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Catching Ovarian Cancer Early: Inside UK's Research Screening Program · Talking FACS

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  Welcome to Talking FACS, and thank you for tuning in to Cancer Conversations
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  on Talking FACS, a podcast collaboration between the University of Kentucky
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  Markey Cancer Center and the UK Martin-Gatton College of Agriculture,
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  Food and Environments Cooperative Extension Service.
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  We will share with you the latest developments in cancer prevention,
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  diagnosis, treatment and research from the experts at Markey Cancer Center,
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  Kentucky's only National Cancer Institute designated Comprehensive Cancer Center.
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  Talking FACS is hosted by the UK Family and Consumer Sciences Extension Program.
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  Our educators share research knowledge with individuals, families,
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  and communities to improve quality of life.
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  Hello and welcome to Cancer Conversations on Talking FACS.
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  I am your host, Mindy McCulley, Extension Specialist for Instructional Support
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  with Family and Consumer Sciences Extension. My guest today is Dr.
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  Charles Dietrich, the Associate Professor of Gynecologic Oncology with the Markey
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  Cancer Center. He is the Medical Co-Director with the Ovarian Cancer Screening Program.
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  Welcome, Dr. Dietrich. Good morning. Thank you so much for having me. It's a pleasure.
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  So glad that you're here to talk about this really important program that has
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  impacted so many lives across Kentucky. I know that we are touching families
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  from Pikeville to Paducah with this program.
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  Yeah, it's a fantastic program.
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  Avarian cancer is a very challenging cancer.
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  There's probably about 20,000 new cases in the United States each year.
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  Which is not a lot compared to some other cancers, but it's very impactful because,
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  unfortunately, most patients are diagnosed with advanced disease,
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  and they're not very symptomatic until it's already metastasized.
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  We at University of Kentucky have really tried to move the diagnosis up into
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  earlier stages where it's much more treatable and has a much higher success
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  rate in curing. reason the ovarian cancer program was founded.
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  So, the ovarian cancer research program really tries to find cancers before
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  they metastasize or even before they have any significant impact on a woman's life, right?
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  Exactly. So, again, most patients with ovarian cancer are diagnosed in stage
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  three or four, at that point, the cure rates are 30, maybe 40% at the highest.
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  If you can catch it earlier in stage one, the cure rates are over 90%.
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  So if you can find a way to diagnose it in that earlier stage,
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  you're going to have a significant impact on our patients.
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  And as we mentioned before, ovarian cancer presents with very,
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  very few symptoms when it's early.
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  It's not until it's more advanced when symptoms start happening.
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  And that's where screening really comes in to try to catch it before those symptoms
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  develop and before it's metastasized.
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  Who can be screened through the Ovarian Cancer Research Program?
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  Sure. So the program was started in 1988. So it's been around for over 30 years.
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  And it's a research program. So it's,
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  Under the protocol, patients that are older than 50 are offered an annual screen that's free of cost.
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  You can also enter the program earlier if you have a family history of ovarian
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  or breast cancer or if you have a known mutation like a BRCA mutation.
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  And so those are the patients that we are currently screening.
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  And so I know that patients can be screened in Lexington. Are there other sites
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  across Kentucky where they can be screened? Yeah, absolutely.
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  So COVID certainly had an impact on our operations, and we had to close down some sites.
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  But fortunately, over the last
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  several years, there's been a big effort to reopen sites across the state.
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  And so we have sites available in Paducah, Elizabethtown, Somerset.
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  Stanford, Harrodsburg, Maysville, and Hazard.
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  And we're currently working to open up additional sites.
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  Probably the next one that will come online is Prestonsburg.
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  Oh, that's fabulous. So any woman over the age of 50 is eligible then?
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  That is correct. And again, the screening is offered free of charge.
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  It just is a transvaginal ultrasound. The exam takes probably less than 30 minutes.
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  It's a pretty easy exam and we get a lot of information from it. Scans are reviewed.
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  I'm involved in the reviewing process.
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  And if there's a normal findings, then the next scan is in the following year.
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  If we do find something abnormal, this is kind of where our algorithm really is helpful.
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  We may ask you to come back for an earlier screen, anywhere from three to six
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  months, and we may also ask our participants to get a blood test called a CA-125 test,
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  which is a screening marker for ovarian cancer.
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  So I know that women will often say, well, I've had a hysterectomy,
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  but I still have my ovaries.
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  So would they still be eligible for the screening?
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  Absolutely. Yeah. So if you still have ovaries in place, you're eligible for screening.
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  And if something is found, then what happens?
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  So again, if we find an abnormal finding, we have an algorithm that we use to
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  either do serial screens to kind of see what the history of the abnormality is going to do.
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  You try to find out what trajectory the cyst or the mass is on.
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  And if we see continual growth or we see that the cyst is becoming more complex,
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  at some point we may recommend a surgery to remove it. to get a definitive diagnosis.
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  So when something is found, is the woman then referred to another oncologist
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  or is that work done at UK?
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  So they certainly are welcome to come see us at the University of Kentucky.
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  We have a group of five GYN oncologists that actively practice and are trained
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  to deal with complex ovarian masses and the decision-making that's required intraoperatively.
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  But if they prefer to have their primary care or their primary OBGYN involved
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  in the care, that's certainly reasonable as well.
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  And I know through the MCCAN network, there are lots of UK physicians throughout
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  the state of Kentucky who might be able to handle that work as well.
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  That's correct. You do have to be a little careful though, because if there's
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  a chance that it's a malignancy, you know, the surgery is best handled by a GYN Oncologist. Right.
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  But we certainly involve the primary care providers and the decision-making
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  when it comes to that point.
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  That is interesting to know as well.
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  So, throughout the history of the ovarian cancer research program,
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  about how many cancers have been identified?
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  Great question. So I think over the life of the program, over 50,000 women have been screened.
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  And we've detected around 130 ovarian cancers to date.
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  And the majority of those are earlier stages than the traditional stage 3-4
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  that we find ovarian cancer.
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  And that has translated into a significant survival advantage for the patients
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  that have had ovarian cancer in the screening program that we've been able to detect.
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  When we find cancers at an earlier rate, that has a significant cost benefit.
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  I'm thinking for the family, of course, and of course, for their emotional health
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  as well, I would imagine. For sure.
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  You know, obviously, any cancer diagnosis is a very stressful period in a patient's life.
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  But if you can diagnose a cancer in stage one or stage two, outcomes are significantly better.
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  Still a process patients have to go through with surgery, and sometimes they
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  need chemotherapy afterwards.
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  But survival is definitely improved the earlier the cancer is found.
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  So what is something that may keep someone from going to get a screening?
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  Well, I think, number one, not knowing that this program is out there is a barrier.
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  Certainly. And hopefully we can communicate that this is an option for the women
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  of Kentucky and improve the numbers of people coming to screening.
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  I think some people may worry about the cost, but through this program, the screening is free.
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  We have a lot of grants and we have state funding to run the program,
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  to keep the program going.
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  And so this is a free screen for women.
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  You know, other barriers, people may worry about, you know, the exam being uncomfortable.
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  It really is not. It's very similar to a pelvic exam.
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  I think those are some of the barriers that people worry about.
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  Well, and as someone who's had the exam, I can say you're not lying.
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  It's the truth. It really is very non-invasive.
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  Dr. Dietrich, I have appreciated the time that you have taken to share with
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  me about this fabulous program. Are there any other details that we need to share before we wrap up?
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  We're also expanding the screening to look at other areas as well.
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  So in addition to looking at ovaries, we also get information on the uterus and the cervix.
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  We can sometimes detect abnormalities that may need attention.
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  And over the last couple of years, we've really paid more attention to that
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  and have started reporting out those findings as well.
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  Oh, that's great. And I think the future of the program is to really try to modify our algorithm.
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  We're trying to add some additional biochemical testing to our screening algorithm
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  to help define and improve our sensitivity and specificity and to really minimize
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  the amount of surgeries that we need to ensure that we're only doing surgeries on the right patients.
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  In the screen population at the University of Kentucky, the stage of diagnosis
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  is a lot lower than in the unscreened population.
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  Okay. And that has translated into survival advantages.
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  This is a difficult program to replicate. I think other people have had interest
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  in trying to replicate it.
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  But we run the program at a very low cost.
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  And that is a hard thing to replicate because it does take manpower to run the program.
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  And this program has such an amazing history.
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  And it's challenging sometimes to get that type of funding and manpower to run,
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  program of this caliber.
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  We're very fortunate in Kentucky to have this as an opportunity.
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  We're hopeful that it will continue to advance in the future,
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  more sites being opened up, and hopefully more refinements to our algorithm
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  to make it even more accurate.
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  That is fascinating that we have kind of been on the cutting edge for, what, 30 years now?
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  That is right. Well, I really appreciate your time to talk to me about this
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  program because I do know that it has been life-saving for those people who have benefited from it.
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  And hopefully, as we progress in the future, then maybe we'll find a way to
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  prevent the disease altogether.
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  Fantastic. Thank you again for having me. If you are just tuning in,
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