Access to clinical trials. A prestigious designation in minimally invasive surgery. A dedicated gynecologic tumor board. A revamped system that is changing the way patients recover from surgery.

Hoag offers an unrivaled level of expertise and sophistication for the prevention, diagnosis and treatment of gynecologic cancer. All five of Hoag’s gynecologic oncologists are leading experts in cancer treatment, and each is quick to point out that the rest of the medical team – the nurses, anesthesiologists, genetic counselors, social workers and nurse navigators – are the best in their fields.

“Being at a high-volume center is critical to the successful treatment of your cancer. And that’s what we offer here at Hoag,” said Alberto Mendivil, M.D., a gynecologic oncologist. “At the same time, ‘high volume’ does not mean ‘factory.’ While patients receive expert care, they also receive the benefits of personalized care that comes with being part of a community hospital.”

That nurturing community hospital approach is evident in some of the outreach programs by Hoag’s gynecologic oncology team. For example, Hoag is reaching out to pediatricians and parents to discuss a vaccine to prevent human papilloma virus (HPV), which is the cause of nearly all cervical cancer cases.

“We talk about ‘curing cancer’ but really prevention is so much more valuable,” said gynecologic oncologist Tiffany Beck, M.D. “The HPV vaccine is most effective before people become sexually active. We go out to the community to educate parents and pediatricians about the HPV vaccine and what it means to the future of these kids’ health.”

Hoag is also at the forefront of curtailing ovarian cancer, which kills about 14,000 women a year. By offering clinical trials to test possible therapies and a unique program to help women who are at high risk of developing the disease, Hoag is dedicated to finding better ways to treat cancer – and more effective ways to prevent cancer from developing.

“Because the medical community doesn’t have an effective screening test for ovarian cancer, by the time a cancer is diagnosed, it is usually at an advanced stage. To be able to identify this risk and prevent it from happening is a real gift,” said Lisa Abaid, M.D., co-director of gynecologic oncology for Hoag’s Breast & Ovarian Cancer Prevention Program.

In other areas of gynecologic cancer care, with the support of philanthropy, Hoag is bringing world-class medicine to a local setting. For instance, Hoag is involved in several clinical trials to provide the best and most advanced care for patients. And Hoag is a designated Center of Excellence in Minimally Invasive Gynecology (COEMIG™).

“Very few hospitals have received this designation, so for a community hospital this is particularly unique,” said John (Jeb) V. Brown, M.D., medical director of Hoag’s Gynecologic Robotics Program. “We have made minimally invasive robotic-assisted surgery a priority because it improves outcomes, reduces surgical risk and speeds up recovery time for our patients. They know that when they come here, they are being treated by teams who are dedicated to ensuring the best possible outcomes.”

Minimally invasive and robotic surgery techniques are particularly important for pregnant patients who are diagnosed with cancer, Dr. Mendivil said. Gynecologic cancers affect an estimated four to eight of every 100,000 pregnancies. Minimally invasive procedures have made it possible to treat these women without harming their unborn babies.

While robotic surgery has reduced recovery time, more could be done to help women back on their feet after surgery. Physicians in Europe have discovered that what patients do pre-operatively can determine how well they recover post-operatively. Hoag has brought Europe’s evidenced-based model to Orange County with the Enhanced Recovery After Surgery (ERAS) program.

Gone are the requirements that patients fast for extended hours before surgery. Patients are advised to quit smoking, improve their diet and increase their exercise before surgery. And instead of fasting for 12 hours, patients are asked to drink high-carb beverages up until three hours before surgery. All of these adjustments help them develop the strength they need to “perform” better after surgery.

“This is a fundamental shift from the way we used to do things,” Dr. Mendivil said. “Fasting is antiquated, and we have been proving that we shouldn’t follow that anymore. It inhibits the body’s own immune system.”

Of course, Hoag also does more than treat gynecologic cancer. Hoag’s multidisciplinary team takes a thorough and comprehensive approach to the management of complex benign pelvic conditions, as well as the full spectrum of gynecologic malignancies.

“Many disorders can lead to the formation of a pelvic mass, so it’s important to diagnose the cause of the mass to determine an appropriate treatment plan,” said gynecologic oncologist Kristina Mori, M.D. “What we offer at Hoag is the expertise and team approach to help patients reach the best possible outcomes.”

From Hoag Hospital, Newport Beach, Ca: https://www.hoag.org/about-hoag/news-publications/hoag-for-life/spring/2018/a-comprehensive-approach-to-gynecologic-cancer/#~z3i2k11

“The most effective cure for breast and ovarian cancer is prevention, so ‘prevention’ is prominent in our program’s name because that is our mission and our commitment to women who come to us for help,” said Lisa Abaid, M.D., who was recently named the co-director of gynecologic oncology for Hoag Breast & Ovarian Cancer Prevention Program.

Dr. Abaid, a gynecologic oncologist, joins breast surgical oncologist Heather Macdonald, M.D., medical director of the program, in developing and guiding treatment regimens tailored to “previvors,” women who have tested positive for a genetic mutation, like BRCA1 and BRCA2, which increases their risk for breast and/or ovarian cancer.

As a gynecologic oncologist, Dr. Abaid provides comprehensive services through the program to high-risk ovarian cancer patients, including pelvic exams, ultrasounds, screenings, surgery and medical management.

“Many of the women we help have watched their grandmothers, mothers, aunts, and sisters battle breast and ovarian cancers,” Dr. Macdonald said. “Dr. Abaid and I are here to let them know they can take steps right now to help prevent these frightening diseases from gaining a foothold in their lives. Early detection can be important in treating breast cancer, but because we don’t have tools to detect ovarian cancer early, it becomes critically important to do all we can to prevent ovarian cancer in the first place. The comprehensive resources for surveillance and prevention through Hoag’s program enable women to take action that gives them greater control over their lifelong good health. Many of these steps include lifestyle choices which are an integral part of this program.”

With the help of donor support, Hoag Breast & Ovarian Cancer Prevention Program helps women reduce their risk for cancer by increasing surveillance, offering chemoprevention, surgical prevention and holistic guidance for the entire woman – mind, body and soul. Once a woman has tested positive for a genetic mutation that increases her risk for breast or ovarian cancer, she is followed with more regular screenings and medical management, as well as access to a multidisciplinary team of experts in meditation, fitness, nutrition and sexual and mental health.

“Our goal with this program was to establish a one-stop-shop for women who have been identified as high risk,” Dr. Abaid explained. “Most of our patients are young women juggling busy lives involving work and family responsibilities, so it was important for us to design the program to provide them convenient, streamlined access to the services and screenings they need, in a central community location.”

From Hoag Hospital, Newport Beach, Ca: https://www.hoag.org/about-hoag/news-publications/hoag-for-life/spring/2018/supporting-previvors-of-breast-ovarian-cancer/#~o8O6a11

Many people think eradicating cancer is an unattainable goal. But for cervical cancer, we are well on our way to doing just that.

Cervical cancer was once the leading cause of death in women in the U.S. But we are on the cusp of vanquishing this disease thanks to regular Pap screening and a vaccine that protects women and men from developing the human papilloma virus (HPV), the cause of nearly all cervical cancers.

In fact, over the last 40 years, the number of new cases and deaths from cervical cancers has plummeted. The disease that once claimed the lives of more women than any other disease is now largely preventable.

But an important element to the story of cervical cancer is that it is up to all of us — especially parents of pre-teens — to do the work of prevention.

The U.S. is lagging behind other countries in reducing HPV-related cancers because the most effective time to vaccinate is well before a person becomes sexually active, usually around ages 11 and 12.

Talking about sex with a pre-teen is hard enough; preparing for the fact that one day your child will be a sexually active adult can be terrifying. Pediatricians tell me that many parents believe that vaccinating their children against an STD will somehow encourage sexual behavior. While pediatricians in the community are doing a good job educating parents, the idea of vaccinating against an STD still doesn’t sit well with parents.

What is important to remember is that the vaccine isn’t a license to have sex — it is a protection against a common and sometimes fatal disease later in your child’s life.

Some pediatricians have told me that parents will ask whether their children can wait until they are in their early 20s to be vaccinated. The short answer is, “Please don’t.” Younger children have a more robust immune response. At the age of 9 to 15, children develop higher antibody levels after the vaccine than 16- to 26-year-olds do.

Parents also ask whether boys need to be vaccinated, since they are obviously not at risk of developing cervical cancer. To protect against the spread of HPV, both boys and girls should be vaccinated. Also, HPV increases the risk of cancers that do affect men, including penile, anal and throat cancers.

Even if a woman and her partner have been vaccinated, she can further reduce her risk of developing cervical cancer by undergoing routine pelvic exams, including pap smears. If a pap smear is abnormal, meaning there is some evidence of cancerous or pre-cancerous cells, a gynecologic oncologist, in collaboration with a woman’s gynecologist, can provide the appropriate monitoring or procedure to reduce the likelihood of cervical cancer from developing.

As excellent as cancer treatments are these days, no treatment in the world can outperform prevention. And what we’ve learned from the past 10 years is that the HPV vaccines, if delivered effectively, should be able to eradicate HPV-related diseases completely in our children’s lifetime.

No, we haven’t cured cervical cancer. But with the vaccine, we literally have a shot at preventing it.

From The Los Angeles Times: http://www.latimes.com/socal/daily-pilot/opinion/tn-dpt-me-commentary-20180205-story.html

One of the most unsettling aspects of cancer is the unknown.

There is the unknown of what is in store for you if you receive a diagnosis of cancer. But on a larger scale, we all live with the uncertainty of whether we’re going to develop cancer in our lifetimes.

That is why I view the diagnosis of genetic predisposition as something of a gift. If recognized early by genetic testing, knowing that your genes predispose you to developing certain cancers can be incredibly empowering.

As a gynecologic oncologist, I know that my patients often don’t share my view — not at first. But I have watched how with education and planning, many come to see that the more information a woman has about her health the more power she has to take control of it.

The uncertain “What if?” gives way to the confident “Not on my watch.”

By knowing what to look for and taking the appropriate steps, women whose genes predispose them to breast and ovarian cancer, for instance, can proactively work to keep those cancers at bay.

As the co-director of Gynecologic Oncology Hoag’s Breast & Ovarian Cancer Prevention Program, I encourage women to talk with their doctors about their family history to determine if genetic screening and counseling is appropriate for them.

Women with a strong family history could be eligible for genetic screening to see if they carry the BRCA1 or BRCA2 genes, which are associated with breast and ovarian cancers. These genes are responsible for about 15% of all ovarian cancers, which makes them an important road map for women and their doctors.

Ovarian cancer ranks fifth in cancer deaths among women, accounting for more deaths than any other cancer of the female reproductive system. It can be an insidious disease that often has no symptoms in its earliest stages.

Because we don’t have an effective screening test for ovarian cancer, by the time a cancer is diagnosed, it is usually at an advanced stage. This means that knowing you have a genetic predisposition can serve as a red flag, instead of a possible death sentence. It’s a gift to be able to identify this risk and be proactive, rather than reactive.

But having these genes and knowing that you have them are two different things. The knowledge about genetic predisposition becomes powerful only when women use it as a jumping off point, educating themselves about the tools they have to assess their cancer risk and prevent the disease from developing.

For instance, I see women at high risk for ovarian cancer for pelvic exams, ultrasounds, screenings, surgery and medical management as part of Hoag’s program. By knowing what to look for and taking preventative actions, such as an oophorectomy (removal of the ovaries), we can nearly eliminate the chances that a deadly cancer will develop.

In addition to negating ovarian cancer risk in women who have the BRCA1 or BRCA2 genes, prophylactic ovarian removal can also lower the risk of breast cancer by up to 50%.

One of the most unsettling aspects of cancer is the unknown. By identifying the hidden warning signs in their genes, many women have the ability to alleviate that dread and turn knowledge into action.

From The Los Angeles Times: http://www.latimes.com/socal/daily-pilot/opinion/tn-dpt-me-commentary-genes-20180705-story.html?utm_medium=social&utm_campaign=hoag-in-the-news&utm_source=facebook&utm_content=genetic-screening-abaid