Season 4 Episode 12 – Different Types of Cancer

Dr. Mironda Williams:

Welcome to Take Good Care podcast.

Dr. Deanna Guthrie:

An endeavor that grew out of our love for obstetrics and gynecology.

Dr. Karen Greene:

Our aim and mission is to serve as a source of vital information for women of all races, ages, and walks in life.

Dr. Mironda Williams:

I am Dr. Mironda Williams.

Dr. Deanna Guthrie:

I am Dr. Deanna Guthrie.

Dr. Karen Greene:

And I am Dr. Karen Greene.

Dr. Mironda Williams:

Welcome to our show.

Dr. Mironda Williams:

Welcome to this episode of Take Good Care podcast. I’m Dr. Mironda Williams.

Dr. Deanna Guthrie:

I’m Dr. Deanna Guthrie.

Dr. Karen Greene:

And I am Dr. Karen Greene.

Dr. Mironda Williams:

As those of you who followed us through our now four seasons of this podcast series, we like to bring information that is medically oriented, but also some other things that may not be strictly related to medicine. But on today’s episode, we want to just review some cancer facts for women in particular. Again, we’re a gynecologist by training. This is our specialty. We’ve all been in practice well over 25 years, and we trained together in the same residency program. So we have a wealth of information and experience just on our own clinical life as we’ve done gynecology. Any information that we give to you today is not to substitute or replace any of your conversations and your interactions with your own healthcare providers. This is strictly for information only. It’s not to guide your care or anything along those lines. As always, we encourage you to use information so that you are empowered to ask questions and to better understand the plan of care that your personal healthcare provider may provide.

So on today’s episode, we just want to go into some of the most common cancers that women may be diagnosed with. So Dr. Greene is going to get us started, going over breast and colorectal cancers. Dr. Guthrie is also going to follow up talking about endometrial or uterine cancers, as well as lung cancer. And then I’ll finish up giving some general information about cervical, skin, and ovarian cancers. Now in a previous episode we did some talks on wellness examinations for women. Dr. Guthrie did an excellent, excellent discussion about pap smears, when to pap, why to pap. We also recently posted, on our social media platforms, an article also talking about when to pap and why to pap. So if you have other questions specifically about that, please make sure you go back and listen to previous episodes. That one for season four was on wellness examinations. But Dr. Greene, why don’t you get us started, going over some of the information that you have about breast and colorectal cancer as it relates to women.

Dr. Karen Greene:

Thank you, Dr. Williams. As gynecologists, of course, breast cancer, and being women gynecologists, we probably think of breast cancer more than any other cancer. October is breast cancer awareness month. We happen to be wearing pink today. But breast cancer affects women in a lot of different ways. Most women know someone that have been affected by breast cancer, or they’re related to someone that has been affected by breast cancer. One in eight women will develop breast cancer in their lifetime. Which, when you think of it, that’s a pretty alarming statistic, as has nothing to do with genetics. And so because it has nothing to do with genetics, screening is so important. And so when women come into our office, that’s one of the things we talk about, especially as a new patient. “Have you had a mammogram? Have you scheduled a mammogram? Are you planning on scheduling a mammogram?” And we try to allay some of their fears maybe about mammogram and also talk about why they need to have a mammogram.

Dr. Mironda Williams:

Dr. Greene, can you say that again? Because I know we all have patients who are hesitant about mammograms or decline mammograms. They’ll say, “Well, I don’t have a family history. Nobody in my family’s ever had breast cancer.” Can you just say that again about how it’s not as much of a genetic issue as people think, commonly.

Dr. Karen Greene:

People think, “Well, I have no family history so I’m not going to develop it.” And there is some to do with family history, but the fact that one in eight women will develop it has nothing to do with genetics. It’s just sadly a fact of being a woman with breasts. And men can develop breast cancer as well. We’re talking today about women, but it has to do with just the breast tissue. So genetics are a factor, but for women who come in and say they don’t have any family history, that’s the first thing I’m going to tell them. That one in eight women will develop breast cancer. Nothing to do with family history. But the way we can prevent it, the way we can treat it early and help you survive it if you do have it, is early detection. And so that’s what we stress, is early detection.

For our younger patients who aren’t even the age of getting a mammogram, we put a bug in their ear to let them know, it’s early detection. Breast cancer is common, one in eight women will develop it. Nothing to do with your family history. You’re probably not even thinking about it. As a 20-year-old, who thinks about breast cancer or even mammograms, or even what they have to do. So education and letting them know that when you hit a certain age, it is important to get screening tests. So early screening for average risk women, and that’s really what we’re talking about. When people come into our office, most people are considered average risk. So between age 40 and 44, the American College of Science actually recommends yearly screening if they wish.

Dr. Mironda Williams:

That one too.

Dr. Deanna Guthrie:

Say that three times.

Dr. Karen Greene:

I know.

Dr. Mironda Williams:

I know.

Dr. Karen Greene:

I know. And this information actually comes from cancer.org. And so looking in that information in terms of what the screening levels are. And so we try to be partners with our patients, so we give them the information, we give them what the recommendations are. But ultimately, it’s their decision. But if you’re armed with the information and you still make the decision you want to make, at least you know, you understood why you were making that decision, not out of fear, not out not wanting to know because you’re just afraid you might find something, or fear of the machine, but armed with the information so you can make a good decision. So for average risk women, age 40 to 44, yearly screening if they want to. And in our office when women come in, yes, at age 40 we will recommend a mammogram. Between ages 45 and 54, yearly mammogram is recommended. And 55 and older, continue yearly mammogram or switch to every two years. And again, patient preference.

So if you’ve started your mammograms at age 40, you’ve had them every year, and you hit 55 and you decide, “Well, I don’t have any risk factors. I’ve had all normal mammograms. I’ve got no family history at all and I want to go to every other year,” then it’s okay. Screening should continue as long as women are in good health. And I can’t stress that more. That for a lot of women, they think, “Well, I’m 60. Why should I continue to get mammograms?” Well ma’am, you may live until you’re 80.

Dr. Mironda Williams:

Hopefully.

Dr. Karen Greene:

And hopefully, if you’re healthy, you’ll be healthy at 80. And we can’t stress enough that if we detect it early, and you’re a good candidate, you might actually survive the surgery, the treatment and whatever else follows, and then go on to live another 10 or 20 years.

Dr. Mironda Williams:

Exactly.

Dr. Karen Greene:

And so that’s really the reason, that if we detect it early, early detection is key. You’ll hear that in breast cancer awareness month in October all the time, early detection, early detection. Even on our social media platforms where we talk about breast cancer awareness month, we always say that early detection is key because it is, if you detect it early, if you catch it when it’s small size. And so women that say, “Well, I can’t feel anything,” well that’s the reason for the mammogram. We want to see it when it’s microscopic. We want to see when it’s making changes that signify that a biopsy may be needed, or signify that there’s a further evaluation that may be needed. We want to catch it then so that something can be done. You can be treated and you can survive.

So understanding what the test can and cannot do, becoming familiar with your breasts. We stress to younger women as well as women that are getting mammograms, breast self exam. And that’s really feeling your breasts, knowing what they feel like, knowing what normal breast tissue feels like, knowing what a normal lump and an abnormal lump is. So when a woman comes in, we show them how to do it. We ask them, “Do you examine your breasts?” “Well kind of.” “Do you think you know what you’re doing?” “Well, maybe not.” And so you show them.

And so we do the breast exam, we let them know that, as I said, just because you can’t feel it doesn’t mean something’s there. And so a patient will ask, “Well, Dr. Greene, why do I need to do it?” So you’ll know if you feel something, how long it’s been there. So when you come into the office and say, “I know this wasn’t there before, it’s there now. Should I be concerned?” And even if you’ve had a normal mammogram, because again, breast cancer is a scary diagnosis for a lot of women. A lot of women think, “If I get breast cancer, I’m going to lose my breast, I’m going to lose my hair.” They think the worst case scenario, not that, “If I detected early, I’m going to live a long and prosperous life.”

Dr. Mironda Williams:

That’s right.

Dr. Karen Greene:

But women at higher risk need to be screened differently. In our particular office, we offer genetic testing for those women that may be at higher risk. And what the genetic testing is, is they look at your genetic makeup to see whether or not you are a carrier of some of the genes that maybe make you more susceptible to breast cancer. It does not mean that you’re going to get breast cancer. But if you have the gene, what can I do to catch it even earlier? So do I need to have something done before age 40? Do I need to have additional studies other than a mammogram? Because there are additional studies other than mammograms that will detect breast cancer a lot better, but it’s only indicated in those women who are elevated risk.

And so that’s what the genetic testing is. The particular company that we use, we draw the blood in the office, send it off to the lab, and they do the analysis. And again, it’s a personal decision. If you have a strong family history and want to know, am I going to get it? It’s not going to tell you that, but it will at least give you the risk. It will at least tell you is there anything I can do to potentially prevent it? And that’s what it’s about, early detection, early cure, early treatment, and potentially prevention.

Dr. Mironda Williams:

Let me just ask a question. I want to get both of you guys’ opinion about this because there’s been a lot of conversation recently, at least I’m more aware of it, of younger women with dense breast tissue. Younger women meaning under 50. I don’t mean under 40 necessarily. But there are a lot of women, at 40, have very dense breasts. There’s also been some conversation that African American women, in particular, may have a higher incidence of these extremely dense breast tissue, therefore regular two-dimensional screening mammograms may not pick up those early changes in women with that dense breast tissue. And so the conversation that I’ve been hearing people have is, when do you then, because of their physical examination and the density of the breasts, say that getting a three-dimensional mammogram may be better for women in that category who have extremely dense breasts? What are your thoughts about that?

Dr. Deanna Guthrie:

So it’s based on the technology. And so as the three-dimensional mammograms are becoming more and more widespread, I think eventually we’re going to get to the point where the three-dimensional mammogram is now going to be the routine mammogram.

Dr. Mironda Williams:

The standard.

Dr. Deanna Guthrie:

What I typically do is I look at the patient’s report, and if they make a specific… They make comments all the time about the density of the breast.

Dr. Mironda Williams:

They being?

Dr. Deanna Guthrie:

The radiologist who’s reading the mammogram. But sometimes, depending on their wording, if it seems like it’s definitely denser than the regular dense breast, then I will talk to that patient about now starting to do 3D mammograms for that reason. So that’s how I do it.

Dr. Karen Greene:

I think also, for those women who keep getting callbacks because of that dense breast tissue, that they have to get. And what a callback is, you get your screening mammogram and then because of something they may see because of the density, the radiologist will request a cone down or a specialized view of one or both of the breasts, and so that’s a diagnostic. And for women that get, let’s say, a diagnostic and maybe an ultrasound, and everything turns out normal, and then the next year that happens again, on those women a lot of times I would recommend, let’s just start with the 3D mammograms so we can get a better picture off the bat.

Because when women get callbacks, it’s scary. It’s scary. I’ve gotten callbacks on both sides and you try to talk yourself off the ledge every time like, “Okay, so if it’s bad, what am I going to do?” I’ve already made my decision of what I’m going to do, but it’s still scary. So I understand that kind of … and for women that know they have dense breasts, they think, “Well, are they seeing everything? Are they missing something?” And I think it is helpful if we at least talk to them about, there is something else we can do. Maybe we need to take a closer look.

Dr. Mironda Williams:

And I appreciate your point, Dr. Guthrie, and you can go ahead too, but it’s a clinical issue about the technology for the imaging. Because I’ve heard some people say, “Oh, insurances just don’t want to pay for it.” Well, it’s not that. It’s if there are clinical indications based on examinations. So can you go ahead.

Dr. Deanna Guthrie:

And then I was going to say, too, because then women actually get scared when they get those callbacks. And a lot of times there’ll be a follow-up mammogram in six months. And several times I’ll have patients who went for that callback, but because it scared them so much, they don’t go back for that follow up in six months, and then think they can come in and just get their regular mammogram when they come in for their wellness. And so then that’s another reason, too, like I said, trying to decrease the number of callbacks. And again, of course helping the patient with their fears and things like that.

Dr. Karen Greene:

Thank you. So the other cancer I’m going to talk about is colon cancer, colorectal cancer. Colon cancer is cancer that starts in the colon or in the rectum. And we’ve talked about factors that increase colon cancer risk, which would include being overweight or obese, physical inactivity, diet in high in red and processed meats, smoking, heavy alcohol use, being older and a personal family history of colorectal polyps or cancer. Now as we’ve said many times, we’re gynecologists, so we’re not doing colonoscopies. But because for a lot of patients we are the one doctor they see on a regular basis, we are going to be the first point of entry. The first point of saying, “Okay, have you gotten your colonoscopy?” And the recommendations for colonoscopy have changed over the years. And so because, as women, they often don’t think that they need a colonoscopy, they will often either not be aware of the recommendations or assume that because in the past the age was 50, “Oh, I don’t have to have that till I’m 50.”

And so when they come in now because the recommendation has changed to age 45, and we’re the first person to say, “Have you gotten your colonoscopy? Has your primary doctor talked about getting a colonoscopy?” And so at least we put the bug in the ear of them saying, “Okay, yeah, I probably should do that. My doctor did tell me that last year.” Or, “I don’t have a doctor. What do I need to do?” And most of us would easily give them a referral to the colorectal surgeons in our area. So when it comes to colon cancer, again early detection. Most colorectal cancers are going to start as a small little mass or a polyp, which is a small growth in the lining of the colon or the rectum. Screening can help because what a colonoscopy is a ability to actually look inside the colon, see that polyp, biopsy it and send it off to the pathologist to determine whether or not this is early cancer or is it just a polyp, and does it increase your risk and should you have another colonoscopy sooner rather than later because of the polyps?

On the flip side, it also, the colonoscopy allows us to look into your colon and say, “Wow, everything is squeaky clean. We don’t need to do anything and you can come back in 10 years.” So the recommendations are to screen for colon cancer before it gets to cancer, to screen for those polyps. So we want to find them, we want to remove them before they turn into cancer, that is the colorectal surgeons, the gastroenterologist. So age 45 is the recommended age to begin regular screening and continue until age 75 as long as life expectancy is more than 10 years.

So what that means is if your mom was 90 when she died, there’s a potential that you could get colonoscopies until 80, and it’s okay. Because more than likely if you’re healthy and you have no medical issues, you’re probably going to be around. And so because again, we want to catch it before it spreads, we want to catch it at its earliest stages and then treat it, it’s a good idea just to have them on a regular basis, even though it’s something that most people will dread. Age 75 to 85, screening is based on their preferences. And over age 85 no longer needs screening. High risk is based on family history and may actually need to start screening at age 45. One of the benefits of the genetic test that we do in our office is not just for breast cancers, it’s actually for all cancers.

Dr. Mironda Williams:

All that we have markers for.

Dr. Karen Greene:

All that we have markers for, correct. So any marker we have for cancer, if you have a family history of let’s say colon cancer or breast cancer, the screening test will signify that you may be a carrier. And so doing the blood work actually will allow us to see, do you have a marker for colon cancer, let’s say at age 35 when you wouldn’t be thinking about a colonoscopy and need to have the test done early. Because again, the marker doesn’t mean that you’re going to get cancer. It means that there is a potential for something to change based on your genetics, that you could develop a polyp that could turn into cancer. So by doing the colonoscopy, catch it early, treat it before it gets to that problem.

Dr. Mironda Williams:

Yep.

Dr. Karen Greene:

There are also tests which are known as stool-based tests. So the stool-based tests are the tests that people probably are more aware of, where they get the exam every year and we check their stool, see if it changes with certain chemicals. And if it’s positive then you need to proceed to colonoscopy. If it’s negative, a lot of women, or even men, would prefer just to doing the stool-based test. There are also tests that are DNA tests. As opposed to checking for blood in your stool, which is what the stool-based test does, the DNA test checks for DNA in your stool. The most classic test for that is Cologuard. Cologuard is a test that you can do in the convenience of your own home. You don’t have to have a doctor probing in areas you don’t want them to probe in. You send it off to the lab and they tell you whether or not everything is negative in terms of your DNA and you’re good for three years.

We’ve talked about colonoscopy and we’ve talked about Cologuard and all the tests in depth. But again, we try to educate women on other ways. Because the thing about the colonoscopy, and even though it is kind of the standard, for a lot of women it’s hard to schedule. Scheduling becomes an issue because you have to have someone to bring you and someone to pick you up. You have to do a prep that requires probably a couple of days either downtime or a couple of days out of work. And so if you’re at normal or very low risk, then doing something that’s in the privacy of your own home makes sense. And educating our patients to let them know that yes, we recommend having a colon cancer screen of some sort at 45. You do have options. And so letting them know what the options are. I think that it is just important for women to understand that you have options, number one. Early detection is key for treatment as well as cure.

Dr. Mironda Williams:

Absolutely. Dr. Guthrie, what do you have for us?

Dr. Deanna Guthrie:

So today I’m going to be discussing endometrial cancer or uterine cancer and lung cancer. So I’ll start with endometrial cancer. So this is the type of cancer that develops in the cells that make up the lining of a woman’s uterus. So there are two types of cells for the uterus. There is endometrial tissue and then there’s myometrial tissue, which is the actual muscle, almost the body of the uterus. Typically, endometrial cancer is typically found in older patients. So this is not something that somebody’s going to develop at age 26 or 30 or 40, except in extremely rare situations. Unfortunately there is no real screening test for this cancer.

And by the time… But if you had to pick a, this is what we normally say, we said this all through residency. If you had to have to choose a cancer to have in the female reproductive system, endometrial cancer is the one that you would want. Now nobody ever wants cancer. That’s not what I’m trying to say. But even though yes, it is a cancer a lot of times, it’s not all the time aggressive, it’s easier to treat. Usually surgery is what usually treats it. And you may not even need chemotherapy or radiation. But again, it all depends on early detection.

Dr. Mironda Williams:

Exactly.

Dr. Deanna Guthrie:

So this is a situation where, like I said, it usually happens in older patients. The average age is age 60. And what happens is that the only way the uterus really has to talk to us is with bleeding, or sometimes pain, but that’s not a typical symptom of cancer. But bleeding. So if a woman has gone through menopause, has not had a period for over a year and even longer, if you start bleeding again, that is your uterus trying to tell you something. It doesn’t matter the amount. It could be just spotting or a little bit of pink when you wipe, to a full-blown period. But any bleeding that you see, you should come in and be evaluated. The way to test to see if everything is okay is by taking a biopsy. It’s called an endometrial biopsy from the lining of your uterus. It’s a fairly simple procedure that’s done all the time in the office. Not very pleasant sometimes, but there’s no cutting involved or anything like that. We can easily do it at any visit. It doesn’t have to be scheduled at a special time.

So even a woman who comes in who is very, very concerned, more than likely we’re going to be able to start the evaluation on the day that you come in to see us. And so we do this endometrial biopsy, and they look at the tissue to make sure the cells are normal or not. Another way to evaluate if you have bleeding is to do an ultrasound. And what we do is we look at the size of your uterus, we look to see if you have fibroids or polyps, and then we also look at the thickness of the lining of your uterus. For women who have gone through menopause. And what that means is that your ovaries are producing less and less hormones to the point where you’re not triggering cycles anymore. And of course you’re not ovulating anymore, and that’s when you are not able to have children anymore. But for a woman who is, what we call postmenopausal, because you’re not having cycles anymore, the lining of your uterus should be very, very thin. And we know the amount of thickness that we should see on an ultrasound.

So if a woman comes in with bleeding and we do an ultrasound, if the lining is thicker than we think it should be, that is also going to trigger that endometrial biopsy. The good news on the other side is that if you do have a little bit of spotting, and we do an ultrasound and everything looks normal and the lining is very thin, the likelihood of cancer is extremely rare, and you may not even need a biopsy. So even if you’re hearing the word biopsy and it’s concerning you, come in and be evaluated anyway, because it doesn’t mean that you’re going to have 10 tests or anything like that, but you want to let your physician, provider be able to make that decision on what needs to be done to get the information that we need. Another test that can be done to check to see if there’s endometrial cancer or not is something called asano histogram.

And that also helps us evaluate the lining of the uterus even more. Just a regular ultrasound, we can measure the thickness of the lining of the uterus, but we can’t really tell if there’s a polyp or a fibroid that’s in the cavity of the uterus. And so what we do is we put a catheter at the opening of your cervix and we inject just a little bit of fluid that opens up the uterus so that we can take better pictures to evaluate and see if there are any lesions in the cavity. And then the last way that we can evaluate the lining of your uterus is by hysteroscopy. Now that is… It can be actually done in the office depending on the setup of the office, but what we’re doing is we’re actually looking inside the uterus with a camera. So instead of looking at shapes and things like that on an ultrasound screen, we are actually using a camera and a scope to look inside the uterus to see if we see any lesions. And we can also do biopsies at that evaluation.

So endometrial cancer, going back, is the most common cancer of the female reproductive organs. And in the United States in 2023, they’re estimating that they’re going to be 66,000 new cases, and 13,000 women will die. As I said, the average age is 60, so it’s older women. And as with some cancers, it’s more common in black women than in white women. And black women are more likely to die from endometrial cancer. There are risk factors for endometrial cancer, which include obesity. When you have more fat tissue in your system, in your body, that tissue gets converted into estrogen, so your body’s seeing extra estrogen than even your ovaries are producing. Any kind of hormonal imbalance, so there are medications that you can take that can change your hormonal balance, that can promote abnormal cell growth in the lining of your uterus.

There are medical conditions, one’s called polycystic ovary syndrome. Tamoxifen is a drug that some women have to take if they’ve had breast cancer. So there’s certain other things that can change your hormonal makeup that can then increase your risk for endometrial cancer. Type two diabetes, because typically people who are type two diabetic are typically overweight, which goes along with that. Family history is another risk factor. If you have pre-cancerous cells in the uterus, then of course that can lead to cancer. And if a woman has had any kind of radiation to her pelvis for another reason, then of course we know that radiation can change cells. And so that’s endometrial cancer. So like I said, no real screening test. We go by your symptoms. But it’s so key to understand that any kind of vaginal spotting, bleeding, pink, brown, whatever color you think it is, that may be blood, you really should contact your physician to be evaluated.

Dr. Mironda Williams:

And again, we like our patients to be well-informed. We know that a lot of you love Dr. Google. Dr. Google cannot evaluate you. So even when you go to Dr. Google, please come in and see your healthcare provider if you have any abnormal anything so that we can concur with Dr. Google or not.

Dr. Deanna Guthrie:

And I’ll say too, and the thing is when we do this biopsy that I said that we do all the time, again, nine times out of 10, 9.6 times times out of 10, it is normal.

Dr. Mironda Williams:

It’s normal.

Dr. Deanna Guthrie:

And so we just want to confirm that, yes, everything is normal. And I say this every time. Every time I’m doing one of these biopsy, I say, “I know it’s going to be normal. I know it’s going to be normal.” But then there’s that one time it comes back abnormal. And you almost say to yourself, it could have been that day, you’re saying, “Do I really need to do this biopsy? Do I have to do this biopsy? I guess I know it’s going to be normal. I’m going to put her through.” You need to do it every single time.

Dr. Mironda Williams:

Because your point, as you said before, this cancer is treatable, and it’s treatable most often with surgery only, without needing to continue other chemotherapy or radiation therapy or other things that can also cause other issues with prolonged cancer treatment. So come in, get the test. It may hurt for a little bit, but you can live your life.

Dr. Deanna Guthrie:

So that’s endometrial cancer. The second cancer I’m going to talk about is lung cancer. And this is the granddaddy of them all. Lung cancer is the leading cause of death and worldwide in both men and women.

Dr. Mironda Williams:

And Dr. Guthrie, I just want to stop you right there because I really want people to hear that. And again, the reason we’re doing this, just remind everyone as a reintroduction, since we’ve been talking about this for a while, the reason we’re doing this topic is that we wanted to go over those cancers that are most often affect women, being breasts, colorectal, endometrial, lungs, cervical skin and ovarian. But what I want everyone to make sure they hear, common things are common, people. Hit it, Dr. Guthrie.

Dr. Deanna Guthrie:

Okay. Yes. So it’s like I said, in 2023, it’s going to be estimated that 1.7, 1.8, actually, million people are going to die from lung cancer worldwide. It’s also the most common cancer in the United States for both men and women. It’s the second… Excuse me, the second most common cancer for both men and women in the United States, where for women, breast is more common than lung. And for men, prostate is more common than lung. In the United States, they’re estimating about 238,000 cases, new cases this year. And about 127,000 people will die in 2023 from lung cancer. The thing about lung cancer is that it develops in older people, but it’s your behavior when you were younger. So when you feel that you can conquer the world, nothing’s going to get you, you can fight anything. I’m invincible. It’s the years and the length of smoking that make you end up with cancer at an older age. So with lung cancer-

Dr. Karen Greene:

[inaudible 00:30:45] You stop.

Dr. Deanna Guthrie:

[inaudible 00:30:47] So it occurs mainly in people over age 65. It’s one in five of all cancer deaths. And lung cancer, more people die from lung cancer than breast, colon and prostate combined.

Dr. Mironda Williams:

Say that again, Dr. Guthrie.

Dr. Deanna Guthrie:

Okay, so more people in the United States die from lung cancer than if you added up all the breast cancers, colon cancers and prostate cancers together.

Dr. Mironda Williams:

And what’s the major factor in developing?

Dr. Deanna Guthrie:

The best factor, smoking. We’re going to talk about that. There are two main types of lung cancer. There’s what they call small cell cancer and non-small cell cancer. And you treat them differently. 85% of the time it’s cell and 10 to 15% of the time it is small cell. But we’re going back to the risk factors. The number one risk factor for lung cancer is tobacco smoke. 80% of lung cancers are caused by smoke. And you can have non-smokers who can get lung cancer, but a lot of times it’s their exposure in environments where there is smoke.

Dr. Mironda Williams:

We call that secondhand smoke.

Dr. Deanna Guthrie:

Secondhand smoke, the longer you smoke, like I said, and the more packs that you smoke increase your risk for lung cancer. Now this is a myth. People think that you’re smoking light cigarettes or low tar cigarettes, that that’s going to help out.

Dr. Karen Greene:

No.

Dr. Deanna Guthrie:

It does not. It does not change. It does not decrease your risk for lung cancer. Also, menthol. Menthol, it says it makes people able to take deeper breaths when they’re smoking and you hold the smoke longer. So that may even increase your risk for lung cancer. So menthol is not in… So these menthol low tar and light cigarettes, it doesn’t matter. Smoke is smoke, tar is tar, your lung is your lung, you’re going to get lung cancer.

Dr. Karen Greene:

That’s it.

Dr. Deanna Guthrie:

The secondhand smoke as Dr. Williams is saying, like I said, when you’re in environment, so people who, even though you’re hanging out with your friends and everybody’s smoking in your face, it’s like you’re smoking a cigarette almost. That is the third leading cause of lung cancer. Then there are others like exposure to radon. Radon is a naturally occurring breakdown of uranium and soil. It’s around. You can do testing in your homes to see if there is radon or not. I don’t want anybody to panic and think that you have to wear hazmat suits everywhere you go. But that is also a risk factor for lung cancer. Asbestos is another risk. We don’t have that around anymore. It was more the older buildings. But there’s some people who still, depending on their work environments, that are still exposed to asbestos, but that could cause a particular type of lung cancer. And then they put on here marijuana.

They think it also increases lung cancer risk. It has tar in it, people don’t think. But the reason why they think also that it increases your risk of progressive cancer is because you smoke that little joint all the way to the end, and that’s where there’s no filter, number one. And you take it all the way to the end, and they think that that’s where there a lot of tar ends up. And then you also inhale deeply and then-

Dr. Karen Greene:

Hold it.

Dr. Deanna Guthrie:

And then they said, because you can get it from anywhere, it’s not even regulated like cigarettes are being made in factories and things like that. You don’t know what they’re putting in there. You’re getting marijuana and what? We don’t know. So that can also increase your risk for lung cancer. And then there are the e-cigarettes. So even though there’s no “smoke,” they are still doing a lot of research because they really don’t know how much fully affects your risk for lung cancer. But they’re also seeing increased risk for oral cancers, throat cancers and things like that. A lot of e-cigarettes still have nicotine, and that is the offending agent there.

Dr. Karen Greene:

So Dr. Guthrie, why do you think people use e-cigarettes to get off of the regular center cigarettes?

Dr. Deanna Guthrie:

Well, when it first came out, it was supposed to be the solution to get away from the smoke and the tar.

Dr. Mironda Williams:

It was marketed that way.

Dr. Deanna Guthrie:

It was marketed that way. But then you can get just as addicted to e-cigarettes. And then they’re even saying that vapor, they don’t even know the force of that vapor, which is a whole lot more than the amount of smoke that you were getting from a cigarette. They don’t know the damage it’s doing to lung [inaudible 00:35:24] Exactly.

Dr. Mironda Williams:

And I think that was really brought to light during the height of the Covid crisis, because what we were seeing is that a lot of the patients who were becoming sicker in the initial stages of Covid were patients who did vaping. Because again, you’re taking something into your lung tissue that your lungs aren’t used to having in there. And so how is that changing the nature and the character of your lungs, that may set you up down the line for something else.

Dr. Deanna Guthrie:

Now there is early detection for lung cancer. Of course you’re going to take the people who are at highest risk. So of course, smokers. They used to do yearly or annual chest x-rays to see if you could find anything. But studies are now showing that the chest x-rays really don’t help, and it doesn’t decrease the death rate from lung cancer. So they’re not really recommending chest x-rays anymore. What they’re now recommending is what they call low dose CT scans. And so it’s a CT scan of the chest. It’s less than the CT scan that you would get for a study to look for a mass or anything like that, but it’s a little bit more than a chest x-ray. But again, in finding something early, the small risk that you may get from that low dose of radiation may save your life and prevent you from having chemotherapy and surgery and things like that.

So what they recommend guidelines for screening are if the patient is age 50 to 80 and in good health. And what they mean by that is that if you’re going to find a cancer, you want to be healthy enough to undergo surgery, chemotherapy, things like that. So if you’re 50 to 80, in good health, and you currently smoke or have quit in the past 15 years. And if you have at least a 20 pack year history, then you should be screened for lung cancer. And what they call a pack year history is you take the number of packs you smoke a day for how long you smoke. So if you smoke one pack a day for five years, you’re a five-year pack history. So if you have a history of 20 pack years or more, then you should be screened for lung cancer. Then you also want to be, if people at your screening, you want them to have available resources to be treated and counseling for quitting.

And so important is that, number one, you don’t want to start in the first place, but we understand looking cool, going out, hanging with your friends, things like that, that a lot of teens get started or young adults get started. But quitting is so, so important. So there are tools to quit smoking. Interesting statistics, most adults who spoke want to quit, which is sad. You’re doing so something. A lot of patients want to, you hear them talking, “Oh yeah, I really want to quit.” But we understand that it is number one in addiction. And there are two parts to smoking, I always tell my patients. There’s the nicotine part, which is the chemical that your body gets dependent on, and then there’s the habit of smoking. So there are people who, there’s certain behaviors that they do every day, and part of that behavior is having a cigarette in your hand.

I don’t know if you all remember that commercial. There was a commercial that was talking about that, and it had this guy who was trying to quit smoking, but he would always have a cigarette while he was driving his forklift at work. And so it showed him at work like crashing into things because he didn’t have his regular cigarette in his hand. But those are the two parts to quitting. There’s the actual dependence and then the habit. And you want to try to change both. There’s so many tools out there to help. The most successful way to quit smoking is with, number one, counseling and medication. A lot of people quit cold turkey, and kudos to them. Some people can get up and decide one day, “I’m done,” and fight through it. But the most success that you’re going to get is with counseling, which means help whether or not you’re going online, getting support, that sort of thing. And there are medications that you can take that can help you through that withdrawal period. From the dependence on nicotine.

More than half of smokers have made an attempt in the past year. So if you’re going to take a pool of smokers, most of them have tried to quit and then have probably not been able to. And less than one third of smokers do use these aids. So that’s why there’s less success in quitting smoking. So just to be real quick, like I said, if we can get you to quit, that’s the most important thing. And understand, you have to be ready. No one can tell you when that day is, but there are things that can help you and support you during that time and make it easier for you. So they have, what they call, quit lines. There are certain websites, things like that, that have a wealth of information for you. I saw one that had a calendar.

They had it broken down into a woman trying to quit versus a teenager trying to quit versus a man. And so they have so many different tools. But there’s the American Lung Association, which is lung.org. There’s the National Cancer Institute, which is smokefree.gov. There’s American Cancer Association, which is cancer.org, and American Heart Association, which is heart.org. And so I encourage anyone who’s a smoker to make that decision. And like I said, speak to your doctor, your physician, they’ll be more than happy, more than happy to prescribe those medications for you to help you to quit.

Dr. Mironda Williams:

And so as we get ready to wind down this episode of Take Good Care podcast, and we wanted to talk about some of the more common cancers that affect women in particular. You’ve had already great discussions on breast cancer, colorectal cancer, endometrial or uterine cancer and lung cancer. Cervical skin and ovarian cancers, again, are common ones that we see with women. But again, common doesn’t mean frequent. Common doesn’t mean everyone is coming down with it. And so again, I point you to some previous episodes that we have recorded this season, as well as other seasons, where we go into great detail about wellness examinations for women in which cervical cancer screening is of course the primary thing that we do. The wonderful thing that we can report now, again, we’ve all been in practice over 25, me over 30 years. When we were in residency training, we saw cervical cancers all the time.

We saw bad cervical cancers all the time. When you talk about late stage cervical cancer, women had to have extreme surgical treatment and then radiation and then chemotherapy on top of that. It was very debilitating for these women and their quality of life. The blessing that we can now say, as seasoned gynecologists, is that we don’t see cervical cancer any more like that. Yeah. Thank you. The reason is because of pap smear screening, and also because of HPV screening. That’s H, P as in Paul, V as in Victor, human papillomavirus. That is screened now with all pap smears based on guidelines. I’m not going to go through guidelines for paps, when to pap and why to pap, because we got an episode on that. Check it out. Also, if you go to our website, there are articles there that explain that in great detail.

But that is truly a success story about why screening works, and how you can impact generations by making a simple screening test more widely available. So as we talk about all the time, access to healthcare and access to good, relevant, culturally sensitive healthcare is important, so that women feel comfortable coming in to get your pap smear. So we don’t see cervical cancers like we did in the past, and it’s because of the wide availability of this easy screening test, because that’s what we want to do. Get it early before it goes to the debilitating cancers. So cervical cancer is an issue for women, but thankfully not as much as it has been before. Skin cancers. Skin cancers are things that, and we are sun lovers, and even though we’re melanated sun lovers, we still have to use our sunscreen. So protecting your skin by using sunscreens, you heard about it, your eyes as well from the UV rays.

All of that is so important. Limiting your exposure to these UV rays. Being mindful of molds and spots. If you look at your body, we tell women all the time, stand in the mirror, look at yourself naked, make sure everything looks like it’s supposed to look. If something pointing one way, another pointing another way, okay, you may want to come in, let’s check that out. If you see spots and moles, even for women of color, please either point it out to us or go have a general skin examination with your primary care physician or with a dermatologist, so that if those areas are noted, it can be checked. More often than not, it’s just a mole. But if it’s something different, again, early detection is key. And then another cancer, one that women fear as well. Ovarian cancer.

Unfortunately, ovarian cancer is the one cancer, for gynecologists, we don’t have a screening tool for. This is one of the more common cancers, not a frequent cancer, as Dr. Guthrie pointed out, but it does occur. There is no screening test for ovarian cancer. Pap smears don’t screen for it. So we have to rely on our examinations. A woman coming in, for us to try to feel if there’s something going on differently with their examinations or if a patient comes in reporting different symptoms that seem unusual for them. Bloating, swelling, especially if you’re losing weight, but your tummy’s getting bigger, you need to come in and be evaluated about that. Digestive changes, that’s increase in gas. Now as we get older, yeah, things happen. That’s all I’m going to say about that. But if it seems unusual, loss of appetite, bloating. Again, you know your body. If something doesn’t feel right, then come in.

You don’t have to try to tell me what doesn’t feel right. You can say, “Dr. Williams, something, just don’t feel right.” It’s my job. It’s our job. It’s the healthcare community’s job to do the investigative work to figure out what’s going on. So unusual abdominal pain, pelvic pain, feeling like you have to go to the bathroom or urinate all the time to empty your bladder. Again, these are vague symptoms, because unfortunately we don’t have that one thing that we can say, “Oh, that might be ovarian cancer. I need to check it out.” Routine examinations. Having a relationship with your healthcare provider is key, because then you’re coming in. If things change or we feel something, we can evaluate it. Early detection, even with ovarian cancer, is key. The main thing, and Dr. Guthrie, thank you so much for going over. That’s one reason why I wanted to talk about the lung cancer, because women were always thinking about, “Oh, I’m going to get ovarian cancer.” That’s probably not the one-

Dr. Deanna Guthrie:

That’s not going to get you.

Dr. Mironda Williams:

That’s not you. There are other things that we have to be aware of. And if there’s nothing else you can hear, again, on this list as you, if you’ve been taking notes and listening, all of these cancers, the risk factor that is common to all of them, smoking. Secondhand smoke as well as directly smoking. So for all the cancers that we have gone through today, again, the common ones, and again, common doesn’t mean frequent, doesn’t mean you’re going to get it, but these are more likely to occur in women, breast, colorectal, endometrial lung, cervical skin, and ovarian cancers. The thing that you can do to decrease your risk for all of these cancers, number one, stay away from tobacco. Try to get to and stay at a healthy weight. Get moving, regular physical activity. You don’t have to run marathons, you don’t have to swing 50 pound kettle bells, but you need to get moving.

[inaudible 00:48:05] Yeah, because I got… Check out a previous podcast about the kettle bells. Get moving. Regular physical activity, follow healthy eating pattern that includes plenty of fruits, vegetables, whole grains, limit or avoid red processed meats and highly processed foods. You’ve heard that mentioned today for all of the cancers that the ladies have discussed. You’ve heard it mentioned on previous podcasts as it relates to hypertension, diabetes risk, it all ties in together. So again, a healthy eating pattern that includes plenty of fruits, vegetables, whole grains, limit or avoid red or processed meats and highly processed foods. Drink in moderation. If you drink alcohol, try to limit it. No more than one per day for women. Protect your skin. That’s all skin. Melanated skin needs to be protected, including wearing a hat. Appropriate sunglasses that protect your eyes from the UV rays. Know yourself.

And I want to add to that, trust yourself. Don’t let anybody talk you out of what you think you know. Know yourself. Know your family history. Know what your genes could and could not be doing for you. Know your risk factors. We’ve all talked about what those risk factors are. Have your regular checkups and get your cancer screening tests as indicated, based on your personal health history, your family history, and any symptoms or signs that you may be experiencing. So this was just to give you an overview, never to substitute for going in and seeing your doctor or healthcare provider on a regular basis. Come in, be seen, trust yourself, know yourself and your family. Any closing thoughts before we sign off for today’s episode?

Dr. Deanna Guthrie:

I just want to trust again what Dr. Williams said is, come in to be seen. Do not think, I’ve had a lot of patients who apologize, “Well, I didn’t mean to come in and bother you today.” No.

Dr. Mironda Williams:

That’s my job.

Dr. Deanna Guthrie:

That’s my job. That’s what I do. I’d rather you come in, and I want to give you good news. That is if you’re thinking, I’m thinking, “Oh, this is nothing.” No, that makes my day. I want to tell you that, “Yes, you paid attention to yourself. You came in and now we know everything is okay.”

Dr. Karen Greene:

Yeah, I just want to echo that. I think that women will put off and put off and think, “Oh, it’s probably nothing.” But it’s bothering them. And as a teacher always will say, “There’s no stupid question.” There is no stupid question when it comes to the gynecologist. If you think that, “Well, I just have to ask this.” Know yourself as Dr. Williams says. And the other thing is, early detection is key. And so if you know yourself, and you know feel something is wrong, you want to get in, get that early detection and hopefully find out there’s nothing wrong.

Dr. Deanna Guthrie:

Exactly.

Dr. Mironda Williams:

Exactly. And more often than not, there is nothing wrong.

Dr. Karen Greene:

Yeah.

Dr. Mironda Williams:

That’s the good news. So thank you once again for tuning in, and taking time out of your busy schedules to listen to us as we try to give you some important information that you can use for yourself and your family’s health. Please make sure you continue to share our podcast with all of your family and friends. You can check us out on our website ptcobgyn.com. We’re on all the social media platforms. So until we get together again, I’m Dr. Mironda Williams.

Dr. Deanna Guthrie:

I’m Dr. Deanna Guthrie.

Dr. Karen Greene:

And I am Dr. Karen Greene. Take good care.