Talking various aspects of gynecologic cancers with Dr. Jordan Mattson

May is National Women's Health Awareness Month. This month we sat down with Dr. Jordan Mattson, gynecologic oncologist at the University of Minnesota, to chat about an array of topics, including the various types of gynecologic cancers, current options for screening and detection, and health disparities. Dr. Mattson is the special expert guest at our next Fireside Chat, happening May 15! 

Could you give us a brief background on your education, what intrigued you about your field of specialty, and what brought you to the University of Minnesota?

Having grown up just 45 minutes north of the Twin Cities, I embarked on my academic journey at the University of Minnesota, where I pursued a degree in biomedical engineering. After that, I ventured to West Virginia University for medical school and the University of Iowa for residency, only to find my way back home to the University of Minnesota for my Gynecologic Oncology fellowship and current position as an attending physician. The dynamic and ever-evolving nature of gynecologic oncology has always captivated me, driving my passion for this field. What sets gynecologic oncology apart is the opportunity it provides to deliver comprehensive care to patients, overseeing their entire treatment journey from surgery to chemotherapy. I firmly believe that this holistic approach leads to superior patient care, by addressing both the individual and their cancer treatment as a unified entity. It is this patient-centered approach that inspired me to pursue a career as a gynecologic oncologist.

What are gynecologic cancers and how are they typically diagnosed?

Gynecologic cancers are cancers that originate in the female reproductive system, including the cervix, ovaries, uterus, fallopian tubes, vulva, and vagina. Each type of gynecologic cancer has its own set of risk factors, symptoms, and treatment options. 

Below is a breakdown of how each gynecologic cancer is typically diagnosed:

• Cervical Cancer: Diagnosed through a combination of a Pap test (Pap smear) to detect abnormal cells on the cervix and an HPV test to identify high-risk strains of human papillomavirus (HPV). If abnormalities are found, a colposcopy (a visual examination of the cervix) and biopsy may be performed for further evaluation. Some women present with abnormal vaginal bleeding or pelvic pain. Imaging tests like CT scans, MRI, or PET scans may be used to determine the extent of the cancer.
• Ovarian Cancer: Diagnosis often occurs after disease has spread. Common symptoms include nausea, early satiety (a feeling of fullness lasting beyond hunger and into the next meal), and abdominal bloating. Ovarian masses can sometimes be found incidentally during a pelvic exam or imaging for another problem. If an ovarian mass is found, then a transvaginal ultrasound and blood tests, such as the CA-125 test, are typically performed to determine concern for malignancy. If the pelvic mass has a concerning appearance or CA-125 levels are elevated, further imaging studies (like CT scans or MRIs), surgery, or a biopsy may be performed for confirmation.
• Uterine (Endometrial) Cancer: Endometrial cancer is often found at early stages when a woman presents to her doctor with post-menopausal bleeding. Pre-menopausal women can also present with irregular bleeding. When this occurs, a transvaginal ultrasound is performed and an endometrial biopsy is obtained, where a sample of tissue from the lining of the uterus is taken and examined under a microscope. Occasionally, a more invasive procedure called a hysteroscopy, which looks inside the uterus with a camera for a directed biopsy, is performed. Imaging tests like transvaginal ultrasound, MRI, or CT scans may also be used to evaluate the extent of the cancer.
• Fallopian Tube Cancer:  There are no routine screening tests for fallopian tube cancer. Diagnosis usually occurs when symptoms arise or during surgery for another condition.
• Vulvar Cancer: Diagnosed through physical examination of the vulva for any abnormal lesions or growths. If suspicious areas are found, a biopsy is performed to examine the tissue under a microscope. Imaging tests like CT scans, MRI, or PET scans may be used to determine the extent of the cancer.
• Vaginal Cancer: Diagnosis involves a physical examination of the vagina for abnormalities. Biopsy is performed if suspicious lesions are found, and the tissue sample is examined under a microscope. Imaging tests like CT scans, MRI scans, or PET scans may be used to assess the extent of the cancer.

In summary, diagnosis of gynecologic cancers typically involves a combination of screening tests, physical exams, imaging studies, and biopsies to confirm the presence of cancer and determine its extent. Early detection is crucial for effective treatment and improved outcomes.

What preventative measures can people take to lower their risk against gynecologic cancers?

Preventative measures against gynecologic cancers involve a combination of lifestyle choices and medical interventions. Here are some strategies:

• Regular screening: Regular screening tests such as Pap smears, HPV tests, and pelvic exams can detect abnormalities early when they are more treatable.
• HPV vaccination: Human papillomavirus (HPV) vaccination can protect against certain strains of HPV that can cause cervical, vaginal, vulvar, and anal cancers. It's most effective when given before becoming sexually active.
• Safe sex practices: Practicing safe sex by using condoms can reduce the risk of contracting sexually transmitted infections (STIs) like HPV, which is a major risk factor for cervical cancer.
• Healthy diet: Consuming a balanced diet rich in fruits, vegetables, whole grains, and lean proteins can help maintain a healthy weight and reduce the risk of obesity-related cancers.
• Regular exercise: Engaging in regular physical activity can help maintain a healthy weight and reduce the risk of certain cancers, including endometrial cancer.
• Limiting alcohol: Limiting alcohol consumption can reduce the risk of developing certain cancers, including breast and ovarian cancer.
• Avoiding smoking: Smoking increases the risk of many cancers, including cervical and vulvar cancer. Quitting smoking can significantly reduce this risk.
• Family history and genetic testing: Knowing your family history of cancer can help determine if you have an increased risk. Genetic counseling and testing can identify mutations that increase the risk of certain cancers, such as BRCA mutations associated with breast and ovarian cancers.
• Maintaining a healthy weight: Being overweight or obese increases the risk of several types of cancer, including endometrial, ovarian, and cervical cancer. Maintaining a healthy weight through diet and exercise can reduce this risk.
• Regular health check-ups: Regular visits to your healthcare provider can help detect any abnormalities early and provide opportunities for discussing cancer prevention strategies.

By incorporating these preventive measures into their lifestyle, individuals can lower their risk of developing gynecologic cancers and improve their overall health and well-being.

What health disparities exist in regards to gynecologic cancers? 

Health disparities in gynecologic cancers refer to differences in disease incidence, treatment outcomes, and survival rates among different population groups. These disparities can be influenced by various factors, including socioeconomic status, race/ethnicity, geographic location, access to healthcare, cultural beliefs, and health behaviors. Here are some key disparities observed in gynecologic cancers:

• Access to screening and early detection: Socioeconomically disadvantaged individuals and those from marginalized communities may have limited access to healthcare services, including screening tests such as Pap smears and HPV tests. Lack of access to preventive care can lead to late-stage diagnosis and poorer outcomes.
• Incidence and mortality rates: Certain racial and ethnic groups, such as African American and Hispanic women, have been found to have higher incidence rates and lower survival rates for gynecologic cancers compared to non-Hispanic white women. Factors contributing to these disparities may include differences in healthcare access, socioeconomic status, and cultural beliefs.
• Quality of care: Disparities in the quality of care received by women with gynecologic cancers can arise due to factors such as insurance status, geographic location, and provider biases. Women from underserved communities may receive suboptimal treatment, leading to worse outcomes.
• Genetic risk assessment and counseling: Access to genetic testing and counseling for hereditary gynecologic cancers, such as BRCA mutations associated with ovarian and breast cancers, may be limited for certain populations, impacting their ability to make informed decisions about risk reduction and screening.
• Clinical trial participation: Minority populations are often underrepresented in clinical trials for gynecologic cancers, which can limit the generalization of research findings and potentially lead to disparities in access to innovative treatments and therapies.
• Cultural and linguistic barriers: Language barriers, cultural beliefs, and mistrust of the healthcare system can hinder effective communication between patients and providers, impacting treatment adherence, follow-up care, and health outcomes.

Addressing these disparities requires a multifaceted approach that involves improving access to healthcare services, increasing health education and awareness, promoting culturally competent care, reducing barriers to screening and treatment, and addressing social determinants of health such as poverty and discrimination. Efforts to eliminate health disparities in gynecologic cancers should prioritize equity and inclusivity in healthcare delivery and research.

How is your research at the Masonic Cancer Center advancing understanding of gynecologic cancers and how we prevent/diagnose/treat them?

I will be opening a couple of clinical trials soon at the cancer center. I also hope to bring the clinical trials offered at the university to more women in rural Minnesota.