An elevated cancer risk asks you to juggle a lot: appointments, surveillance, planning…

But according to Dr Deanna Gerber, it can often boil down to something simpler: knowing what to look out for, knowing yourself, and knowing when to speak up. 

Dr Gerber is a gynecologic oncologist at New York Presbyterian Weill Cornell. As a triple negative breast cancer survivor and BRCA-1 carrier herself, Dr. Gerber is passionate about bringing more awareness to the complex needs of cancer survivors. 

Dr. Gerber sat down with The Peak to talk about gynecologic cancer screening and its limitations, ovarian cancer risk reduction, and how her experience as a patient is changing the way she works with patients. 

This interview has been edited for clarity and length.

The Peak: Cancer screening is limited for gynecologic cancers. Why is that?

Deanna Gerber: A screening test needs to be effective. It needs to reduce the risk of the thing we’re trying to screen for, and it also has to be affordable, and, unfortunately, for most gynecologic cancers outside of cervical cancer, there really are no tests that meet those criteria.

TP: In the absence of screening, what symptoms should Breasties be mindful of?

DG: Any changes in your menstrual cycle, so any heavier bleeding than normal bleeding between menstrual cycles is important to note. Any post-menopausal bleeding, that’s a big one. If you notice anything on your vulva or vagina that is like a sore or something that is itchy, talk to your gynecologist.

In terms of ovarian cancer, there aren’t many symptoms of early ovarian cancer, but if you’re having any nausea or vomiting that’s new and nagging, any changes in your bowel habits, constipation, diarrhea that’s nagging for a few weeks or so, talk to your doctor. 

📖 RELATED: The Breasties Guide to Gynecologic Cancers

TP: If someone is at high risk of gynecologic cancer, what are some things they should consider when it comes to risk reduction?

DG: People at high risk of gynecologic cancer definitely want to talk with a genetic counselor and with a gynecologic oncologist about risk reduction strategies.

Some things to consider are that birth control pills are really effective at reducing the risk of ovarian cancer in women with a high risk of ovarian cancer … It is a very big decision that should be made thoughtfully with both your breast team and your gynecology team.

The birth control pills may increase the absolute risk of breast cancer, but the relative risk is still pretty low. And so it’s definitely something to consider and talk about with your medical team.

Other things to consider are risk-reducing surgery, and so removal of the fallopian tubes and/or ovaries within a certain timeframe or when you’re done growing your family.

TP: Can you share more about removing the fallopian tubes to reduce the risk of ovarian cancer?

A salpingectomy is removal of the fallopian tubes, and there’s a lot of research that’s being done currently to see if removing just the fallopian tubes, a risk-reducing salpingectomy, is sufficient at reducing the risk of ovarian cancer in people who are high risk for developing ovarian cancer in the future.

The salpingectomy for risk reduction right now is experimental and is only being done within a clinical trial setting. But we have some large national and international studies that should be giving us a lot of data on if it’s safe and effective at reducing the risk of ovarian cancer [in the next five, 10 years].

TP: How might a salpingectomy reduce one’s risk of ovarian cancer?

What we know in terms of ovarian cancer is that ovarian cancer might actually be a misnomer. Especially [for people] with BRCA mutations or other high-risk genetic variants, we think that ovarian cancer actually is fallopian tube cancer. So it’s starting at the edge of the fallopian tube.

And so in theory, removing just the fallopian tube should be sufficient at reducing the risk of ovarian cancer. 

TP: It seems menopause and menopause hormone therapy are everywhere lately. What should Breasties know about menopause symptom management and cancer risk?

This is a great question, but not a well-studied question so far. Hormone replacement therapy in our country is having a big renaissance after it was kinda taboo and off the table after the FDA put a black box warning on hormone replacement therapy.

That black box warning has now come off, and so there’s a lot more interest in hormone replacement therapy and how it affects all women. 

For breast cancer survivors or people who are at high risk for breast cancer, it remains to be seen if hormone replacement is definitely safe, but we know that in certain situations it may be safe, especially in those who have hormone receptor-negative breast cancers. 

But we don’t have any high-quality studies showing that it is, [so] always talk with your doctor about whatever specific symptom you’re hoping to manage with the hormone replacement therapy. There might be a way to treat just that symptom alone that may not require systemic hormones. 

TP: Can you give us an example?

DG: Sure. So vaginal dryness or frequent UTIs…. Systemic hormones may improve that, but really you could probably get away with just using topical estrogen, which we think is safe in breast cancer survivors.

TP: How has your experience as a breast cancer survivor impacted the way you care for your patients?

DG: My experience as a breast cancer survivor has shaped the way I interact with my patients in every single way. It was so meta being on the other side of the table, on the other side of the conversation, and I think understanding just how scary it is and the waiting…

That’s definitely impacted the way I manage my patients and interact with my patients. But, really, every single thing about me has changed, and I think it really helps to have a true understanding of what my patients might be going through to really connect and meet them on their level.

TP: Have you been able to share any of that with your colleagues or other physicians?

DG: In terms of sharing my breast cancer journey with my colleagues, with my community, I am an open book. I love talking about it. I feel very lucky that me having breast cancer has such a clear correlation to meaning in my life.

Like I was an oncologist, I had breast cancer, and I continue to be an oncologist. So I had a really clear path, a really clear silver lining, if you will, on how my cancer journey could impact my life. 

That is something that I don’t take lightly, and I do not take for granted. I want to share that with everyone and hopefully make at least one other person’s cancer journey less scary, make other people feel more validated, and teach other doctors what it’s like being on the other side of the conversation.

So hopefully it’s a ripple effect, and people are getting better care because of this really terrible thing that happened to me. 

TP: What is one myth related to gynecologic cancers that you think is important to debunk?

DG: I might get a little pushback on this, but people think that ultrasounds improve outcomes with ovarian cancer or can detect ovarian cancer, that they’re a good screening test. They’re not. 

Studies have shown that routine ultrasounds are not effective at picking up early ovarian cancer and that routine imaging, like ultrasounds, does not improve outcomes in ovarian cancer. They also provide a false sense of security and have been shown to increase anxiety. The NCCN guidelines recently removed routine ultrasound from it’s recommendations for all of these reasons.  

TP: Is there anything that you’d like to share?

DG: Know your family history, know which symptoms to look out for, and find doctors that you really like, that you really connect with, and that hear you and listen to you. That’s it.