Ovarian Cancer Awareness - Research and Screening in KY

Host:  Dr. Jennifer Hunter, Assistant Director for Family and Consumer Sciences Extension, University of Kentucky

Guest:  Dr. Edward Pavlik, Director of the Ovarian Cancer Screening Program, University of Kentucky Markey Cancer Center

Special Edition Series – Cancer Conversations Episode 9

0:00 Welcome to Talking FACS and thank you for tuning into Cancer Conversations on Talking FACS; a podcast collaboration between the University of Kentucky Markey Cancer Center and the UK College of Agriculture, Food and Environment's Cooperative Extension Service.

We will share with you the latest developments in cancer prevention, diagnosis, treatment and research from the experts at Markey Cancer Center; Kentucky's only National Cancer Institute designated Cancer Center.

Talking FACS is hosted by the UK Family and Consumer Sciences Extension Program. Our educators share research knowledge with individuals, families and communities to improve quality of life.

0:41 Dr. Hunter: Hello and welcome to Talking FACS. This is your host, Dr. Jennifer Hunter, Assistant Director for Family Consumer Sciences Extension at the University of Kentucky.

Today, I'm pleased to have joining us Dr. Pavlik, the Director of the University of Kentucky Ovarian Screening Research Program. Dr. Pavlik, thank you so much for joining us today.

1:02 Dr. Pavlik: It's great to be here.

1:03 Dr. Hunter: So, September is Ovarian Cancer Research Month. And I appreciate you joining us to share with us more information about ovarian cancer and really and truly helping to inform women about risks, maybe ways that they can learn more information and just general guidance on the area of ovarian cancer.

So, let's just get started. I'm talking about ovarian cancer occurrence. Is it higher within the state of Kentucky as compared to nationally or is it higher in certain areas of the state?

1:38 Dr. Pavlik: No. I would say that we are about the same as everybody else. We don't have risk factors that would be environmental. We probably don't have risk factors that are lifestyle related.

So, the difficulty that we do have is, as we've looked at incidence of ovarian cancer on a county by county basis, we find that because it's a rare disease and Kentucky is a relatively little population, that we see no significance.

2:08 Dr. Hunter: Are the risks of ovarian cancer the same for all women?

2:12 Dr. Pavlik: No, they're not. Ashkenazi Jews have a notorious ability to carry the BRCA-1 and 2 mutations. Women who have large families are generally protected against ovarian cancers. The more children you have, the greater your protection.

2:32 Dr. Hunter: That’s interesting.

2:33 Dr. Pavlik: Yes. And that likewise, that carries over to women who have been on oral contraceptives. So, if you had two or more children or have been on oral contraceptives for two or more years, you achieve the maximum protection.

So, in the end, with the number of people really in the population that are unprotected is the big number, because people don't take oral contraceptives after their childbearing years and that's when the risk of ovarian cancer is the greatest.

3:03 Dr. Hunter: So, what can be done to help reduce the risk of ovarian cancer?

3:08 Dr. Pavlik: Well, one can move to Kentucky and that would allow you to participate in the Ovarian Cancer Screening Program. It's unique to this area. We have women participating from every county in the state. We have enough women participating that we could fill up arena more than twice. So, that's one thing.

The other thing that we could do is to say stay in tune with your bodies. Women really have a unique ability to know if something's amiss, something's wrong. And they should not say, “Well, I'm not going to worry about it.” I think they should seek advice from their physician. So, those that those are the two main things.

If they know that they're in a family that's had other folks having ovarian cancer, I think this should make them much more concerned about their risk. Also, if they'd had themselves a diagnosis of breast cancer, they should know that their risk is higher for ovarian cancer.

4:06 Dr. Hunter: I've often heard and I don't know if it's true or not, that sometimes women will… maybe the signs or symptoms of ovarian cancer, they assume it's something different or that they don't really kind of recognize what those signs or symptoms may be. Could you share with us a little bit about that?

4:23 Dr. Pavlik: Sure. And they're generally right. The chances of those symptoms being informative for something other than ovarian cancer are very, very high. And they know that the chances of the symptoms finding early stage ovarian cancer are not that high; they’re very low. So, it's easy to sort of put aside concerns either defensively or just from natural habits.

The real thing is that if you have one of these symptoms, something's wrong. And whether it's ovarian cancer or not, it should be chased down by your physician. And his job then is to rule out ovarian cancer. And you'll do that by referring you to a GYN Oncologist.

5:05 Dr. Hunter: And you mentioned the University of Kentucky Ovarian Cancer Screening Program. Can you tell us a little bit more about that program?

5:12 Dr. Pavlik: Sure. This is a transvaginal ultrasound screening approach. And we recommend it for women, once they're in, to have it annually. Some women, we have come back more often because we're concerned about them being at higher risk.

Those women, first of all, would be those who had an abnormal screen. And we find that the majority of abnormal screens go away. So, this is a way of ruling out ovarian cancer, and that's usually due to something else. And this is also a way of sending less people to surgery who really don't need it because they don't have them have a malignancy.

Now, the participants are around 45 thousand plus women. They have received over 320 thousand free screens. I think our top survivors have survived for over 25 years.

6:06 Dr. Hunter: Wow.

6:07 Dr. Pavlik: The national average really is able to say the people coming in the door to be seen by a doctor, in our hands, 60 percent plus have early stage disease, but coming into the doctor's office, only about 15 percent have early stage disease.

And early stage disease is curable; curable by surgery alone. And this is a type of disease where the malignancy is confined to the ovary.

6:34 Dr. Hunter: And how does a lady become a participant? Are they referred by their primary care doctor or their GYN or can they just sign up themselves?

6:44 Dr. Pavlik: Right. They can sign up themselves. The way the thing works is as women talk; believe it or not. And I depend upon them to talk and to give an honest opinion about what their experience has been.

And this has led to more and more women coming into the program there. There are physicians who refer, but I think referral by women is the major way that people get in.

Kentucky Extension Homemakers has been a statewide network that has been extremely helpful to us in gaining participants as well as gaining support that has kept the program going.

7:23 Dr. Hunter: I know that also our homemaker participants also have several survival stories from participating in the screening programs as well. So, for a typical female that may be interested in enrolling in the screening program, are there certain demographics or is it truly open to all women? Is there an age that women should start maybe looking towards ovarian cancer screening?

7:48 Dr. Pavlik: Sure. All women who are 50 are automatically eligible and should call. Women down to age 25, who have a family history of ovarian cancer, which in particular would be a mother or aunt or sister that had ovarian cancer would be eligible down to age 25.

We consider people who are adopted too and wouldn't know their relatives risk to have that lower age group risk and we would admit them that way.

Those people are being admitted at a younger age, we ask them to document the family member's ovarian cancer as part of the study, just so that that we have that.

8:28 Dr. Hunter: And is there any cost to the participant or do they have to have a specific form of insurance?

8:33 Dr. Pavlik: No, there's no cost. This is a free screening program. It’s free the first time and every other time.

There are certain abnormalities that we want to pursue with a test called CA-125. And if someone has an abnormality that falls into this category, then that also is free and the program pays for the CA-125 determination.

8:52 Dr. Hunter: And for our listeners in the show notes for the podcast, we will actually place a link if they want to learn more about the ovarian screening program or how they might possibly register as well.

As we begin to wrap up today, one question that that I had to kind of finish this out is that I feel like maybe on the Internet or on social media that you see a lot of maybe… I don't even know that advertisements is the right word, but different things about ovarian cancer.

Can you tell us a little bit about why does the Internet give ovarian cancer, for lack of a better word choice, kind of a bad rap?

9:30 Dr. Pavlik: Well, sure. Well, first of all, there been one study, the PLCO study done in this country that was a very poorly executed study. It found that there was no benefit to screening and that did not detect early stage disease.

Subsequently, the British have completed a study where if they limit their study to cancers that didn't occur at entry, but appeared later, that there was a survival benefit, which they're following up now with increased years of follow up.

That's the major reason from the scientific literature. I think there's a huge complication to doing these studies. And the study that was poorly designed, did not really concentrate on the complexities of doing this. And in particular, one has to not only find the cancer, but it has to do something quick enough and it has to be doing what it's doing with people who are expert in the treatment, not just any old surgeon.

And then in the long run, it really has to have an adequate follow up for seeing that the people who were screened and were positive for the disease were kept in the treatment group considerations, so that if they didn't get treated, they shouldn't be shouldn't be counted in the cohort of being screened.

10:52 Dr. Hunter: Dr. Pavlik, thank you again for joining us and sharing more about ovarian cancer and also the importance of ovarian cancer screening and the UK Ovarian Cancer Screening Research Program.

Again, to our listeners that if you are interested in learning more about the program, we'll have that link within the show notes. But you could also feel free to reach out to your local county Cooperative Extension Office and through the Kentucky Extension Homemakers Association that many of our local counties will do screening days and they'll bring several women from a county at a time to make transportation easier as well. So, feel free to reach out to your local resources as well. Thank you so much.

11:36 Dr. Pavlik: Great to be here.

11:39 Thank you for listening to Cancer Conversations on Talking FACS. Our goal is to connect you with the latest advances in cancer research in the Commonwealth.

If you enjoyed today's podcast and have a suggestion for a future show topic, please messages on the UK Markey Cancer Center Facebook page at facebook.com/ukmarkey. Or visit our website at markey.uky.edu for more information.

You can find University of Kentucky Family and Consumer Sciences Extension Programs at your local extension office or online at fcs.uky.edu. Building strong families. Building Kentucky. It starts with us.