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There's nooo screening for ovarian cancer

[00:00:00] Morning gals. Okay, it's Saturday and I wanna talk about screening tests. I feel like I might be repeating myself, but this is incredibly important because this week alone, no fewer than four patients, all of whom are very educated, smart women, said to me, did you find out about your ovarian cancer through your pap smear Again, What's the answer, ladies? 

I hope you're all, you know on your Saturday doing fun stuff, watching this video going, no, you can't find ovarian cancer through a pap smear because the pap smear is the screening test for what? What, what your cervix. Okay. Let's review screening tests. Again, I'm gonna try to make this brief, but screening test is a specific term in medicine that has very specific parameters with which it has to hit. 

Meaning a screening test has to be fairly inexpensive, fairly easy to perform, widely available, not just in like specialty doctor's offices, but across, you know, all different, um, socioeconomic groups in medical. And you have to be able to have [00:01:00] a preclinical phase, meaning you're not just screening for cancer, you're screening ideally for an earlier pre-cancer precursor that you can either find and fix before it turns into cancer or a very early, early stage cancer, right? 

So you don't wanna just pick up and say, Hey, I screened you and you have stage four cancer. You wanna say, Hey, I screened you and we either caught you before something turned into it that we can modulate, or we found an early stage one that we can actually. Um, change the, the future of, right. So has to be easy to, to, easy to do has to be relatively cheap. 

It has to have a good preclinical, um, issue that it can pick up and it has to really, um, be able to sensitively pick things up and specifically pick things up. These are. Very annoying bios, statistical words that I hate by the way. Um, while not causing a lot of, um, ruckus with the follow up tests that you can do. 

A classic example would be mammograms. So [00:02:00] screening tests that you guys should be doing. If you are over 35 or 40, talk to your doctor. Screening mammogram, right? That means not, oh, I feel the lump. That means I'm fine. I'm going in for a screening mammogram because hopefully it's gonna be normal. But if they pick something up, they have caught it early, which falls into my, one of my many paradigms I love, which is if I can find it and fix it, I'm not stressed out about it. 

Right? So screening, mammogram screening, pap smear. Pap smear is for cervical cancer, right? So when you look inside your vagina, we deck a little. I hate the word scrape, so I don't say that, but a little swab basically with a, a very soft brush of the cells from your cervix. And we send that to the lab, and that is the screening test we say for cervical cancer. 

But in reality it's a screening test to find the very early changes that might turn into cancer so that we can actually fix those changes if need be before a cancer. Okay, so mammogram. Pap [00:03:00] smear, colonoscopy. They just changed the guidelines from 50 to 45. I'm actually having my colonoscopy on March 31st. 

So you guys are gonna get a whole lot of colonoscopy teaching. And again, that is not meant to be, oh, I have a lot of pain and pressure and bloating and I'm, I have bloody stools and I'm gonna go in cuz that means something could all, could already be occurring. You go in at age 45 now because the guideline changed from 50. 

So that you can be screened so that if there are any polyps that might have turned into cancer, you find them early. Okay, so those are three perfect examples of screening tests, mammogram, pap, smear, and colonoscopy. Those three, I don't fear, I don't fear anything, you know that, but I definitely don't fear those because those represent to me things that, like I said, I can find and fix. 

Can I always find and fix them? Of course, not people, but if we all keep our wits about us and we try to find and fix those, That eliminates a lot. Okay. Can there be people who, unfortunately at the screening test with zero symptoms were [00:04:00] found to have a stage three or four cancer? Yes. Is that common? No, we cannot be obsessively worried about things that are uncommon. 

We have to hang our hat on the things that we can try to find and fix. Now, ovaries, they are a conundrum, and for those of you who are new to me, I had ovarian cancer in 2016. I was diagnosed at a very early stage two, which is unusual because the vast majority of women will be diagnosed with ovarian cancer at stage three or four because as women, when we. 

Bloating, pain, pressure in our pelvis or abdomen. We tend, and this has been studied widely, to say things like, um, I ate too much Chinese food, or like, in my case, like last week, I had pizza and it ravaged my stomach, so I'm bloated because of that. And by the way, I was bloated because of that, but that should end within a day or two if it persisted past. 

I usually tell patients two weeks. So if you have bloating, pain, or pressure and it's [00:05:00] onset has happened and it has not resolved through whatever means you've done like stopping the wine and stopping the crappy food and doing whatever it is that you think you need to do to alleviate it, and two weeks have gone by, do not dramatize and think you're dying of ovarian cancer cuz you're likely not. 

But, Go see your gynecologist and ask for an ultrasound. Is an ultrasound a screening? No, and I'll explain why in a second. Do you sometimes have to ask your gynecologist? Yes, and it's not because your gynecologist doesn't care, it's because your gynecologist, unfortunately, is bound by things like, well, if I sent her for an ultrasound, it might cost her money because since it's not a screening test, her insurance may not cover it. 

If she has a high deductible and I feel bad for that patient and I don't wanna incur two to $400. Which I fully understand. That said, especially because of my situation, I tell patients all the time. I will encourage an ultrasound in any patient who has bloating or pain or pressure, not because I'm sure they [00:06:00] have ovarian cancer. 

In fact, I'm fairly certain they don't. But the fact is I don't know who has it. There's no way to tell outside of those small high risk groups whose mothers or sisters or aunts might have had ovarian cancer. Otherwise, you don't know. I didn't have any risk factors as far as family history. So again, if we do not have a low threshold to look with an ultrasound and a high index of suspic, Without being paranoid, we will miss ovarian cancer over and over and we will find it at stage three or four, which is what incurs fear and anxiety for you guys. 

If instead we say it's likely nothing that I'm gonna go get checked out, we will, yes, unfortunately incur cost to potentially you or your insurance company for your ultrasound. Something I cannot control, but we will find those few cases, okay? Now if we just hedge our, be. We will be right most of the time that someone doesn't have ovarian cancer and we've not missed anything, but we will miss a small portion of the time. 

And that small portion is a group of [00:07:00] people who like me, could have actually been fine. I am fine. I am four years out. Almost done. So why is the o ovarian ultrasound or pelvic ultrasound not a screening test? Because remember I said it has to be inexpensive, it has to be widely available, and I said it has to be sensitive and specific. 

When you do a pelvic ultrasound, it's really common to find stuff like patients will come to me, oh, I had irregular bleeding, or I had pain and pressure. I send them for an ultrasound. The likelihood of it being something bad is so small, but we often will find ovarian cysts. Ovarian cys are often not cancer. 

In fact, the vast majority of the time, they're not cancer, but they could be. And so most of the time when you have an ovarian cyst, your doctor will say It's likely nothing but come back in six to eight weeks to look again. I'll do a separate thing on ovarian cancer, I mean on ovarian cyst, but right now, I want us to know that when you do a pelvic ultrasound because you have pain, or pressure or bloating, your doctor has no choice. 

She cannot say it's a screening test because it is not a screening test. The [00:08:00] ovaries are tucked up inside. They can't be accessed easily with something like a pap smear, so they can't be screened. It's not because scientists don't care. It is because when your ovaries change every month, which most of them do with ovulation. 

There's no screening interval with which we can say, oh, this is safe. Look, you're fine. So again, an ultrasound of your pelvis, which is the only way you'll find ovarian cancer, which means you have to be proactive about saying, I have bloating, pain, and pressure. I'm not gonna freak out. I think it really was the wine, but now it's been two weeks. 

So I'm gonna call my doctor, but it's not a screening test. But the biggest reason I brought this up was because, again, the patients this week, who said, did you find it from your pap smear? And what did we saw? The resounding answer is no. We did not find it because of my pap smear. Because my pap smear is for cervical cancer. 

So what did we learn today? Mammogram, colonoscopy, pap smear. Great screening tests. You should be doing them. Talk to your doctor about what interval she thinks you should do. What did we find out about ovarian cancer? There is no screening test. That's [00:09:00] not, oh my god. So scary. That means let's be calm. 

Let's remember that there are symptoms. It is not the silent killer like you guys often hear it. Subtle and not killer. It is the subtle entity that creeps up on us, whispers to us and says, Hey, something's going on down there. Please don't ignore it. So this is, um, a, a good opportunity for you guys to like really figure out what's going on with your body, right? 

If now you're saying, oh my God, I've been bloated for five years. Don't worry if you've had bloating for five years, it's not ovarian cancer, cuz it would've shown up by now in much bigger ways. Okay. Um, and again, there is no screening test for ovarian cancer, so just be very clear that when you go to your doctor's office, She is not screening you ovarian cancer. 

Not because she doesn't care, but because she cannot, because there is no screening test, that pelvic exam that she does where she puts one hand inside and then feels your belly from the outside. It's unfortunately a very insensitive exam. I don't mean insensitive like we don't like you insensitive, but from a medical perspective, the word sensitivity means able to pick [00:10:00] something up. 

It's not sensitive because something can grow in your pelvis to a fairly large size without anyone being able to. So that test is really a very cursory, just meant to make sure there's no huge mass in that you're not having terrible pain, and that is the only test that's being done. And again, it's not a great test for ovarian cancer. 

Okay? All of this is not meant to incite angst and fear. It is meant to quell your angst and fear and put some control into your hands so that you know that like me, if something happens and you are proactive and you go to your doctor, you will probably be able to find it and fix it. Okay?