Gynecologic Cancer Prevention and Screening

Podcast Transcript

Erica Newlin, MD:

Welcome to Ob/Gyn Time, a Cleveland Clinic podcast covering all things obstetrics and gynecology. These podcast episodes are intended to help you better understand your health, leaving you feeling empowered to live your best. We hope you enjoy today's episode.

Hi everyone. I'm your host, Erica Newlin, MD. Welcome to Ob/Gyn Time. During this season, we are focusing on topics related to gynecologic oncology, meaning cancers of the female reproductive organs. On this episode, I'd like to welcome Dr. Mariam AlHilli, who will be talking to us about prevention and screening for gynecologic cancers. Dr. AlHilli, thanks so much for joining me on the podcast.

Mariam AlHilli, MD:

Oh, thank you so much for having me. It's a pleasure to be here.

Erica Newlin, MD:

Can you tell us a little more about your role in Cleveland Clinic and about your background?

Mariam AlHilli, MD:

Sure. I'm a gynecologic oncologist in the Department of Obstetrics and Gynecology. So I see patients who have been diagnosed with a gynecologic cancer. This includes ovarian cancer, cervical cancer, uterine cancer or endometrial cancer, and vulva cancer. And I also see patients who don't have a diagnosis of cancer, but might be suspected to have cancer. So precancerous conditions is something that we also treat. And then we also see a lot of women or patients who have a predisposition or high risk for developing a cancer such as uterine cancer or ovarian cancer. And we can counsel them about options to reduce their risk of developing these cancers.

Erica Newlin, MD:

Great. And then let's start by talking about the differences in the most common gynecologic cancers. Could you review for us the anatomy of the female pelvic organs and how the cancers differ and how risk factors might differ between those organs?

Mariam AlHilli, MD:

Sure. So maybe we'll start with some anatomy. The uterus is connected directly to the cervix, and then the fallopian tubes and ovaries. When someone has a hysterectomy, actually that means just removing the uterus and almost always a cervix as well. And the ovaries and fallopian tubes are removed separately oftentimes, or together with the uterus. And then sitting just in front of the uterus is the bladder. So it sits in between the bladder and the rectum, the bowel on the backside. The common gynecologic cancers and the differences between them. So the most common gynecologic cancer in the United States, it's a little different from the rest of the world because cervical cancer is one of the most common gynecologic cancer worldwide. But in the United States, uterine cancer is a common cancer, and this is cancer that starts in the lining of the uterus often. Cervical cancers, cancer starts in the cervix, and then ovarian cancer and fallopian tube cancer, as well as cancer starts in the lining of the abdomen, are all considered together under the same umbrella of ovarian cancer.

Erica Newlin, MD:

And then would it be fair to say... I know there are some nuances in the different types of uterine cancer, but we sometimes use endometrial cancer and uterine cancer interchangeably.

Mariam AlHilli, MD:

Correct, yeah. The endometrium is the lining of the uterus, so where the cancer starts. So the technical term is endometrial cancer, but uterine cancer can sometimes include cancers that are not from the lining. Cancers of the muscle of the uterus are much less common, and they're called sarcomas.

Erica Newlin, MD:

And then what role does the routine annual exam, say, at your GYN specialist and that routine annual testing have in GYN cancer prevention?

Mariam AlHilli, MD:

Yeah, I would say the routine annual exam is an important part of any patient's general care, just like mammograms, which are recommended for screening. We do have certain screening tests in gynecology, but a routine exam is part of a screening test, and that involves a pelvic and internal exam as well as an exam to visualize or look at the cervix. And then depending on the age of the patient, a pap smear would be performed at the same time. And then any abnormal findings can be seen directly and then assessed further with either some imaging studies or sometimes biopsies as needed.

Erica Newlin, MD:

So I have a lot of patients ask me, since the pap smear guidelines have changed to be less frequent, what the point is in coming every year. And so we often talk about how looking visually at that vulva, looking more on the inside, looking for any changes can still be valuable.

Mariam AlHilli, MD:

Correct, yeah. So that's absolutely true. A pap smear is not enough as part of the overall evaluation, let's say. A visual exam is always necessary because there are certain cancers that are not picked up on a pap smear, like you mentioned, looking at the vulva, the external part of the skin for any changes, any lesions. And then also to ask a little bit more about symptoms. You know, that's where the annual exam really has its value, because you can have a conversation with your doctor about any problems you might be having, which to you might not be apparent as an issue, but your doctor might have to look into further. So with the pap smear, that only just takes cells off of the cervix to test them further. But there can be problems with the vagina, there can be problems in the uterus that a pelvic exam or an annual exam will be able to detect better than a pap smear.

Erica Newlin, MD:

And then that kind of leads into my next topic, focusing more on cervical cancer. And we've talked a little bit about how pap smears have a role in screening for cervical cancer or issues with the cervix that may with time lead to cervical cancer. And those guidelines have undergone a lot of evolution in the past 10 to 15 years, which has-

Mariam AlHilli, MD:

Mm-hmm.

Erica Newlin, MD:

Led to a lot of confusion and doubt with patients.

Mariam AlHilli, MD:

Mm-hmm. Right, yeah. So just like any other guidelines, the guidelines will always continue to change. So it's important to ask your doctor what those recommendations are for you and for your age group in particular. The pap smear guidelines currently recommend that screening begins at age 21 and continues generally until age 65. But it's important to keep in mind that the age that the cancer screening ends really depends on the history of abnormal pap smears. So if anyone has a history of having any abnormal pap smears, they should be getting more frequent testing. And that is something that you can get more information from your doctor. The frequency of pap smears, this is something that has changed over the years. And at this time, between the ages of 20 to 30, pap smears are done every three years without HPV testing.

Following that, after the age of 30, an HPV test is added to the pap smear. And that's something that your doctor will order automatically. And if both are normal or negative, then pap smears can be done every five years. So it really depends on the results of that. If both are negative, then every five years until generally age 65.

Erica Newlin, MD:

Can you explain the relationship between HPV and cervical cancer?

Mariam AlHilli, MD:

Yeah. So HPV is a virus that is a very, very common, very highly prevalent virus. It's unfortunately sexually transmitted, but there are many different types of the HPV virus and there are certain types of HPV that are more risky than others or would put you at risk for cervical cancer more than others and can cause some precancerous changes. So that's the number one cause, really, of cervical cancer. And what a pap smear does is it tells us if there are any abnormal looking cells under the microscope. The HPV would tell us if the virus is present or absent, and together, a lot of information can be gained because the HPV can make the pap smear results a lot more accurate in figuring out if there is actually a precancerous problem or not and what type of further testing is needed. So after a screening test, we always have to do a confirmatory test. So further testing with a colposcopy and biopsies.

So having an abnormal pap smear doesn't automatically mean that someone has cancer. This can just indicate that there are abnormal cells. The cells may be on a spectrum anywhere between fast-growing or most of the cells being abnormal to only a few cells. So there's different degrees or grades. So that's why a biopsy is necessary to confirm if there are actually abnormal findings.

Erica Newlin, MD:

And just clarifying, with the coloscopy, that's where we take a scope and kind of a magnifying glass to get a really close look at any abnormal areas on the cervix?

Mariam AlHilli, MD:

Correct. Yes. So, that's the second step after most of the time, abnormal pap smears. But you'd have to see what your doctor recommends 'cause there's certain guidelines that we follow. And your doctor will be able to tell you when the tests should be done, generally right after the abnormal pap and what the follow-up after that will be needed.

Erica Newlin, MD:

And you mentioned this, but again, to underline the point that HPV is super common, and so it may come and go in patients, and I have a lot of young patients who are devastated by this diagnosis.

Mariam AlHilli, MD:

Mm-hmm.

Erica Newlin, MD:

But it may clear with time. Correct?

Mariam AlHilli, MD:

Correct, yes. There are times in your life that your HPV test results may be negative and times where it can be positive, just like having, you know, a cold or any viral infection tends to come and go, or be apparent or not apparent. So we just have to keep that in mind. And it's extremely common. That's why we actually don't test young women for it, because it's almost always going to indicate that it's there. It's just whether the HPV is causing any precancerous changes, that's when we worry. But having HPV in itself is not a major concern. It's an indication that your doctor has to watch you more closely.

Erica Newlin, MD:

And I tell many of my patients, if you're having sex, you're coming into contact with it. So it's worthwhile to just keep getting your exams, but it's not something that means you're going to get cervical cancer.

Mariam AlHilli, MD:

Mm-hmm.

Erica Newlin, MD:

Just means that we should watch closely.

Mariam AlHilli, MD:

Exactly. Absolutely.

Erica Newlin, MD:

And kind of changing course a little bit, can you talk a little bit more about the HPV vaccine?

Mariam AlHilli, MD:

Sure. Yeah. So the HPV vaccine, I would say is the number one step to take to prevent cervical cancer and sticking with the schedule of regular pap smear screening. So the HPV vaccine is usually given... Generally the guidelines recommend that it's given between ages of nine to 45. It actually used to be up to age 28 and the guidelines changed recently because we've seen benefit to patients getting the HPV vaccine at older ages, even up to age of 45, which says again that you can have the HPV vaccine any time during your lifetime, even if you've been exposed to it before. So it does play an important role in preventing cervical cancer. In some ways, it can boost your immunity if you haven't had it and you're in that age group, especially, you know, including if you are in your forties and sometimes even older women.

The FDA recommendations are for up to age of 45, but I've certainly given to a lot of my patients who are older and have HPV, because there is some evidence and research that shows that giving the HPV vaccination might not only prevent new types, but could help the immune system to fight the HPV virus better.

Erica Newlin, MD:

Sure.

Mariam AlHilli, MD:

Mm-hmm.

Erica Newlin, MD:

And as you mentioned, since they've changed those guidelines recently, I think a lot of us and more primary GYN have really been trying to close that gap-

Mariam AlHilli, MD:

Yeah.

Erica Newlin, MD:

And talk to patients who kind of missed that window-

Mariam AlHilli, MD:

Mm-hmm.

Erica Newlin, MD:

Previously. So definitely something that is worth talking to your GYN provider about.

Mariam AlHilli, MD:

Right. I would definitely ask your doctor if you haven't had the HPV vaccine, if you qualify for it, or if you can get it if you have not received it.

Erica Newlin, MD:

And it's worthwhile to mention it covers not only the HPVs that may lead to cervical cancer, but also those leading to warts.

Mariam AlHilli, MD:

Exactly. So, yes, it covers the more common types of HPV, including the two main ones that cause cervical cancer, which are HPV 16 and 18, but it can prevent genital warts and other HPV virus subtypes.

Erica Newlin, MD:

And can you just clarify if you can still get HPV if you've had the vaccine?

Mariam AlHilli, MD:

Yeah. So that's always something that can be a little confusing, is if you've had the vaccine, how would you get HPV? Well, just like any vaccine, the HPV vaccine is not 100% effective. It improves your immunity against it, but doesn't guarantee that you don't get it. So it's generally the rates of developing HPV are lower in patients who get the HPV vaccine than those who don't. That's where the benefit is.

Erica Newlin, MD:

And then other than HPV, are there other things that put people more at risk for development of cervical cancer?

Mariam AlHilli, MD:

Yeah. So the other common risk factors, so to speak, are smoking. That's a big risk factor. Now, I have to say, as an oncologist, I also see some cervical cancers that are not HPV related, and that's important to also keep in mind. They're very rare, but almost always HPV is the common cause, or most cervical cancers are caused by HPV. So the other risk factors are, you know, having multiple sexual partners over a lifetime, that can increase the risk. Smoking would be another big one.

Erica Newlin, MD:

And then also if patients are immunosuppressed for some reason.

Erica Newlin, MD:

Correct, yes. Yes, exactly. So if someone for example, is on medications that suppress the immune system, those could be at risk.

Erica Newlin, MD:

And sometimes those patients will get missed in their screening changes. So I think it's always, when people are taking power over their own health, something to keep in mind.

Mariam AlHilli, MD:

Exactly. So if you have any conditions that lower your immune system or you're on any medications that lower the immunity, and that's why it's important to have this conversation with your gynecologist, then the screening guidelines even are completely different. Sometimes these guidelines change and the recommendation is for more regular or annual pap smears.

Erica Newlin, MD:

And then are there any symptoms that would make you suspicious for cervical cancer or would prompt you to say someone should see their doctor?

Mariam AlHilli, MD:

Yes. The red flags, although a lot of times... Most of the time, actually, cervical cancer is picked up on a pap smear. That's when it's early. But when it's advanced, when it has grown further into the cervix, it can cause irregular bleeding. So any bleeding outside the regular menstrual cycle or bleeding after menopause should be evaluated. You should see your doctor for it. And even if you've had a normal pap smear within the last few years, it's always important to double check and see your doctor for that. So, again, most common symptom when the cancer is advanced would be abnormal bleeding, or it could be bleeding after intercourse, or it could be sometimes pain, pelvic pain that's just out of the ordinary. Those are the most common things. Any abnormal discharge as well. Sometimes that might not be necessarily blood, but it can be blood tinged discharged or gray, or any color of discharge. And that is definitely a sign that you need to be evaluated if this is not your normal pattern.

Erica Newlin, MD:

Let's move on to ovarian cancer. Are there any risk factors for ovarian cancer?

Mariam AlHilli, MD:

Yeah. So the most common risk factor for ovarian cancer is having a genetic mutation, but a lot of times ovarian cancer may not be related to any risk factors. Some things that can protect from ovarian cancer are breastfeeding. Going into menopause early can potentially sometimes increase the risk, or starting periods later in life could increase the risk. So anything that avoids the ovulation period with breastfeeding or not menstruating is always protective of ovarian cancer. Birth control pills can also reduce the risk of ovarian cancer. The longer that you're on the birth control pills, the more protection you would get.

Erica Newlin, MD:

Can you talk a little bit about ovarian cancer screening?

Mariam AlHilli, MD:

Mm-hmm.

Erica Newlin, MD:

And whether it exists.

Mariam AlHilli, MD:

Yeah. Thank you for that question. Ovarian cancer unfortunately is the most lethal cancer. It's the most aggressive gynecologic cancer. And there are no screening tests for ovarian cancer, unlike other cancers like cervical cancer, which we're just talking about, or breast cancer.

Erica Newlin, MD:

And can you touch briefly on just the risk of ovarian cancer and how it may relate to the fallopian tubes?

Mariam AlHilli, MD:

Yeah. So we now believe that almost all of the common ovarian cancers start in the fallopian tubes because of that relationship between the fallopian tubes and ovarian cancer. And we call a lot of cancers ovarian cancer, but they may have started in the fallopian tube. Removing the fallopian tubes can provide protection from ovarian cancer. And now, I'm sure Dr. Newlin, if you do a lot of salpingectomies or removal of the fallopian tubes, because it prevents ovarian cancer much more so than a tubal ligation, which used to be done in the past. So whenever possible, we try to do that, and that can reduce the risk.

Erica Newlin, MD:

For sure. So mainly when patients are coming to me looking for some sort of sterilization procedure "having their tubes tied," we don't really do the clips or the rings as much anymore. We're just taking the tubes out completely.

Mariam AlHilli, MD:

Mm-hmm.

Erica Newlin, MD:

And going a little bit back to screening-

Mariam AlHilli, MD:

Mm-hmm.

Erica Newlin, MD:

Why can't we just do an ultrasound for someone every year?

Mariam AlHilli, MD:

Yeah. So the ovaries, especially in premenopausal patients, are very active, meaning that there's always cysts or follicles that develop with every menstrual cycle. And there can be some changes that are completely benign that are picked up or noticed on ultrasound.

Erica Newlin, MD:

Mm-hmm.

Mariam AlHilli, MD:

So we know that the ultrasound's not the most sensitive way to pick up an abnormal finding or especially cancer, because there are a lot of benign conditions or benign cysts that can develop on the ovaries in the premenopausal years. So ultrasounds will not help us detect ovarian cancer because by the time that cancer develops, usually it's probably beyond that point. Not to say that ultrasounds are not useful at all. They can be useful, especially if there are symptoms. And there are certain symptoms like pain, for example, or bloating, but there are certain things on the ultrasound that we look for that may indicate that a cyst is more abnormal that requires further testing, potentially even an intervention like surgery. So routine screening with an ultrasound is not beneficial.

But if somebody is at high risk, for example, if there's a gene mutation that runs in the family, then we do recommend screening with an ultrasound because it could help confirm or reassure us that the ovaries are normal until the time when I know, I think we'll talk about this a little later, preventing the risk in patients that are at high risk, what can be done. So an ultrasound can be done in the time period leading up to doing a surgery to reduce risks.

Erica Newlin, MD:

And as far as blood tests, have there been any blood tests that have been investigated as being useful in detection of ovarian cancer?

Mariam AlHilli, MD:

Mm-hmm. There have been many tests that have been investigated and a variety of tests. And not one test has been shown to be effective or sensitive enough to pick up ovarian cancer. But there is a test called CA-125, and along with the ultrasound, those two can... If it's elevated, and if there's an abnormal finding, an abnormal appearance of the ovaries, then that could place somebody at a higher risk for having an abnormal cyst or abnormal finding, or possibly even cancer. But this test is... Sometimes the reason it's not sensitive enough as it can be elevated for many other reasons, especially in premenopausal women. So just having an abnormal test is not enough to say you have cancer.

Erica Newlin, MD:

Mm-hmm. And when I have patients come to me for their annual visit asking about ovarian cancer screening, we talk a lot about going more off of symptoms. Can you discuss more symptoms that might be more concerning?

Mariam AlHilli, MD:

Sure, yeah. So unfortunately, there are no clear symptoms oftentimes for ovarian cancer. The symptoms can be very vague unlike some other cancers. Like, for example, we'll talk a little more about this later, but uterine cancer, the first sign is bleeding after menopause. And this is not the case unfortunately, for ovarian cancer. So that doesn't mean that we, you know, don't have to watch for certain things. There are certain symptoms like bloating that is not the usual or any GI gastrointestinal changes in the bowel habits, any inability to eat or unexpected weight loss. All of these can be some warning signs for certain cancers and should be brought up. If you experience any of those symptoms, bring them up to your doctor, and then they will decide if you need any further testing or any additional evaluations.

Erica Newlin, MD:

And then moving on to endometrial or uterine cancer, can you talk about which patients might be more at risk for development of these cancers?

Mariam AlHilli, MD:

Sure, yeah. So as I mentioned, uterine cancer is one of the most common gynecologic cancers here in the US. The things that increase the risk for uterine cancer. So unlike ovarian cancer, most of the time these cancers are not inherited. They don't run in the family. The most common cause would be an imbalance in the estrogen hormone compared to the progesterone hormone. So older age after menopause. Sometimes if the estrogen levels are higher than progesterone levels, the lining of the uterus can grow abnormally and then develop into cancer. The causes for high estrogen levels, there are many causes you can be taking estrogen in, but your body can also be releasing estrogen. And the most common source of estrogen after menopause is not the ovaries, it's the fat cells in the body. So being overweight or obesity is one of the most common risk factors for uterine cancer.

And like I said, the imbalance in the estrogen-progesterone caused by some conditions like polycystic ovary syndrome. And then if you're taking any hormones that your doctor doesn't know about, for example, those are things that we need to monitor and watch closely 'cause sometimes the lining of the uterus can grow abnormally.

Erica Newlin, MD:

You briefly mentioned PCOS. I talk to a lot of my patients with PCOS about how important it's for them to have their period 'cause when a lining doesn't shed, then that can lead the cell to make mistakes.

Mariam AlHilli, MD:

Correct. Yep, I agree with that. So not having a period actually means that the lining is not being shed, as you mentioned. So having a period is a sign that the hormone levels are more regular. They're causing the lining to shed every month.

Erica Newlin, MD:

Yeah.

Mariam AlHilli, MD:

And this can be done with birth control pills. It doesn't, you know, have to be a natural period, but with the birth control pills, that regulates the hormone levels and protects the lining of the uterus, so to speak.

Erica Newlin, MD:

Is there any screening for endometrial cancer?

Mariam AlHilli, MD:

Well, at this time, we don't have any screening tests for endometrial cancer, mostly because endometrial cancer is usually diagnosed early. But that's why it's important to bring up any abnormal symptoms. So any bleeding after menopause should be discussed with your doctor. Any bleeding if you're premenopausal that is not in the normal range, like heavy bleeding or any bleeding between your periods, that should also be discussed with your doctor, especially if you have one of the risk factors we talked about for endometrial cancer. So no routine screening at this time for endometrial cancer.

Erica Newlin, MD:

And as you mentioned, it would mainly go off of the symptoms, which would be postmenopausal bleeding, number one, or any big change in bleeding.

Mariam AlHilli, MD:

Correct. Mm-hmm.

Erica Newlin, MD:

And then can you touch on how endometrial cancer would be diagnosed in someone with these symptoms?

Mariam AlHilli, MD:

Yeah. So sometimes your doctor might order, if you have any abnormal bleeding, an ultrasound first. The reason for the ultrasound would be to look at the lining... The measurement of the thickness of the lining of the uterus, or to see if there appears to be any problems of the lining of the uterus looking irregular on an ultrasound. And then the next step to make an actual diagnosis of cancer, that will require a biopsy. This is done in the office, just similar to when a pap smear is done in some ways. It's actually a very simple procedure, but can be painful. But the biopsy can basically detect the cancer or any abnormal cells, including precancer.

Erica Newlin, MD:

Moving on to a little bit of a discussion about genetic testing. So we've touched on this a little before, but to recap, which GYN cancers are known to have more of a family inheritance aspect?

Mariam AlHilli, MD:

Mm-hmm. Yeah. So as we mentioned, ovarian cancer is the number one cancer that is inherited. So there's a certain genes like the BRCA genes or BRCA1 and 2 genes, that would increase the risk of mostly ovarian and fallopian tube cancer as well as peritoneal cancer. If you remember, we said those were all considered to be ovarian cancer. And then also certain types of uterine cancers. It's less common for uterine cancer to be inherited, but there's a genetic syndrome called Lynch syndrome that would increase the risk of uterine cancer as well as ovarian cancer. Other cancers like cervical cancer and vulva cancer are not inherited.

Erica Newlin, MD:

And then would you say that ovarian cancer is more often due to genetic causes, or more often spontaneous or sporadic?

Mariam AlHilli, MD:

Only 20% of ovarian cancers are inherited, but that's a big number considering in the big scheme of things that's something that we, if we know about, we can prevent in a cancer that's very difficult to diagnose and can be diagnosed when it's at an advanced stage.

Erica Newlin, MD:

And then can you describe a little what our current capabilities are when it comes to genetic screening?

Mariam AlHilli, MD:

Yeah. So with genetic screening, it usually begins with a session with a genetic counselor or a meeting with a genetic counselor where they would explain what, you know, having a genetic condition actually means and really get a good family history. By getting a family history, that means asking about any cancer history in your relatives, your blood relatives, and they can look at your family tree and tell you what your risk can be just based on your family history. And they can also discuss with you the tests that are done and what the results might mean so you can decide if this is something that you desire to proceed with. Then once a genetic test is done, it's usually a blood test, can be also saliva test. The blood tests will read out genes that have been tested. These tests go through a lot of changes over time.

Right now, we can test for many genes, actually. There are close to like 100 genes that can be tested for on a genetic test, single genetic test. And they test for a variety of genes that can predispose to cancer. So genetic counseling, then the genetic testing's done, and then once the results are obtained, then the genetic counselor usually is the person who will call you to discuss the results, whether they're negative, meaning there are no genetic mutations, or if there are some mutations, what that might mean for you, what tests you would need, what doctors you need to see. And then also, there are certain results that come back that really are uncertain. So if a test comes back showing uncertain significance, it's called a variant of unknown significance. That doesn't mean that it's a gene that causes cancer. It's a gene that we don't know very much about, but at this time doesn't seem to be a cause for cancer.

Erica Newlin, MD:

And would you agree or would it be fair to say that usually if we can, we're trying to test the individual who has the cancer first, if that's possible?

Mariam AlHilli, MD:

Mm-hmm. Yes. So that's why it's important to discuss your family history and bring it up with your doctor. So especially if there's a family history of ovarian cancer in your first degree relative. So mom, sister, even a cousin on either your mom or your father's side, bring that up to your doctor. And then once that's suspected, then the genetic testing can be done.

Erica Newlin, MD:

And then we've touched on a couple of the genes, but what are the most common genes implicated?

Mariam AlHilli, MD:

Mm-hmm. Yeah. So BRCA or BRCA1, BRCA2. There are other genes that are not as common. With the BRCA1 and 2, the risk of ovarian cancer can be up to 50% with the BRCA1 mutation and up to 20% or so with the BRCA2 mutation. Other genes are called RAD51. There are also genes in the mismatch repair, MMR genes that can be a cause of Lynch syndrome that we just discussed a little bit about. So those are the most common ones.

Erica Newlin, MD:

Yeah. And in a patient who is known to have one of these conditions, has gone through genetic counseling, what would you say-

Mariam AlHilli, MD:

Mm-hmm.

Erica Newlin, MD:

Would be a good next step?

Mariam AlHilli, MD:

Yeah, so the next step is to first talk to your gynecologist. They'll most likely, at least here in our Cleveland Clinic system, refer you to a gynecologic oncologist. So doctor like myself or one of my colleagues that can counsel you, meaning explain to you what it means to have this and what the options are. There are options to help reduce the risk of developing ovarian cancer or uterine cancer. That includes surgery. Usually that's after you're done with having children, you've completed your family. But there's certain age cutoffs based on the gene mutation that is present. And also, just to go back to this a little bit, it's important. Breast cancer history, family history is also important, not just to any ovarian gynecologic cancer, but...

And also colon cancer. So breast cancer, colon cancer, all of these can be related to ovarian cancer or uterine cancer in some ways. So if you have a family member, especially a first degree of relative, that has a diagnosis of that, especially at a young age, so less than age 50, they should be tested first and they should see a genetic counselor first. If they test positive, then automatically that would be an indication that other members of the family have to be tested 'cause these genes can be inherited in a way that you would have a 50% chance of getting the gene or inheriting the gene from your mom or your dad if your mom and your dad have it.

Erica Newlin, MD:

And those screening guidelines can often be very complicated, which is why our genetic counselors are such a great resource in-

Mariam AlHilli, MD:

Mm-hmm.

Erica Newlin, MD:

Going through that family history.

Mariam AlHilli, MD:

Correct. Yes, exactly. But it's important to bring it up with your doctor if your doctor doesn't, you know, ask you about it during a visit. Or if someone is newly diagnosed, just bring it up to your doctor and they can ask you more about it or refer you to a genetic counselor.

Erica Newlin, MD:

Perfect. Well, thanks so much for joining us, Dr. AlHilli. It's been a pleasure.

Mariam AlHilli, MD:

Awesome. You're welcome. Thank you for having me. It was a pleasure, and it was a great conversation. Thank you.

Erica Newlin, MD:

Thank you.

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