ovarian cancer

And in news, the American College of Obstetrics and Gynecology has instituted guidelines on an issue that I think I first covered 20-odd years ago, and you and I covered quite recently.

Yes, so this is basically this big body in the United States has strengthened the recommendation for salpingectomy, which is removal of the fallopian tubes, for the prevention of ovarian cancer.

Now, you did cover this.

I'm about to give you some kudos, Norman Swan.

... or a hysterectomy or indeed, uh, an appendicectomy-

Yes

... whip the tubes out because it's the discovery that, uh, some forms of ovarian cancer start in the fallopian tubes and spread to the ovaries, so they're actually not ovarian cancer.

They're fallopian cancer which spreads to the tubes.

I wanted to take a moment to thank our patient advocacy group partner, the National Ovarian Cancer Coalition.

They provide invaluable support to those patients with ovarian cancer and their care partners.

You can see their website here at ovarian.org.

The NOCC has a number of resources that are available, including information on biomarkers, clinical trials, and side effect management to aid patients at any stage of their ovarian cancer journey.

And so it is really a resource that can be provided to patients for information and care.

20 to 30% of people with infertility will be diagnosed with endometriosis, and it's a common cause of infertility and difficulty conceiving.

But having a diagnosis in and of itself is an independent risk factor for some cancers, especially ovarian cancer.

And number three, hormonal conditions of infertility, specifically anovulation and a common diagnosis of PCOS or polycystic ovarian syndrome in and of themselves have an increased risk or baseline risk of cancer.

So if a study does show that there's an increased risk of cancer and taking fertility medications or doing fertility treatment, a big question is, is it the underlying diagnosis like infertility endometriosis, PCOS, like why is that person taking fertility medications? Or is it the fertility medications in and of themselves that might be putting someone at increased risk of cancer? That distinction is extremely important, and some studies really struggle to try to answer.

ASRM points out to a meta-analysis that shows that if someone takes Clomid for more than 10 cycles in a lifetime, there is a slightly higher risk of breast cancer.

And ASRM calls out in this guideline that that should be discussed with patients and should try to be avoided.

So ASRM's official recommendation from this guideline, quote, women should be informed that there does not appear to be an increased risk of breast cancer associated with assisted reproductive technology, but prolonged or more than 10 cycles of clomiphene should be avoided so that's reassuring news overall for breast cancer topic number three what about other cancers specifically ovarian and uterine so first ovarian cancer this is very nuanced there is weak to moderate evidence according to asrm of a slightly higher risk of invasive ovarian carcinoma in women that do assisted reproductive technology approximately three extra cases of invasive ovarian carcinoma per 100,000 person years.

So this is a very, very low increased overall risk, but they wanna share that it has been found.

So I've been actually pioneering for Unite for Her Integrative Care for the past 18 years.

We serve over 11,000 individuals a year with our program, our wellness program, Breast and Ovarian Cancer, where each of them get $2,000 worth of integrative services.

it's my life's work.

I am honored to be able to be in this position.

We have to do a lot of fundraising for that.

Okay.

There are over 350,000 individuals diagnosed with breast cancer a year and ovarian cancer.

It is staggering.

Well, we had a very simple principle, which was we were trying this principle where checkpoint inhibitors don't work.

Checkpoint inhibitors like Keytruda, for example, have an effect on a subgroup of patients, but across solid tumors, but not in ovarian cancer, with very poor response rates in ovarian cancer.

So we thought what will happen if we train the immune system? in that specific setting where the tumor has been taken out with surgery and patients have undergone chemotherapy, will we see a relevant training of the immune system with this specific product? And we have seen very encouraging signals.

So what we've seen is that out of the 17 patients that we treated in the so-called Allison trial, five patients became long-term progression-free survivors.

And those survivals were also associated with the immune responses that we observed after patients were treated with the product.

Now, ovarian cancer is very different from blood cancers.

There's a tumor microenvironment that you have to deal with.

So with this program, we hope to find clinical partnerships so that we can combine it with other treatments to make it as effective as possible in ovarian cancer.

And we have to consider that ourselves, but also make sure that conversations discuss with the patient.

Because is it actually making a difference? But what does that mean to make a difference for that patient, which is going to be different for different people? I think we talk about this a lot for not just like surveillance, but for say like breast and ovarian cancer surveillance or ovarian cancer surveillance rather for high risk ovarian cancer patients.

Is this lead time bias that we can see in doing detections or doing testing? Can you explain that concept to our listeners and how that might change the data that we see?

Yeah, thank you for asking that question because this is a really hard concept for kind of a lot of people to understand.

And so it kind of showed that prime example of lead time bias.

And I try to use that to explain to trainees and even patients that treating on a test result may not actually be the most meaningful.

it is really hard you see disease on a scan you are going to be inclined to treat that and it's hard to just sit on your hands and i totally get that and this is why we have to be really thoughtful about when we're doing a scan what does six months mean why doing a scan at six months is a meaningful metric right i think there is one little caveat to that and those are patients who are on maintenance therapies which is now becoming pretty standard in ovarian cancer endometrial cancer and cervical cancer in the advanced settings.

And here I think the value of some imaging or evaluation tool can be meaningful because we know the cost of treating those therapies can be quite high.