Could there , could I be at higher risk? Right? And so that may help clue in , um, and clin your diagnosis sooner than later.
Speaker 2:And if it does, just turn out to be menopause and good for you, but
Speaker 3:That's right. Exactly. We'll take it <laugh>.
Speaker 2:Yeah , exactly. Well, thank you so much for your words of expertise and a big thank you to everyone listening. We hope you all feel more empowered to take control of your health. Tune in for our , uh, final episode in our ovarian Cancer 1 0 1 series as we discuss why early detection is so critical to fighting ovarian cancer.
Speaker 1:For more information about gynecologic health, visit tina's wish.org/what to know . That's tina's wish.org/w H-A-T-T-O-K-N-O-W . And like, follow or subscribe wherever you listen to your favorite podcasts.