Understanding Cancer Prevention For Women, with Dr.Valena Wright. Functional Gynecologist Podcast

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Whatever you are. I'm pretty casual. I'm fine with Velina. You can introduce me as doctor you know. Right.

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All right. Well, welcome, Dr. Wright, to the Functional Gynecologist podcast.

Thank you. It's a pleasure to speak with you today. I'm excited to have a conversation.

Yeah. I'm excited to talk about your book. It's time you knew. Because women do need to know about what we're going to talk about today. Such good Information. So I would love for you to share, like, what made you write this book?

So I was really inspired by my personal experience as an observer of my sister's health with the background I have as a gynecologic oncologist. So my personal story is my older sister passed from ovarian cancer. And obviously that's devastating to have your sister die of a disease that you specialize in treating.

But.

During her path, I learned so much. Information that we receive may not be always the most up to date. And I think it's critical for women to understand the changes that have or the improvements in women's health that have occurred and what we've learned in cancer prevention. Because there's such little focus on cancer prevention, we often are waiting for disease to develop before we intervene. It was very fortunate that I had the background in training that I did because I knew that genetic testing was really important for ovarian cancer. I also know from treating patients over the years that risk reducing surgery when indicated can save people's lives. My older sister's diagnosis actually saved my youngest sister Shirley's life because she had risk reducing removal of fallopian tubes and ovaries and was diagnosed with the early stage of fallopian tube cancer.

Wow.

I think a lot of your listeners may not be aware that a lot of listeners may not be aware that we no longer tie tubes for birth control. We do self injectomies, and that medical term just means we remove the tube. Because research on women with genetic predisposition to cancer led to the discovery that a lot of ovarian cancer actually starts in the end of the fallopian tube. It can be a microscopic lesion, meaning we can't see it in the end of the tube, and cells end up spilling out onto the ovary, creating a growth that eventually gets diagnosed as ovarian cancer. So knowing that, and if you're going to have your tubes tied, it's not really the right lingo anymore. We don't have tubes tied, we have them removed. And it's also important that having just your tubes tied or removed doesn't change when you go through menopause. We have enough research now from women having undergone salpingectomy or removal of the fallopian tubes for birth control that we know that it will not predispose to early menopause, which is so important for many women.

Yeah.

So, you know, the motivation of the book was just to honor my sisters and make sure that not just my sisters and my patients have the information they need that. Hopefully they can learn from these other amazing women who allowed me to participate in their care and share their story. As a surgeon in training, I always was trying to learn from my mentors and the attendings because it's never okay to have a bad complication, but when you see things happen or a certain pathway of events occur, if you can only learn from that so you can change the pathway so that you don't make the same mistakes. So sometimes when my older sister, you know, I miss her dearly, but she would get in trouble all the time and I would learn from that. I wouldn't ask my mom and dad the same thing that my sister asked, got in trouble for or do things. So we learn so much in different ways. And I think we need to go to medical doctors with our eyes wide open and make sure that our voices are heard and we understand that the conversation that we have with our doctors so that we get the outcome and better health that we seek, not just showing up when we have a problem or an issue. Because prevention is just so important and it's really not addressed in a disease based model of care.

Yeah, you made so many good points. Oh, my goodness, so many important points. I think that women need to realize that cancer doesn't just turn on overnight. You know, you're not healthy one day and having cancer the next, and you need to listen to your body and be an advocate and ask questions if it doesn't make sense. Right. You know, that was a big reason I shifted into functional medicine. Like I was explaining to you before we started the podcast is women are being told that it's normal for their bodies to betray them and to be hormonally imbalanced and to have crazy heavy periods. And, you know, and you just have this risk of cancer and it kind of is like defeating because you're losing your power. You're being told like, this is just going to happen to you and good luck when really that's not the case. And so, you know, the fact that you helped your sister get proactive and learn from your other sister's experience, you saved her life. That's amazing. So I want to talk about that with you. How can we empower women to be proactive, to intervene and not end up with these cancer diagnoses?

I think the most important thing is, like you mentioned, cancer doesn't happen overnight. There's precursors to many cancers that we recognize. The best example for the cancers that I treat, which include most commonly uterine cancer, fallopian tube Ovarian cancers, cervix cancer, vaginal vulvar cancers. That's what I specialize in. Not breast cancer, but in the gynecologic organs. A lot of women don't have knowledge about those cancers and cancer risk. Of those five organs, the only one that has an effective screening test is cervix cancer.

I think it's really important that women.

Understand the risk for cervix cancer. There's a lot of stigma about cervix cancer because in the past it was linked to different sexually transmitted diseases or infections and behaviors, whereas now today we know it's really linked to the presence of a virus called human papilloma virus. And our practice of medicine is changing so that instead of just getting a Pap test, many countries, and now the American Cancer Society as well, recommends primary screening for the presence of hpv, because that's really the risk. It's not necessarily some of these other things you get asked when you go to the gynecologist. It's whether or not you've been exposed to the virus. You can draw an analogy to Covid. If you've been exposed to Covid, you're at risk, right? As opposed. Or if you're vaccinated, your risk is dramatically decreased. And so knowing your risk by knowing whether you've been exposed to hpv, high risk types, which are associated not just with cervix cancer, but with other cancers.

Of the lower, what we call lower.

Genital tract, so cervix, vagina, vulva, and in men, oral and back of the throat, oropharyngeal cancers.

So knowing that there's a screening test.

And HPV and or Pap smears, the combination as we transition into primary screening over time, and knowing that if your test is abnormal and you go for treatment, it's very unlikely you're going to develop a cancer.

The people that develop cancers are people.

Who don't go for screening, don't know their risk, and haven't been vaccinated.

And large studies support that.

There is a large study that came out recently to show that the most effective time for HPV vaccination is in women before age 17. There's some protection as you get older if you're vaccinated. But having the pediatrician do those childhood vaccinations is key to preventing cancer later in life. That's the one that we can prevent if we're taking care of ourselves, know our risk, and, you know, get those things done. It's very unlikely we would develop Cervix cancer.

Yeah. And, you know, I feel like our medical societies did patients a disservice when they changed those cervical screening cancer. You know, it used to be you'd have it every year and then every couple years, and now it's pushing out to five with this HPV testing. And that is giving patients the misunderstanding of, I don't need to see a doctor at all for anything for five years. And so their uterus and ovaries aren't being palpated, they're not having their breast exams. Like, I just feel like that really sent patients the wrong message. And, you know, so I'm always re. Educating. Like, the cervix is one small portion. The Pap smear is only one part of your exam. You know, it's important. Important. But that doesn't mean that we need to neglect everything else. Right. So I just want patients to be careful when they hear those recommendations. Right. So.

And that's.

That's, like, actually one of the myths in my book, because people will come in and say, oh, I've had my Pap smear, when in fact all they had was a pelvic exam. So having a pelvic exam doesn't mean you get had screening for cervix cancer.

Right?

Exactly. Oh, I got that all the time where they'd go to the ER for some complaint, and then in the office they would say, oh, well, I've already had an exam. I'm like, no, no, no, that's completely different. That doesn't count. You know, so just understanding the different testing that we're doing and, you know, why we're doing it, I think is super important. So thanks for bringing that part up. So, yeah, we can do testing and screening. And you talked about your sister having ovarian cancer. There's not great screening for that. Right, right.

That's another myth that people have is that if they have the most common tests we do or that's been researched is the use of pelvic ultrasound and a blood test called CA125. And we do do that in women at high risk, but it's really never been proven to decrease mortality, even in women who have a gene mutation. So if you're getting a CA125 and an ultrasound even every six months, that doesn't protect you from developing ovarian cancer. Unfortunately, we just don't understand the natural history and biology of the disease well enough. So in that situation, it's really important to know your family history. If you have family Members with ovarian or breast cancer, Then there's models that can predict your risk and whether or not you should undergo genetic testing. But a lot of the time to take a family history and do a good job and understand your cancer risk probably is best done with a genetic counselor if you have positive family history. That way you can understand what gene testing is indicated and if it applies to you. Sometimes genetic testing will lead to a gene mutation. But just because you have the gene mutation and it's identified, it doesn't necessarily mean that you're going to develop cancer because there's a lot of modifiable risk factors around that. But by having the testing, you can better quantify your risk and know what actions you can take to prevent cancer. So, for example, in my family's case, there's other cancers that can be associated with breast and ovarian cancer besides that. And we had some in our family history. My sister, when she had went to her primary care doctor, he said, no, no, no, you don't need to have this done for whatever reason. For a while she didn't have it done because she was just nervous about menopause. But when she did, we were so relieved that, and surprised really, that she got diagnosed with this fallopian tube cancer. For ovarian and fallopian tube cancers, they're different parts of the body. They sit right next to each other, obviously, but they're treated the same pretty much with ovarian and fallopian tube cancer. On average, when you look at the literature on this, it's 18 months of symptoms before women get diagnosed. The reason for that is the symptoms can be vague. There's a mnemonic used called beat, which is b, bloating, eating, meaning indigestion and symptoms you get when you try to eat. Abdominal pain and tinkling for the t, tinkling, meaning frequent urination. So those constellation of symptoms, they make you think about a GI or gastroenterology, like bowel type symptoms. So many women will have had a consult with a gastroenterologist, a colonoscopy. When you have those tests done, they're looking at the inside of those organs, not the outside. And you can sometimes get symptoms when something's pushing or pressing from the outside or growing adjacent to those organs internally. It's not always thought of, it's really common. Many women will have seen the doctor many times. And it's hard because we don't think of ovarian cancer. If you have symptoms that persist more than two weeks with a change in Urine urination, frequency, getting up at night, and that's not your normal. Or if you're having bloating, typically early satiety, which is a medical term. It just means if you eat a small amount yet you feel full. So maybe you have a few bites of your sandwich and you can't finish it because you feel full. Sometimes that's a symptom of ovarian cancer. We all can have some of these symptoms intermittently, but when they're persistent over a period of more than two weeks and otherwise unexplained explained, it's something just to keep in your mind. And you can ask your doctor when you go and see them. You can always ask and say, do you think there's any possibility this could be ovarian cancer? If you have symptoms, the diagnostic testing will help exclude it. The use of ultrasound and CA125 just hasn't been proven in asymptomatic patients for screening. But it is useful for evaluating symptoms.

Yeah, definitely. And there are benign issues that you can identify, too, that cause those symptoms. But you want to get an answer for sure. I love that you are saying, listen to your body. Those symptoms are a warning sign that something is going on. Something's growing and pushing on your other organs that shouldn't be. I don't know about you, but I feel like it's a really common myth that once I'm in menopause, I don't have to worry about ovarian cancer. I mean, that is what I have heard for the past decade from my older ladies is, oh, well, I don't need an exam. I'm done with all that. I'm done with having babies. And can you please just enlighten the listeners? Like that's. The majority of women who have ovarian cancer are in menopause. They are after childbearing years, correct?

Correct. Yes. That's a common myth. And I think. I don't know. I see a lot of women who, once they've had their children, they completely.

Neglect their gynecologic care.

They just think that I've had my last child and that's the last time I'm going to see the gynecologist. And that's the last time they've even had a pelvic exam or pap smear.

Yes.

And our gynecologic health is really important, whether we're sexually active or not. Being healthy and sexually active, but paying attention to symptoms. Abnormal discharge, abnormal pain can really lead to a diagnosis. And if you have those symptoms, they're not normal.

And so many women just say, oh, it's menopause.

My doctor told me it was menopause, or it's hormonal. And they don't follow through because they accept it as normal.

Exactly. So another important issue you touched on was the genetics. So I hear that myth a lot. Like, oh, well, I had my genes tested. I don't have a mutation, so I'm good. So can you clarify for listeners like, cancer is not always genetic, Right?

Right.

The majority of cancer, especially ovarian cancer, depending on the study, it's only 10 to maybe 15% of the cancers that are genetic. The rest we really don't understand fully the risk factors for ovarian cancer. Never having had a child is a risk factor. Interestingly, birth control pills protect us against ovarian cancer and uterine cancer. So there's other, obviously a hormonal component to the risk. It's been very controversial, but talc has been there in the media forever about dusting powder or perineal powder, because this.

Powder that some women will use is.

Found in the peritoneal cavity. And whether it's associated with cancer or not is a little controversial. The studies have. It's not a strong risk factor, but some studies have.

And other than that, it's just family.

History, really, and a gene mutation. We don't understand really what causes ovarian cancer.

So it's important, though, family history is not always reliable. About 30% of the time, people will have a gene mutation with no family history. Some of that obviously can be adoption related. Some people don't realize that your paternal history is as important as your maternal history. Sometimes that's where people don't accurately consider their risk. But Mary Claire King, a geneticist who discovered the BRCA genes, had an article published in one of the medical journals, jama, advocating that everyone be tested, every woman be tested at age 30, and if they have a positive gene test, be followed in a specialized center. Because of that, not knowing that it's inaccurate 30% of the time, just family history. And so if we know your. If we know, again, it's about knowing your risks. So if you know you're at higher risk, then there's things you can do.

Proactively to decrease your risk, such as.

Birth control pills or having your tubes removed after you've had your children. Making sure you maintain ideal body weight because hormones and body weight all interact and modify your risk.

Yeah, definitely. I mean, we know that our fat cells make estrone right? And we don't like too much estrone floating around. It's not good. So I think that's where some women feel maybe frustrated going to the doctor. They're told they, they need to lose weight, and they're not really given an explanation of how or why they can do that and what the benefit actually is going to be. And so if you sit down and have that conversation like, hey, that type of estrogen is actually driving uterine and ovarian proliferation, inflammation, sugar issues, like that's why we want to get control of it, then I think that women are more apt to think, okay, let me work on some lifestyle changes. Right. As opposed to just shaming. I just hear that over and over. Like, oh, I went to my doctor, he told me to lose 30 pounds again, and here I am. And so I think just. Could you speak on that a little bit?

Yeah, no, I think it's super important.

We understand the risk associated with obesity. And obesity is a medical diagnosis. It shouldn't be a stigma, which unfortunately we know that in the US it is in most of the world it.

Can be a stigma.

And being able to talk to our patients about it in the right way with their support is really key. So our most common or the most common cancer I treat is uterine cancer. And more than half of those cancers are obesity related. And most women are unaware of that. The risk increases linearly. So even 15 pounds over your ideal body weight increases your risk. And as your BMI is over 30, over 40, over 50, it really increases. In my book and it's time Uni, there's also a chapter on a very young woman, most uterine cancer is diagnosed as after menopause, and the most common symptom is postmenopausal bleeding. So people recognize that and come in and get evaluated. But with the obesity epidemic in the United States, the group of women with the highest increase in incidence, meaning more people being diagnosed per year, is in the younger women between 25 and 40. And that's really a shame because before they've had their children. And the treatment for uterine cancer is often hysterectomy. And so we're seeing women in their 30s being diagnosed with uterine cancer. One of the other risk factors when we see uterine cancer in young women is polycystic ovarian disease. And that again, it can predispose to heart disease, diabetes, what we call metabolic syndrome. What a lot of women don't know is that the underlying risk factors for obesity related uterine cancer are exactly the same as for heart disease, the number one cause of death in America is heart disease, cardiovascular disease, and number two is cancer. And they have the same shared risk factors. If someone has obesity related uterine cancer, they're four times more likely to die of a heart attack than they are of uterine cancer. But more importantly, if we don't focus on are diseases just the ability to really enjoy your life and live a healthy, vibrant life, it's being impacted by these chronic diseases over time. So a lot of the patients I treat with uterine cancer, often they've already had a cholecystectomy or removal of their gallbladder, often in their 40s.

Right.

Because it's the same profile of risk factors for gallbladder, gallstones and gallbladder disease. Many of them develop arthritis, osteoarthritis in the knees because of the excess weight and wear and tear on those joints, and then sleep apnea because the weight.

Makes the work of breathing harder.

And diabetes is strongly associated with increasing weight. And so what we do every day, as far as modifiable lifestyle changes can make such a huge impact in your quality of life, especially over time. I kind of compare it to interest in the bank and your savings account or in your investments.

Right.

It starts out small, but when years go by, your quality of life is just so, so much impacted by your daily habits.

Yeah, definitely. I see that all the time with pcos. Polycystic ovarian syndrome, like getting control of your sugar and your insulin production is key to reversing all of that. And like you, I've seen women in their 30s, I've diagnosed them with uterine cancer and it's heartbreaking. And just to know that there is a way to get control of all of this. You know, I want women to feel empowered, like, you know, this is changeable. But the problem is they don't have the tools. They're not being told the right thing. So I love that you're getting this message out there that it's not just wait until your diagnosis and then have this surgery. It's like, get control now. Shift your diet, change your lifestyle, move your body, manage your stressors. You know, like, take care of yourself. That that's kind of what we're saying right now.

That's really. Yeah, yeah. Such an important message. If we don't care about our own health, how can we really expect other people to care for it? Well, in addition. Right. I mean, we have family and friends that care about us, but we really should have the most interest in our Own health because it's our bodies, and we should be proactive because there's payoffs.

Another risk factor for cancer a lot.

Of people are unaware of is just sitting for six hours a day independent.

Of your weight, is a risk factor.

And for our bodies to be healthy, we have to be active. If we put someone in a surgical ICU that requires intubation and be on a breathing machine, basically, they lose 3% of their muscle mass per day. And if we're just sitting and we're not moving, our muscles do get weak and atrophied and can cause misalignment and hip pain and all these other issues. And by being proactive and doing a.

Little bit of exercise every day, you.

Don'T have to be like a superstar athlete. Just put your sneakers on and go outside for a walk. It changes your physiology. It changes your endorphins or good feeling hormones from a workout. It can improve your sleep, your mood. So many benefits to some exercise. The key, I think, is getting to a point where women are enjoying what they do. So the exercise, it has to be sort of an internal motivation.

And women, when they're asked why they want to lose weight, often they're too.

Focused on the weight or appearance. They want to lose weight for an occasion like a wedding or something like that. And we all obviously want to look.

Good, but I think it's more important.

Not just to look good, but to feel good. Because how we feel is often what motivates our behavior.

And so if we find something that.

We can do to be more active and we do it consistently and are able to stick to it, then we're more likely to see an impact of what we do on our behavior, because it does take time. And it's one of the most challenging things, as, you know, for weight loss or diabetes, because there's no immediate impact. It's not like brushing our teeth, where we, like, feel better and our breath is fresh. And, like, if we don't brush our teeth, people don't want to talk to us. But for some of these other things, it just has to be internally motivated and you are going to feel better, so much better. But it takes time to get that habit in place to see the benefits.

Yeah, definitely. And so you just have to keep reminding yourself of your why, like, why you're doing this. And I just can't emphasize that enough that women should take control of their health. They need to speak up if they feel like something's not making sense, if they're not feeling heard from their Doctor or they're not getting answers that make sense. Like, you know, keep looking, keep asking, go somewhere else. You know, like, read your book. Like, that's awesome that people have those resources now so that they don't have to just say okay and you know, just not deal with it. Because I think that's what happens most often.

I think that's very true. Because women, we take care of our.

Children, we take care of our husbands, we take care of our pets. You know, we do all of this caretaking as women. We're so strongly socialized to do that.

And so it's really important in our.

Busy lives with all our different hats we wear, to make sure that we do take time to eat well, to make sure we sleep and, you know, exercise. It's common sense, but it just makes your life so much better if you have good health. Without good health. Health is our most important asset.

And so it deserves some investment of time and energy.

Yeah, exactly. So I love that you're sharing your patients stories and I just think there's so much knowledge to gain from hearing other people's stories and journeys because then you might see yourself in that situation. You know, I want women to listen to their body and, you know, listen to the symptoms they're having. And so I really want them to check out your book and, and see, like, do I need to go see a different doctor? Do I need to be checked out? Because I don't want women to ignore things anymore. That's, that's where you get the bad diagnosis. You know, I remember being in the ER too many times for a woman who couldn't poop for two weeks and she finally came in and she had ovarian cancer or, or she can't stop leaking and she thinks she has a bladder infection. Like it, you'd be surprised at how things are diagnosed. So it's just, you got to pay attention.

I also think sometimes fear limits people's presentation. And you know, more than 80% of what people fear never comes to fruition.

Like most of it is the fear of the unknown. So just going in and getting a.

Diagnosis, even if it's a cancer diagnosis, people, people feel relief in that, in.

That their symptoms are explained and then they're not dismissed. They were heard, a diagnosis was made.

And then you can make a treatment.

Plan about, even if it is a.

Cancer diagnosis and you need to have chemo or radiation or surgery, at least you have a diagnosis and you can plan your future. Whether it means medical care and cancer treatment, it's Much more important to have some knowledge about the future and what you can do to deal with the diagnosis. If it's a cancer diagnosis, lots of people get second opinions, too. You should never be reluctant to get a second opinion about a cancer diagnosis. Some cancers are very common and straightforward, like uterine cancer, but some of them can be more difficult to treat. And. And it's always better to treat cancer right the first time around than to try and play catch up. It's really important to get the right care. And for gynecologic cancers, your primary care doctor is great, and so are obstetrician gynecologists in making diagnosis. But you really want to see someone that treats the cancer that you're diagnosed with on a regular basis because it's the context of care. It's like having the expertise of someone that really knows that cancer inside and out. That's.

Sometimes.

People don't want to travel from their community hospital, perhaps, but we know for ovarian cancer in particular, that's a difficult cancer to treat. People have a better prognosis if they're managed by a gynecologic oncologist and often what we refer to as the tertiary care center, or not a small community hospital, but a hospital that has teams of surgeons that work together on difficult cancer cases that make a big difference in your outcome. If you do get a cancer diagnosis, make sure that you're being treated by someone that specializes in that cancer and obviously, hopefully is board certified.

Yeah. I mean, that's a super important point, is you want someone who's dealing with it on a regular basis, who's up to date and knows all the latest research so that you can have the best options and get the best outcome. I'm. I'm thinking of so many patients as you're talking. I mean, fear comes up so much. You know, I remember one patient who had just constant postmenopausal bleeding, but she was so afraid of having chemo and dying from chemo because she had, you know, a family member that happened to that she didn't want to get that diagnosis. And it turned out all she needed was surgery, and that was it. And she put herself through so much.

Hell because so much anguish. Right.

And it's like, just, you know, figure out what's going on, get the diagnosis. Don't live in fear. Like, that just breaks my heart so much.

Yeah. And especially, like, for postmenopausal bleeding, if you take all comers with postmenopausal Bleeding, it's only 10% of women that end up with a cancer diagnosis, there's so many benign things that can cause that.

Well, most common, yeah, the pre cancer. Right. Like that you can intervene and do something with before you get to that cancerous point.

And not even pre cancer. Like probably one of the most common causes that women suffer from is just bad vaginal atrophy where the lining becomes very thin and they sort of get this brownish discharge that doesn't go away and it's just from lack of estrogen and like it's solved. And then you're, you're not spotting, you're not wearing pads. It can impact your sex life because you're not having pain with sex. And you stayed home because you were worried you might have a diagnosis of cancer. So that's in from our perspective. You know, we feel for those patients because they could just be enjoying their life so much more if they came and sorted out what the problem was rather than stay away in fear. And I think Covid's made that worse. Right. Where people are afraid to a certain extent to come to the hospital, hopefully their fears start to start to resolve now that so many more people have been vaccinated and pretty much the entire hospitals population of workers has been vaccinated. At this point, your risk is much higher outside of the hospital than in the hospital.

Yeah, yeah. I think it's such an important point. Like it's most likely not going to be cancer, but if it is, you want to know sooner than later. So don't ignore your symptoms. Go get evaluated by the appropriate person, get it checked out. But in the meantime, you, you know, do what you need to do to prevent it. So where can my listeners find your book and follow you? Dr. Wright?

So I have a website called valenarightmd.com and it links to where you can buy the book.

It's sort of structured that way, so.

That'S the best place. And Amazon has it on its website as well, so you can buy it on any of the online distributors as well.

Awesome. I'll have all those link in my show notes so people can just connect with you. Are you on social media at all?

Yes, I'm sort of just starting with this. So Instagram and Facebook.

Awesome.

Well, direct message at Instagram, you have questions or you want to reach me. And then also on my website there's the top five ways to prevent women's cancer. If you sign up for the email list, you get sent those sort of written Top 5 Ways to Prevent women's cancer.

Perfect. Your inbox Yeah, I would encourage everybody to get that at the very least. That's good. Great information. So thank you so much. This has been really helpful. I hope that somebody resonated with it and is gonna, like, take action because of you.

Yeah, that's the. That's the whole reason I wrote the book. I just want people to have a better life and better women's health. Yeah.

Well, thank you so much for all you do, and stay in touch. Okay.

All right, great.

Thanks for having me as a guest.

It was really a pleasure.

That was good. Do you feel like we covered everything?

Yeah, I think so.

Pretty much.

Awesome.