Information Session: Gynecologic Cancer and Women’s Health

Corporate Speakers

• Carol Brown; Memorial Sloan Kettering; Gynecologic Oncologist and Chief Health Equity Officer 
• Deborah Goldfrank; Memorial Sloan Kettering; Head of General Gynecology 
• Latasha Anderson-Dunkley; Memorial Sloan Kettering; Nurse Practitioner  
• Kara Long Roche; Memorial Sloan Kettering; Gynecologic Oncologist 
• Ying Liu; Memorial Sloan Kettering; Medical Oncologist 

Presentation

Operator:  Good afternoon and welcome to the Memorial Sloan Kettering Information Session: Gynecologic Cancer and Women’s Health.  Our host and moderator for today’s call is Dr. Carol Brown, gynecologic oncologist and Chief Health Equity Officer at MSK.   

I would now like to turn the call over to Dr. Brown.  Please go ahead.   

Carol Brown:  Good afternoon, everyone.  Welcome to the MSK Information Session on Gynecologic Cancers and Women’s Health.   

We're so excited you could join us.  This is Gynecologic Cancer Awareness Month in September so we're especially happy to be able to welcome you and answer important questions that you’ve brought to us about GYN cancer and women's health.   

I'm a GYN oncologist which is a specialist who specializes in the surgical care of women with cancers below the belt and I am also the MSK Chief Health Equity Officer which means I'm involved in our clinical efforts to expand access to care in clinical trials for all of our patients and potential patients.   

I want you to know that MSK is working really hard to keep you and your loved one safe when you come to an appointment for treatment at any of our locations, and to remind you that cancer doesn't stop even though there is a pandemic and we want to encourage everyone and their families to make sure you get your cancer screening test and keep your appointments.   

Together with our panel of experts, we're going to answer some of the many questions that you gave us in advance to this call, and I just want to remind you that your MSK doctors and care teams are always ready and willing to talk to you directly about your concerns.  The purpose of this call is not to address individual’s personal healthcare issues, but to talk about the general topic itself.  If you have a personal issue, a question about your care, I would encourage you to reach out directly to your MSK doctor and discuss the next steps.   

QUESTIONS AND ANSWERS 

Carol Brown:  So we're going to get started and the first thing we want to talk about is that the COVID epidemic has all of us feeling especially vulnerable and scared about our health, and I just want to emphasize what I said before that with regards to cancer, cancer hasn't gone anywhere and we at MSK are very concerned that people have been putting off their cancer screening tests and their treatments and appointments because of COVID.  And so it's really important not to delay cancer treatment, but to keep your appointments for other health issues.   

So, first, I want to ask Dr. Deborah Goldfrank who is the head of our General Gynecology section here at MSK and Dr. Goldfrank is an important expert and leader in our institution in terms of patient’s experience and flow through our system.  Dr. Goldfrank, can you please add some insights as to why it's important for people to keep up with their routine doctor appointments and general screening?   

Deborah Goldfrank:  Carol, Thank you.  Thanks for the kind introduction and I'm so pleased to be joining this call.   

So as you mentioned, it really is important for people to continue to have their screening and to continue to have the medical care that they need.  We know that at least kind of early on in the pandemic that wasn't happening because we know that the number of cancer diagnoses actually went down early in the pandemic, which obviously we don't think has to do with cancer actually going away, it has to do with people not getting diagnosed.   

And the concern is that because early diagnosis is so important, if people haven't been getting screening and haven't been getting diagnosed that this could unfortunately lead to more cancer deaths in the future.  And it's important obviously to balance risks and benefits, and some of that – the balance of those has to do with where you're living in and what the pandemic is doing in your area.   

But certainly since this has all began, medical centers and doctor’s offices, and even individuals and other patients, we've all gotten much better at keeping each other's faith and making sure that people can get the care that they need and the screening that they need and also remain safe, and this is particularly important for people who are at higher risk.   

So certainly some of the patients that we see it Sloan Kettering, we're sometimes seeing people because we know they are at increased risk for certain cancer.  And so, in that population and with those patients, it's particularly important to continue getting the screening and continuing to get any care that they need despite the other thing going on.   

Carol Brown:  Thanks.   

Deborah Goldfrank:   So I encourage people to get their screening.  Thank you.   

Carol Brown:  Thank you much, Dr. Goldfrank.  Next, I'd like to turn to Latasha Anderson-Dunkley who is a nurse practitioner on the GYN service and she works specifically with our GYN cancer patients.  I would like – Latasha, can you please talk to us about how some of the things that MSK is doing to keep you safe when you come into any of our locations?   

Latasha Anderson-Dunkley:  Thank you, Dr. Brown, for that kind introduction and thank you for having me on this call.   

I feel very safe coming to Memorial Sloan Kettering Cancer Center during this pandemic.  Employees complete a health check screening tool before reporting to work.  Our staff is also present in every lobby to make sure that every person answering the building has a mask on.  Personal protective equipment is readily available in all of our clinic areas, including hand sanitizer and hand soap is also available here.   

Patients are also screened for symptoms before their scheduled appointment and their visitors that accompany them to these appointments are screened for symptoms as well.  We practice social distancing at all of our locations to help keep staffs and patients safe.   

We also have access to testing.  Staffs are encouraged to periodically self-test for COVID-19.  Our patients are also tested prior to biopsies, procedures and all surgeries, and patients are tested upon admission to our urgent care center.  Because of all of these things out into place at Sloan Kettering, I feel very safe coming to work during this pandemic.   

Carol Brown:  Great.  Thank you so much, Ms. Anderson-Dunkley, for that incredibly accurate and warming message, and I just can totally echo that.  I feel the safest in New York City when I am at Sloan Kettering.  We have a great program with regards to protecting our staff and our patients from COVID.   

So many of you wrote in asking about what are the latest treatment advances particularly in ovarian cancer since we're in Gynecologic Cancer Awareness Month.  So I'd like to turn to Dr. Kara Long Roche who is a gynecologic oncologist and a member of Team Ovary here at MSK.  Kara, can you please talk about some of the advancements we've made in the treatment of ovarian cancer?   

Kara Long Roche:  Yes.  Thank you.  Thank you, Dr. Brown.  Thank you for having me on this call.  And to everybody who is listening in, so much for your time.   

So there have been a lot of advancements certainly over the past decade and even in the past few years in the treatment of ovarian cancer.  From a surgical perspective which is sort of in line with my passion in treating in this disease, we are much better at selecting the best time for surgery for an individual patient.   

So, now, we really look closely at all the different factors, what the CT scan looks like, what the labs look like, what the patient’s medical problems are and we work very closely with our team ovary radiologists to select patients who should have surgery before chemotherapy, or patients who should have surgery after chemotherapy.   

Similarly, in terms of selecting the best time for surgery and the setting of a cancer recurrence, we're using our tools I think much better, and helping patients to recover from surgery faster and with fewer complications.   

Moving on from that, certainly in the medical management which I will have Dr. Lui speak of additionally, but there have been significant advancements in both how we help patients tolerate their chemotherapy regimen and also the availability of new drugs, some of which are targeted therapies that work different from chemotherapy.  Patients may have heard of things like PARP inhibitor and immunotherapy, and these are all things that allow us to individualize a treatment plan so that we can give that particular patient – and details of her disease – the best possible treatment plan.   

Carol Brown:  Thank you so much, Kara.  That's really an important message for our patients and our listeners   

In the same vein, can you please share what are some of the advancements in treating other cancers that specifically affect women?   

Kara Long Roche:  Yes.  Certainly, being on the ovarian team, that is a focus of my research.  But just like you, Dr. Brown, I take care of endometrial cancer, and cervical cancer, and vulvovaginal cancer.  And what we're finding is that these cancers all share sort of a commonality and that genetics play a very important role, not just the patient’s genetics that run through their blood stream that they inherit from parents and can pass to children, but also the cancer cell’s actual genetics which can be unique.   

And the more we learn about these different cancer genetics, the more we understand that we can target treatment.  So if a particular patient’s cancer carries a particular mutation, we may be able to target therapy that we know will work the best in that situation.  And so things like targeted therapy drugs like Avastin, also immunotherapy drugs like pembrolizumab are being used much more often in these other diseases as well.   

Carol Brown:  Thanks so much.  Speaking of genetics, I'd now like to turn to Dr. Ying Liu who is a medical oncologist on the GYN team as well as a geneticist.  Dr. Liu, I know your work focuses on genetics and women's health, what role do genetics play in these diseases?   

Ying Liu:  Absolutely.  Thank you so much, Dr. Brown.  It's an honor to be on this panel with this All-Star female class of wonderful clinicians.  And thank you to our listeners for your time.   

So I absolutely agree with everything that Dr. Long Roche said.  Genetics are very important to the treatment of GYN cancers, both genetics of what we call the germline which are what we traditionally think of the inherited risk as well as genetics of the tumor itself.  And testing for both of them is very important for what we call precision medicine, and I like to define this for my patients as finding the right treatment for the right individual.   

So this is looking at individual factors of both the patient and the tumor, and trying to find the best targeted treatment, whether it's traditional chemotherapy, whether it's a novel targeted therapy like Avastin, whether it's a new pill like our PARP inhibitors, or whether it’s immunotherapy which is then an entirely different class of medicine.   

So I think genetics is absolutely critical.  And one of the best things about MSK is that we integrate our genetics with each group and we do a lot of genetic testing for our patients.   

Carol Brown:  Thanks so much, Ying.  You mentioned the tumor genomics and knowing that you have a special expertise and interest in this, could you briefly talk to our audience about the MSK-IMPACT test and how it’s used in gynecologic cancers?   

And while you're doing that, maybe you could – we had a listener who was BRCA positive and wanted to know when she should have her children tested, maybe you could answer that too.  But I would love to hear from you about MSK-IMPACT and how it's used in GYN cancer.   

Ying Liu:  Absolutely.  So there are a lot of different ways to perform genetic testing.  I'm sure all of you have seen commercials for things like Ancestry.com or 23andMe.  I would caution our listeners about these tests because these are commercial entities that are not clinically validated for the type of genetic testing that is necessary for both cancer and for inherited risk.   

So I would counsel our patients that are listening to make sure that the source of genetic testing is reliable.  And MSK-IMPACT is a reliable test.  It's a clinically-validated test where we test the genetics of the patient and that we test the cells that they inherit and are born with as well as the genetics of the tumor.  So it's one test that gives us both results.   

And the unique – one of the unique parts of it is that it allows us to distinguish mutations that are inherited in a family and mutations that are involved in the tumor.  And Dr. Brown, BRCA1 and 2 are definitely some of the most important mutations for our GYN cancer patients.  We think about 10% or 15% of women with ovarian cancer do have these mutations and they do increase your risk of both the ovarian cancer and breast cancer as well as some other cancers that we're still investigating.   

To our listeners out there who may have these mutations, I know it's very tough to think that this is something you may have passed on to your family members and your children.  We're all mothers here so we understand that our children are usually everyone’s main priority, and so we have to balance knowing that knowledge with what we can do about it.  So I always tell my patients, “You know, testing is hard, but it is important to have that knowledge so that you have the power to really change the outcome.”   

So for children of patients with BRCA mutation, we usually recommend waiting to test until they’re adults and can better process this information and that still leaves plenty of time for counseling and any preventative or screening measures.   

Carol Brown:  Great.  Thank you so much.  And one listener – we're going to switch up a little bit, a listener asked about HPV vaccine and is HPV vaccine still recommended for school-age children?  This is such an important topic and of course we all know that we’re very interested in vaccinations with regards to COVID.   

So I just wanted to remind everyone that the HPV vaccine is probably one of the most important scientific advances in the fight against cancer in a generation and that’s because it's a vaccine that could previous many different types of cancer in your children.  It's important not to think about it as having anything to do with sexual activity, which we all know who follow the news that sometimes get stigmatized, and understandably parents are concerned about having their school age – middle school age boy or girl vaccinated against something that might be related to a cancer that's been associated with sexual activity which is what cervical cancer is.   

However, who doesn't want to do something for their child that can prevent them from getting cancer as an adult.  So I just want to remind this audience that, yes, it is still indicated and approved by the Centers for Disease Control, the American Society of Pediatrics, the AMA, ACOG, every possible professional society that boys and girls are vaccinated against HPV.   

There’s now a vaccine covers nine different cancer-causing type of HPV and that we really encourage everyone to do this for their school-age children, and also important that you can be vaccinated even as an adult, even up to age 45.  So again this is a very important thing to remember.   

But on the subject of vaccine, another listener asked about vaccines for ovarian cancer and again I'm going to ask Dr. Liu, can you address that question?   

Ying Liu:  Thanks, Dr. Brown.  Yes, it's a – this is a very exciting area of research.  If we had a vaccine that could prevent ovarian cancer or help treat it, that would be wonderful.  Unfortunately, we have not developed that vaccine yet.  We do have a number of clinical trials looking at vaccines as part of the treatment and maintenance therapies for ovarian cancer.   

And just speaking about clinical trials in general, that’s something that I would encourage all the patients listening to talk to their practitioners about – I always tell my ladies that clinical trials are something we're very passionate about here at Memorial Sloan Kettering and it's really an opportunity to receive cutting-edge therapies of which vaccines are one of them.   

Carol Brown:  Great.  Thanks so much.  Now, speaking of prevention, Latasha, we've had a lot of questions about the role that diet play not just in overall health but specifically in cancer prevention.  Can you please share some of the recommendations around diet and also exercise?   

Latasha Anderson-Dunkley:  Of course.  The role of exercise has been shown to decrease cancer risk.  It is especially important for our patients who have already been treated for cancer in order to reduce secondary cancers and to improve overall health.   

We recommend at least 30 minutes of exercise five times a week.  Some examples include walking, running, cycling, yoga and/or weight training as tolerated.  We also encourage our patient to eat a healthy balanced diet with fresh fruits and vegetables, whole grains, lean meat and plenty of water.  We try to encourage patients to maintain a healthy weight.   

We also have a nutrition service here at MSK and we frequently refer patients to specialists if they have specific nutritional need.  We are also currently studying the benefits of a ketogenic diet in patients with newly diagnosed endometrial cancer.   

Carol Brown:  Thank you so much.  Those are really important words of advice.   

Now, there are many patients that are concerned about diet and exercise, and things that they can do to prevent cancer from happening.  But a lot of patients who are in the stage of survivorship and they’re worried once they completed their treatment about what they can do to keep their cancer from coming back.   

Deborah, what's the best way to stay proactive about your health and how often should women be seeing their OB/GYN after they've completed their treatment for GYN cancer?   

Deborah Goldfrank:  Hi, thanks.  It's a very good question, and obviously a huge and incredibly valid concern.  And over time, following treatment recommendations will change.  Often initially, patients will be told to see their medical oncologist or their surgical oncologist sometimes every three months or every six months, and often that gets spaced out to once a year over time.  And sometimes check-ups are exams and sometimes may include imaging or blood test.   

And it’s important to listen to your doctor's advice regarding screening because unfortunately one of – kind of a common misperception is that more screening is always better screening and that’s not necessarily true and that's been proven to be not necessarily true.  Unfortunately, there really are things like false positive to test and they can sometimes have real – they can cause real harm to the patients.   

Patients will get unnecessary tests, or sometimes unnecessary, or ultimately unnecessary procedures.  So it's important to follow the advice of your oncology team.  It's also important to pay attention to any symptoms you have or anything that you're noticing, particularly symptoms that are new for you that aren't explained by other things going on in your life or other activities, and symptoms that don't go away.   

When we talk about symptoms associated with cancer, the symptoms that are most concerning are things that you really notice kind of every day or almost every day that haven't gone away for a couple of weeks or more.   

The other thing I just want to echo, Carol, what you said because I think kind of in the – on the topic of cancer prevention, the HPV vaccine is really one of the best ways to prevent cancer and I'm really glad that somebody asked about that.  We know HPV is associated with at least six types of cancer, cervix cancer, anal cancer, vaginal and vulvar cancers, oropharyngeal cancers, and even penile cancer.   

And we also know that there are probably more than – more than 40,000 cancers related to HPV in the U.S. every year and up to 90% of those would be prevented by the vaccine.  So one of the most important things you can do to prevent cancer is to get the HPV vaccine series.   

Carol Brown:  Thanks so much.  That is really, really a critical message for our audience to take away.  Deb, you mentioned some things about symptoms so, Kara, we did have a general question about ovarian cancer.  How can you detect ovarian cancer?  Are there symptoms to look for?  Can you please take that question?   

Kara Long Roche:  Of course, I'm happy to.  This question is a hard one to answer because unfortunately many women with ovarian cancer don't notice their symptoms until the disease has progressed and spread outside of the ovaries into the abdominal and peritoneal cavity.   

Certainly, there can be situations where women can have symptoms of earlier stage disease.  And in general, we find that those symptoms are things like pain in the pelvis, abdominal bloating or feeling like the abdomen is larger than it was previously.  Patients can have changes in their bowel habit or their bladder habit, so anything that sort of deviates from the usual pattern, pain with intercourse, and then not being able to eat a normal meal so getting full quickly.   

Those are all symptoms that we hear women with advanced ovarian cancer coming in with.  And unfortunately, there's not only always symptoms of early stage disease, which is why what Dr. Liu was talking about earlier, knowing genetics and being able to give your family members the gift of knowing their genetics ahead of the cancer diagnosis can be really helpful in preventing the onset of the cancer.   

Carol Brown:  Great.  And while we're still on this topic of ovarian cancer, Kara, another listener asked how long – how often when you're about a year after being diagnosed with ovarian cancer should you get a CAT scan?   

Kara Long Roche:  So every patient is a little different and patients need to work closely with their medical oncologist and their gynecologic oncologist to make their own surveillance – individual surveillance plan.   

For some patients, blood tests like a CA 125 are a very good marker and in some cases can be the primary mechanism of monitoring.  For other patients, CT scans are very important.  For a patient in the first few years after diagnosis, usually they'll get a CT scan every three to six months.  And then as time passes and more time passes from the diagnosis through the end of treatment, those CT scans can be spaced out and in some patients stopped completely especially if the blood test CA 125 is a good marker.   

Carol Brown:  Great.  Thank you so much.  Ying, another listener wanted to know, switching up to uterine cancer, what are some of the long term effects of uterine cancer and what extra care should we take if we've been diagnosed and treated for uterine cancer? Can you answer that question?   

Ying Liu:  Absolutely.  So to our patients out there, everyone with uterine cancer is a little bit different.  And as we're learning more about uterine cancer, we're actually learning that there are different types of uterine cancer depending on sort of the molecular and genetic profile.  And every type can act a little bit differently, so it's hard to predict for any particular patient exactly what to expect.   

But I would say the long-term effects of uterine cancer really do depend on where the cancer is in your body and the type of treatment that you’ve had for it.  For example, if you've had surgery, if you've received chemotherapy, if you've received hormonotherapy or other types of therapy, even immunotherapy is often used in endometrial cancer.   

And then as far as extra care, it does depend on your individualized treatments and what side effects you may have from that.  But like everyone else has said close follow-up with your entire team and one of the best things about Memorial Sloan Kettering is that we are – we all work together as medical oncologists, gynecological oncologists and the other members of our team that helps take care of everyone.  So I would sort of say it's an individualized plan for everyone.   

Carol Brown:  Okay, great.  And while we're on the topic of uterine cancer, you mentioned this a little bit earlier, but there's been a lot of incredible advances, some of them from right here at Sloan Kettering that have shown us that immunotherapy can be used to treat endometrial cancer.   

We have several listeners asked about the role of immunotherapy in GYN cancers.  Ying, could you maybe address in particular what people asked about which is the use of KEYTRUDA and how you should be on it if you have a GYN cancer?   

Ying Liu:  Absolutely.  So this is one of the most exciting areas of research and clinical advancement in all cancers that – especially GYN cancers and endometrial cancer.   

So immunotherapy is approved right now in endometrial cancer as well as cervical cancer.  Unfortunately, in ovarian cancer, it's still only available on clinical trials right now.  And in endometrial cancer, there is a certain type of endometrial cancer that is sometimes associated with the genetic condition called Lynch syndrome, sometimes not, but has the genetic profile of a lot of mutations in the DNA.  And these types of endometrial cancer can be treated with immunotherapy specifically pembrolizumab or KEYTRUDA.   

There's another subset of endometrial cancer that don't have the genetic profile, but they can still be treated with a combination of pembrolizumab or KEYTRUDA with a pill called lenvatinib which work to make the pembrolizumab more effective.   

The question about how long one should be on this immunotherapy treatment is a very good question and it's still an area of active investigation in both endometrial cancer and other cancer types.  The reason this question has been so difficult to answer is because unlike traditional chemotherapy, immunotherapy activates the body’s own immune system to detect and fight the cancer.  And once you get even sometimes a single infusion, that effect in your body is already starting.  So even though the drug may leave your body, the effects that it caused may still be persistent.   

And so it's still a little unclear as to how long you need to be on it.  So I would encourage our patients to sort of talk to their oncologist who are giving them the medicine.  It's often a balance of the side effects and the benefits.  And I will say I have a number of women who we’d stop the immunotherapy, but the effects are still lingering.  So this is a great question and an area of active research.   

Carol Brown:  Thanks so much.  So speaking about long-term side effects and benefits of non-traditional chemotherapy or antitumor agents, one listener wanted to know what does research show us about the long-term benefits and also if there any long-term effects of taking PARP inhibitors when you have ovarian cancer.  Kara, could you and you, Ying, also please speak to that question?   

Kara Long Roche:  Sure.  I think that the most important long-term benefit is that we're seeing patients with significantly extended remissions and sometimes even cures on these newer drugs, the PARP inhibitors.  So the most important benefit is just that patients are doing better from their cancer perspective.   

There are certainly things that need to be monitored closely on these medications and I will defer that question to Dr. Liu who is one of our GYN medical oncologists who prescribe these medicines.   

Ying Liu:  Absolutely.  Thanks, Dr. Long Roche.  So I would say that PARP inhibitors are one of the biggest advancements in ovarian cancer.  We – it's a very exciting area and we – there's this new data that’s been recently presented looking at PARP inhibitors in our women with ovarian cancer and BRCA mutations, and these women are achieving longer remissions.   

And we're starting to even drill around the word “cure” which is wonderful thing and we still need to follow these women for longer, but many of them are in very durable remissions after taking PARP inhibitors.  So it's sort of a new area that’s very exciting for all of us.   

These PARP inhibitors are pills that are pretty well tolerated, but there are some side effects that we do have to manage, mostly some nausea or GI side effects that get better after the first few months.  The main side effects we have to monitor long term are the effects on your blood count and they can affect your red blood cells and your platelets in a similar way the chemotherapy, and this requires monitoring and occasionally transfusion.   

And then very, very rarely these PARP inhibitor pills can cause a type of blood-related cancer called myelodysplastic syndrome.  But over many, many studies, many women treated with these PARP inhibitors followed for many years, these rates are very low, around 1%.  And we really think the benefits for these medicines particularly in our patients with BRCA mutation really outweigh these risks.   

Carol Brown:  Thank you so much, Ying and Kara.  So speaking of PARP inhibitors and immunotherapy, both of these advances were in GYN – treating GYN cancers were made through people like in our audience participating in clinical trials.  And I just wanted to say – take a minute to talk about the importance of participating in clinical trials in terms of making this type of groundbreaking lifesaving, survival prolonging advances in GYN cancer.   

Both of the advances with regards to immunotherapy and PARP inhibitors, I'm very proud to say that members of our GYN oncology medical and surgical team here at Memorial played key roles in the advancement of using pembrolizumab and lenvatinib in endometrial cancer.  The national trial for that was led by our own Dr. Vicky Makker.   

And in terms of the trial in PARP inhibitors, our own Dr. Carol Aghajanian played a leading role in some of the practice-changing clinical trials.  And what that means is that there may be some of you in the audience who are listening today or MSK patients who by participating in those clinical trials of lenvatinib, and pembrolizumab, and PARP inhibitors that were led by Drs. Makker and Aghajanian, you played a critical role in gaining knowledge that is saving the lives and prolonging the lives of women with ovarian and endometrial cancers, as well as your own benefit.   

So I just want to remind everyone who's listening that no matter what type of cancer you have, you should always ask your provider about availability of clinical trials and you should know that here at Memorial Sloan Kettering, not only do we prioritize for you clinical trials, but we are actually doing the groundbreaking practice-changing research in gynecologic cancer.   

So now to kind of wrap things up, I would like to move towards again talking about survivorship and thrivership from GYN cancers.  So, Latasha, one of our listeners had this to say, “Next year, I will be five years in remission.  Will I still be followed in MSK and who would follow me?”   

Latasha Anderson-Dunkley:  So we are always happy to hear when our patients reach the five-year milestone.  While in remission, you will still be followed by the MSK Survivorship Program.   

The MSK Survivorship and Surveillance Program is where our patients who are in remission receive their follow-up care and cancer screening with our staff of nurse practitioners or physician assistants.   

In this program, the nurse practitioners continue to monitor for cancer recurrences in addition to addressing post-treatment issues from your radiation, from your chemotherapy and from your immunotherapy treatment.  The nurse practitioner will also discuss secondary cancer and prevention as well.  We would add diagnostic tests and other screening studies, and we also address your symptoms that may be related to previous treatment.   

We also rely on you to report your persistent symptoms just like how Dr. Goldfrank mentioned earlier and we work with your primary care oncologist, and with your medical oncologist, and your surgical oncologist to screen for recurrent disease.   

We also like to make sure that patients are following up with their primary care doctors for other routine testing and to have things like your blood pressure followed and your other cholesterol levels checked and things like that.   

So, yes, you will still be seen at Memorial Sloan Kettering by the Survivorship Program.   

Carol Brown:  Thank you so much, Ms. Anderson-Dunkley.  That was a really important message.   

And so, finally, Dr. Goldfrank, a few of our listeners have asked about hormonal therapy and as a gynecologist and someone who really we all rely on not just on the GYN cancer service but around the institution on your experience and expertise with one of the most commonly asked questions that we all have, what about hormonal therapy after you’ve had a cancer diagnosis specifically a GYN cancer diagnosis?  What’s the deal, Deb?  Is it good?  Is it bad?  Is it safe?  How do we use it?  Can you talk a little bit about it?   

Deborah Goldfrank:  Yes, I'm happy to.  It is a big and controversial topic.  And it's a confusing topic and part of the reason it’s so confusing is because the advice that patients have been getting from doctors has changed so much over the years and not because we’re trying to be confusing, but because the data has changed.   

The pendulum swung kind of several decades ago, we thought hormones were the best thing ever and women should be on hormones always and forever.  And then the pendulum swung probably too far and we started telling people that unless absolutely necessary and critical for their symptoms, they should be off of hormones and never take hormone replacement therapy.   

And now, we’ve kind of come somewhere in between and I think this is a healthier and more safe place to be, and that we really think that under certain circumstances and certainly following certain cancers, usually cancers that aren’t related to hormone receptor status, I mean, that we don't think are stimulated by hormones, that sometimes it is better for women to be on hormones and other times it isn’t.   

We think, for example, for very young women who go through menopause either because of surgery they’ve had or other cancer treatments they've had, particularly for women under 40, we think that there aren't health reasons why they can’t be on hormones.  It's probably more beneficial for them to be on hormones to protect their bone density, to protect their heart health later in life, and just for quality of life, to avoid having symptoms that are associated with menopause.   

And then often for women who are older, certainly over 60, sometimes even over 50, and in cases where there are other medical reasons not to take hormones such as the increased risk of blood clots, or a history of – or a very high risk for hormone sensitive cancers, that in those women the risks outweigh the benefits.   

So this is one of those topics where there's really no one size fits all.  It's a discussion to have with your doctor and really taking your own history and your own risk factors into account to get the right answer for you.   

Carol Brown:  Thank you so much.  That was like perfect answer to a very complicated and controversial question.   

So, everyone, I want to thank all of you who submitted your questions and really thank all of you who took the time particularly during this incredibly stressful time for all of us, about joining this call today.  And again, just putting in a plug, this is Gynecologic Cancer Awareness Month, so we're so happy that you took this time to learn more about GYN cancers.  We hope you found this information helpful and that you'll spread the take-home points to your family and friends.   

I also want to thank our incredible group of as was pointed out, all-female powerhouse amazing healthcare providers and scientists.  And I want to let you know that MSK will be hosting more calls like this in the future and we look forward to speaking with you again.   

A replay of this call will be available soon on our website, which I urge you to visit often for the latest updates, that’s mskcc.org.  We are dedicated to moving your cancer care forward and want to encourage you again to be in touch with your MSK doctors and care team.  Make all your appointments and schedule any necessary screening.  Don't delay your care.  Cancer care cannot wait.   

Please be safe and take care of yourself and your loved ones.  Thank you.   

Operator:  This concludes today's call and thank you for joining Memorial Sloan Kettering's Information Session for Patients and Caregivers.  Have a good evening.