Maggie McKay (Host): Meaningful Medicine is a Novant Health podcast, bringing you access to leading doctors who answer your questions they wish you would ask. From routine care to rare conditions, our physicians offer tips to navigate medical decisions and build a healthier future. I'm your host, Maggie McKay. Today, I'm sitting down with Dr. Lindsey Buckingham, Gynecologic Oncologist, to talk about gynecologic cancer. Before we get started, I would love to know how this specialty became a passion of yours and what made you focus on GYN cancer.

Dr. Lindsey Buckingham: Thanks, Maggie, first of all for having me. I'm excited to talk to you about GYN cancer to which I've kind of dedicated my life and my career and yeah, so for me, I think it's important for you to first know that to get to do my job, you actually have to start as an OBGYN. So I graduated from medical school, and started off in a residency in OBGYN where I delivered a lot of babies, took care of women with gynecologic problems, and through that process, which was four years, had a real calling to take care of women dealing with cancer diagnoses, mostly because I really wanted to hang on to my patients and not just see them for short intervals during a pregnancy or a gynecologic problem, but to be able to really develop strong relationships and often really emotional ones with my patients.

Host: So gynecologic cancer is an umbrella term. Can you briefly provide an overview of what those cancers are?

Dr. Lindsey Buckingham: In the gynecologic oncology world, we mainly deal in four, four or five cancers and they're all below the belt is how I describe it to my patients. So, uterus, cervix, ovary, and then vulva and vaginal cancers are the four kinds of five that we treat.

Host: And speaking generally, do women always know something's wrong with these cancers? Are there common symptoms?

Dr. Lindsey Buckingham: So it really depends on what kind of cancer we're talking about and where it started. I think the one that we often worry a lot about and is getting a lot more attention these days is ovarian cancer, which the short answer is no. Oftentimes folks don't know that this problem is brewing. Ovarian cancer tends to present at advanced stages because the symptoms are very vague and can be as simple as some constipation or a little bit of bloating.

Uterine cancer is actually a lot more common than ovary cancer and is something that we see on a day to day basis here. And that generally presents with bleeding after menopause. And so, most of our patients will realize that that's something that shouldn't happen and they'll get to their doctors, usually starting at a gynecologist before they meet us and they'll get a diagnosis. And then for cervical and vulvar or vaginal cancers, it really kind of depends on if they have any symptoms or not. So some folks don't notice anything is amiss at all and end up in a doctor's office for routine care and get a diagnosis. Others come in with pain or bleeding or a new lump or bump that they've noticed.

Host: Dr. Buckingham, how important are routine GYN visits for catching these cancers early? Because I imagine you should do them every single year, right?

Dr. Lindsey Buckingham: So yeah, what we hope is that our patients are getting in to see their doctor. We love it when you have a GYN, although there are plenty of generalists in our area that still do pelvic exams, which is excellent. And we hope that women are seeing a gynecologist about every year. One thing that makes it a little difficult is that the PAP smear guidelines are changing over time.

And so PAP smears are no longer usually required every year. And that has somewhat muddied the waters for women knowing how often do I need to see a gynecologist at all. But as you say, in general, it's nice to have a check in once a year so that you can have a physical exam, even if a PAP smear is not required, because those exams can pick up things that have nothing to do with the PAP smear, which is specific to cervical cancer.

Host: Should that make us nervous not to have a PAP smear every year?

Dr. Lindsey Buckingham: The data would suggest that it's okay to have a PAP smear every three to five years depending on your history. I think that it's, the PAP smear in some ways is secondary if you're having an exam every year because your practitioner will then be able to decide, do I see something that doesn't look right?

And then I can do either a PAP smear or another test that makes sense in that situation.

Host: For cervical cancer specifically, do you recommend HPV vaccines and screenings?

Dr. Lindsey Buckingham: Absolutely. HPV vaccines are great and really are part of pediatrics these days. So, the idea is that most children should get vaccinated. Age 11 is when most people are getting their kids vaccinated, but the vaccine is approved as early as age 9. The whole idea being that kids get vaccinated well before sexual debut so that they can have protection for that day when they do become sexually active.

We actually are also able to use HPV vaccine now up to age 45 for women who may already have HPV, but we're treating them for some sort of precancerous lesion on the cervix, and that can help the immune system start to fight away that virus.

Host: Many women are afraid to talk about gynecological cancer, it seems. So can you talk about why it can be such a taboo subject?

Dr. Lindsey Buckingham: You know, I think that most things, female health, can be pretty taboo, right? I mean, it's not just cancer. It's most of the way that we get care and you know, access physicians. So, what I think we need to do is, earlier in our lives, and particularly in our schools, be teaching anatomy to both men and women, boys and girls, so that we understand what our bodies look like, how they work, and can then start to recognize in ourselves what may not be working correctly, so that we can seek help.

Things with private parts tend to be taboo, even in men's health. I think anything, you know, prostate or otherwise can also be taboo. But, I do think education is a big part of fighting stigma and helping just normalize that we know what our anatomy is and how it works.

Host: Any other ideas how to break the stigma? Just maybe make it more normal, talk about it more openly?

Dr. Lindsey Buckingham: Absolutely. Just get it out there. So I, I think we've recently had Ovarian Cancer Awareness Month, and there was a billboard on College Road that was talking about symptoms of ovarian cancer. And I think the more that we can talk about these things and normalize them in just day to day conversation, the more likely someone is to speak up and say, actually, I think I need to talk to my doctor about my constipation or whatever it is that they're experiencing.

Host: How common are GYN cancers?

Dr. Lindsey Buckingham: Some are much more common than others. Endometrial cancer is the most common GYN cancer, and it's the fourth most common cancer in women in the United States. So it just fourth behind lung, colorectal, and breast cancer. Endometrial is number four. We see lots of endometrial cancer all across the United States.

It's the bread and butter kind of a GYN cancer. Ovarian, again, one that people really worry about is actually not very common. People without a genetic predisposition have a less than 1 percent risk of having an ovarian cancer in their lifetime. Cervical cancer, as we've hinted at, is directly tied to the HPV virus.

So someone without the HPV virus has a very low risk of a cervical cancer. That said, HPV is something that most of us will encounter at some point in our lifetimes. And if you have that virus, your risk for cervical cancer goes up. As long as you're getting follow up and being seen, we can very easily prevent cervical cancers.

It's when folks get out of care and don't follow up or can't follow up that we end up getting these cancers, vulva cancer, very rare. So, we don't see a lot of that.

Host: Dr. Buckingham, if you have endometriosis, does that mean you have endometrial cancer?

Dr. Lindsey Buckingham: It does not. Endometriosis is a benign problem that happens when the cells that line the uterine cavity and are part of your monthly period escape out into the belly and grow in there every month and cause bleeding in the belly every month. And so that's why it's so painful and causes a lot of scar tissue.

There are some cancers that have been described which are more common if you have had endometriosis. But there are far, far, far more people with endometriosis who don't have cancer than there are women diagnosed with cancers that started as endometriosis.

So, endometriosis is very common, very painful, uncomfortable, and something we do, I also sometimes end up treating, but not super closely linked to cancer.

Host: Is there anything else you'd like to add that you think women should know on this topic before we end?

Dr. Lindsey Buckingham: I would just say advocate for yourself. If something doesn't feel right and the first person you talk to doesn't feel like they're taking you seriously, find another person to listen to you or get yourself set up with a physician who will listen to you.

Host: Well, thank you so much for sharing your expertise. We so appreciate it. And I learned a lot for sure.

Dr. Lindsey Buckingham: Thanks. It was great to be here.

Host: Absolutely. Again, that's Dr. Lindsey Buckingham. And if you'd like to learn more, you can go to nh.team/cancer. And to find a physician, visit NovantHealth.org. For more health and wellness information from our experts, visit healthyheadlines.org. And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you.

I'm Maggie McKay. Thanks for listening to Meaningful Medicine, a podcast from Novant Health.