Robert Rubino offers his take on the present and future state of women’s cancer prevention and treatment.

Question: What’s the next frontier in women’s cancers?

Robert Rubino:  I think any gynecologist will tell you that it’s the ovary, ovarian cancer.  We’re kind of at a loss really.  The only thing we have to rely on is our patient symptoms and being vigilant in our annual exams.  There’s no real good test out there.  CA-125, which is a blood test, which there’s an e-mail going around for years now that it’s a great cancer screener, it’s almost like a PSA test for women and the same as the PSA is for men and it really hasn’t shown to be that.  In fact, there’s a lot of false positives to it so you end up kind of chasing a lot of lab results and coming up with nothing and then creating a lot of anxiety for patients.  So we really don’t have anything that we can offer as good screening so basically just having a high vigilance is all we can offer right now. But I think being on the birth control pill is the best thing you could do as far as prevention over the course of two years.

Question: How will genomics revolutionize the way we treat cancer in women?

Robert Rubino: Well, I think it will help, you know, in counseling our patients regarding diseases they might anticipate when they have children.  I think like any technology it’s always gonna be far ahead of our ability to deal with it, you know, as anything, nuclear power, what have you.  We always seem to be able to do stuff before we really know how to ethically and morally deal with it.  So I think the biggest play is gonna be on predicting cancers in women with the BRCA gene which we have already for the breast.  My hope is that we’ll see that, you know, for the ovary.  That’s probably something that’s not as far down the road as we think right now.

Question: What makes ovarian cancer such a stealthy killer?

Robert Rubino:  Well, partly because the ovaries are well protected inside the abdominal cavity of a woman so a cancerous lesion, basically what they do are cells that grow and don’t recognize their neighbors so they pile up on each other and they grow rapidly.  They are allowed to grow and they have kind of the relative open space of the abdominal cavity in which to grow so women won’t feel too much initially.  And it’s only when the cancer gets to a very large state where they start to feel symptoms of other organs being compressed and things like that.  So that’s why it’s so sinister. There’s nothing obvious like a melanoma, you kind of see it and it grows and it changes so you pick those up early.  The uterus, uterine cancer sends you a literal red flag.  You know, after the menopause if a woman sees bleeding, that’s a sign that there’s something wrong.  And uterine cancer is often picked up early and cured because we have a warning.  So the ovaries don’t give us much in the way of warning.  So bloating is really the one symptom that we hear from patients that we always respect.  And of course most times when you work up bloating, you come up empty-handed, but we always have in the back of our mind is it the ovary.

Question: What is the survival rate?

Robert Rubino:  Dismal for ovarian cancer.  You know, stage 3 and 4, very low survival rate, although it has improved in the last few years with new chemotherapy regimens.  You have a much better survival rate in, you know, stage 1 cancer obviously, but very few are picked up.  The majority are picked up in stage 3 or 4.

Recorded on: 04/29/2008