It is National Minority Cancer Awareness Week and Dr. Carol Brown wants you to know exactly what your risk factors are and when its time to see a doctor. She is a board-certified gynecologic oncologist which means her specialty is diagnosing and treating cancers that affects a woman’s reproductive organs.
For more than 25 years, she has used her skills as a surgeon to provide high-quality and compassionate care to women with ovarian, uterine, cervical, and vulvar cancer at Memorial Sloan Kettering Cancer Center, and this year, Dr. Brown serves as the 50th president of the Society of Gynecologic Oncology.
WHY DOES IT SEEM LIKE CANCER EFFECTS MINORITY COMMUNITIES AT A HIGHER RATE THAN WHITE COMMUNITIES?
People of color, including Asians, Hispanic/Latinos, American Indians and Blacks are affected by some cancers at higher rates than other groups. Blacks in the U.S. have the highest death rate of any racial/ethnic group for lung, colon, breast, prostate and uterine cancer.
The causes of these inequalities are complex, but through research we are learning that biologic differences in the cancer itself may explain many cancer disparities experienced by Blacks and other diverse populations. Socioeconomic factors, especially poverty, also contribute to cancer disparities through barriers to high-quality cancer prevention, early detection, and treatment information and services.
WHAT’S ONE THING MOST PEOPLE DON’T KNOW ABOUT CANCER IN GENERAL?
The risk of being diagnosed with cancer increases with age because most cancers require many years to develop. According to data from the American Cancer Society, about 1 in 2 Black men and 1 in 3 Black women will be diagnosed with cancer in their lifetime.
The lifetime probability of dying from cancer is about 1 in 4 for Black men and 1 in 5 for black women. The one thing that most people don’t know about cancer is, that today, unlike in the past, most cancers can be cured with the right diagnosis and treatment, and even more cancers can be prevented by pursuing a lifestyle minimizes their risk.
The World Cancer Research Fund has estimated that about 20% of cancers that occur in the US are due to poor nutrition (including excess alcohol consumption), physical inactivity, and excess weight, and thus could be prevented.
BLACK WOMEN ARE DYING FROM CERVICAL CANCER AT A RATE 77% HIGHER THAN PREVIOUSLY THOUGHT, BUT THIS IS PREVENTABLE. WHY? HOW IS THIS PREVENTABLE?
The rate at which Black women in the U.S. are dying from cervical cancer is comparable to that of women in many poor nations. What makes these findings especially disturbing, is that the majority of cervical cancer is caused by a virus called Human Papilloma Virus(HPV).
Between primary prevention- which means getting ourselves and our children, boys and girls, vaccinated with the HPV vaccine so that we never get the virus- and secondary prevention-which means getting your PAP smears on a regular basis so that cervical pre-cancer can be detected early and treated- cervical cancer is an almost completely preventable disease. Many studies have shown that the most common reason Black women and any women in the U.S. die from cervical cancer is that they have not had recommended screening with PAP smears.
AT WHAT AGE SHOULD WOMEN STOP GETTING PAP SMEARS?
Many cervical cancer screening guidelines say that women over 65 who have had regular
screening with negative results don’t need to have PAP smears. But based recent research that shows almost 20% of cervical cancer in the US occurs in women over age 65 and the research that death rates for cervical cancer are highest for Black women over 65, I recommend women continue to get regular cervical cancer screening past age 65 and for at least as long as they are sexually active.
WHAT’S THE BEST WAY FOR WOMEN TO DETECT CANCERS AFFECTING THEIR REPRODUCTIVE ORGANS BEFORE IT’S TOO LATE?
The best way for women to detect GYN cancer in an early stage is to get vaccinated against HPV to prevent cervical, vulvar, and vaginal cancer; to get regular screening tests, either PAP smears or HPV testing for these same cancers with your OB-GYN or primary health care provider; and most importantly to know the signs and symptoms of gynecologic cancer so that cancers of the uterus and ovary, for which there are no screening tests available, can be found in the earliest possible and curable stage.
Many of the signs of uterine and ovarian cancer are commonly experienced by most women at some point in their lives. But when things like pelvic pain, bloating, bleeding or discharge happen for a long period of time and you have no other explanation; see your doctor and ask about your risks for ovarian and uterine cancer and whether your symptoms could be a sign of these diseases.
Knowing your family history can be especially important for reducing your risk and even preventing uterine and ovarian cancer- for both of these there are known mutations in cancer-causing genes that can be passed down from one generation to the next.
There are medical and surgical options for both uterine and ovarian cancer that can help women who are at increased risk because of their family history from every getting the disease. For more information about GYN cancers and clinical trials please check out these great videos put together by my colleagues at the Society of Gynecologic Oncology at https://www.sgo.org/patients-caregivers-survivors/clinical-trials/.
WHY ARE CLINICAL TRIALS FOR CANCER IMPORTANT?
Here’s what we know: Clinical research in underserved populations equals cancer health equity. Put simply, clinical trials are a crucial step to finding new and promising ways to improve treatment for cancer. Most medical advances have come as a result of clinical trials.
Participating in cancer clinical trials is the best way to level the playing field for Black people and all underserved groups affected by cancer. We’re not just talking about the best in terms of care, but access to the best in new therapies, access to new drugs and interventions before they are widely available. If the treatment is a success, you are among the first to benefit.
WHAT IS THE PROCESS FOR CLINICAL TRIALS?
Before the clinical trial
All people affected by cancer should ask their doctor about clinical trials and whether there are any available for their particular disease and stage of treatment. If you are interested in a specific clinical trial, your doctor will explain to you the purpose of the trial and how it affects you, including the main risks and benefits of taking part through a process called informed consent. It’s important to know that participating in a clinical trial is voluntary and if you decide not to participate, it will not affect the care your doctor will give you.
During the clinical trial
Once you are on a clinical trial, the researchers running the trial will want to carry out regular tests, including physical exams and sometimes imaging tests, on you to find out how your treatment is working. At the same time, they will be on the lookout for any side effects – so you may be asked questions about any new symptoms you experience while you are receiving treatment on the clinical trial.
Doctors will also look at the wider effects of a treatment on your life as a whole – in other words, your ‘quality of life’. So, they may ask you if you’re able to take part in your usual day-to-day activities, or if you need any extra help around the home or to look after your family.
After the clinical trial: How will trial results be used?
After you finish treatment on a clinical trial, your doctors may still see you and follow you for symptoms on a regular basis for a long period of time to understand all the effects the treatment has had on you and your cancer. For some cancer clinical trials where you are receiving a specific treatment, your participation may give your doctor results that can be used to help find the best available treatment for your particular situation.
Results of cancer clinical trials are also used by your doctor and researchers to help cancer patients in general and to find new and more effective, less toxic ways of treating cancer. Results of the clinical trial you participated in should be made available to you by the researchers if you want them.
WHO SHOULD PARTICIPATE IN CLINICAL TRAILS?
More than twenty years after Congress required that research funded by the National Institutes of Health (NIH) include minorities, and women, less than 2% of all adults with cancer in the U.S. participate in a clinical trial. For minority and underserved people who suffer severe disparities in cancer incidence and death rates, participation in clinical trials is critical. Participation in clinical trials can help us understand how gender, racial, ethnic, and socioeconomic differences can affect the way cancer progresses and how well patients respond to treatments, as well as aid in the development of new treatments and ways to prevent cancer.
Dr. Brown answers your Text Tom questions on the next page: