Continuity Of Care For Women

By Dr. Michael Carney
Interviewed by Melissa Moniz
Wednesday - April 29, 2009
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Dr. Michael Carney
Gynecologic Oncology and Medical Director of Kapiolani’s Women Cancer Center

Interviewed by Melissa Moniz

Can you discuss gyneco-logic oncology and what that entails?

After finishing up my OBGYN schooling, I chose to sub-specialize in cancer. So I don’t do OBGYN at all anymore. A gynecologic oncologist is a unique specialty because it’s the only specialty in medicine that diagnoses, does surgery, does chemotherapy and follows patients to cure or to the end. So we’re trained do all the surgery and all the chemotherapy. It’s continuity of care, and it’s good for patients because they stay with one service. It’s a great specialty.

What makes the Women’s Cancer Center such a unique and beneficial place for women?

When I came here to Hawaii there wasn’t a place you could go for coordinated care for women’s cancer. When I decided to come here to Kapiolani and the University of Hawaii, I was eager to help try to make something great. So we got the space and designed it to make it comfortable for patients. And we have absolutely wonderful people working here. Not only do we have the facility, we also have the research that goes along with it. I’ve opened up many GOG trials (which is the National Cancer Institute’s arm of research trials for women with cancer) through the Cancer Research Center of Hawaii. I’m the principal investigator here in Hawaii for the GOG.

I sit on the ovarian committee in that group, so we work to identify new trials, new drugs, and for a while that wasn’t available in Hawaii. I think a lot of people think you need to go to the Mainland to get good cancer care. What I say now is you can get equal, if not better care here in Hawaii than you can on the Mainland because we’re as good and even better than some places on the Mainland. We have the trials and the facility that are second to none here. The Women’s Cancer Center at Kapiolani has comfort and wonderful staff and a vision of taking nothing but excellent care of patients. In creating this place I wanted windows, and if you walk around here, you’ll notice light. I didn’t want people to see this as a place for people to be afraid. I think light has so much to do with the healing.

What are the most common cancers that you see and treat here?

Endometrial cancer, cancer of the lining of the womb, is the No. 1 gynecologic cancer that I see here. It’s very curable if we catch it early. We have to do extensive surgery for that, and if it does spread then we have to do chemotherapy and sometimes radiation.

I also see ovarian cancer, too much, which is the deadliest gynecological cancer. A lot of the ovarian cancer patients get the cancer, then have chemotherapy, get into remission and then it comes back. We have to do more chemotherapy, maybe surgery. So this cycle happens many times sometimes. So I see plenty of those patients.

And we also see a lot of cervical cancer. Cervical cancer is caused by the HPV virus, which a new vaccine is trying to prevent. Many times we can catch it early and cure it. We get many patients from the Marshall Islands, Micronesia, Guam and other places in the Pacific where they don’t have the benefit of screening for cervical cancer, so many times they come here in a more advanced stage. And it’s much harder to treat those patients.

Dr. Michael Carney checking the chemotherapy infusion of patient Jane Kunishige

You mentioned early detection. Can you briefly explain when women should be getting screened for each type of cancer?

The good news is that of all the cancers I see, the one that needs to be screened for most is cervical cancer. So all women need to get their regular yearly pap smears and see their OBGYN or family doctor for this. And for the younger folks (9 to 26 years old) we can give a vaccine and prevent many cervical cancers. We have a remarkable track record of screening for this cancer. Back in 1940, cervical cancer was the No. 1 cancer in America for women, and it continues to be the No. 1 cause of death for women in Third World countries. So screening has come a long way. A lot of the people who get cervical cancers aren’t seeing their OBGYN regularly. It’s important to go every year for an exam. The flip side of that excellent screening is ovarian cancer, where we don’t have a good screening test. It’s the dead-liest cancer we have. There’s a blood test called CA-125 that we tried to see if it could be a screening test because it does correlate with cancer in many of our ovarian cancer patients, but it turns out not to be a good screening test. It’s just not sensitive enough. So we thought, we could use ultrasound, but we ended up finding too many growths on the ovaries that aren’t cancer, but require us to go in and do surgery. So we’re struggling right now to find better screening methods and we’ll get there. We can’t just sit tight and only focus on the clinical treatment. We need to keep active in our own research here in Hawaii.

Because you mentioned that there’s no good screening test for ovarian cancer, what are early symptoms that women should be aware of?

We used to think there were no symptoms. We called it the silent killer, but as we’ve done some research we’ve found that most people do have some symptoms beforehand. But it’s just that the symptoms are so subtle. They may have trouble eating a little, or a little pain, or it feels like a urinary tract infection. So these are very subtle. Fatigue - well who isn’t fatigued? So yeah, people have symptoms, but to tie those symptoms to a cancer is very tough to do. But if you have pain in your abdomen or pelvis then you need to have an examination of your abdomen or pelvis, which means a pelvic exam.

How much can a woman control preventing these types of cancer, in regard to diet, exercise and other environmental factors?

Very little. Certain cancers are pretty directly related to environmental factors. For example, melanoma is directly related to the sun, so that’s an environmental factor. Smoking is directly related to lung cancer. But when you talk about gynecologic cancers, for example, the environmental factor associated with cervical cancer is the HPV virus. If you don’t have intercourse you won’t get the HPV virus. And the HPV virus is not treatable. The idea of the vaccine is to keep the virus from taking hold and affecting the cervix.

In endometrial cancer, about 20 percent we don’t know what causes it. But about 80 percent is related to estrogen exposure. In this country one of the biggest causes of excess estrogen exposure is obesity. Fat cells produce estrogen, and as our population gets fatter and fatter, we are seeing more and more endometrial cancer because it’s a direct correlation.

For ovarian cancer, there are very few identifiable risk factors. Some things can protect you though. We’ve worked on a very important study and we presented this just recently at a national meeting. Taking birth control pills will reduce your risk of ovarian cancer up to 60 percent. So there are things we can do. But aside from that, there are very few things.

About 10 percent of ovarian cancer and breast cancer is related to heredity. There’s a gene that can be passed on through families and that pre-disposes you to a risk BRCA-1 and BRCA-2. The good news that if there is a family history, we can check your blood to see if you’re a carrier. And if you are a carrier, then we can intervene early, either with medication or more intensive screening or even prophylactic surgery.

The Women’s Cancer Center has a Mamma Mia! opening night benefit fundraiser scheduled on May 12 at the Blaisdell. Can you talk more about that?

One of our patients, Elissa Josephsohn, is so set on giving back to this cancer center. She’s working with the production and arranged for the opening night show to be a fundraiser for Kapiolani. We are enormously grateful because every little bit helps. None of this can be done without adequate funding.

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