Advancing Prevention and Genetic Testing Methods in Uterine Cancer

CancerNetwork® spoke with Ginger J. Gardner, MD, FACOG, physician lead in the Gynecology Disease Management Team Alliance and vice chair of Hospital Operations in the Department of Surgery at Memorial Sloan Kettering Cancer Center and chair of the board for the Foundation for Women’s Cancer, about unmet needs in the gynecologic cancer field, encompassing both uterine cancer mortality—specifically among Black women—and utilizing genetic testing to aid in the prevention of numerous disease states.

Gardner began by introducing endometrial cancer, the most common type of uterine cancer, as one of the greatest challenges presented for gynecologic cancers. She explained that uterine cancer incidence was increasing, particularly among Black women, highlighting a doubled mortality rate among this patient population compared with other populations.

Gardner additionally identified genetic testing as an unmet need, particularly as it related to its use in preventative treatment measures. She further explained that testing has moved beyond BRCA mutations and has additionally encompassed testing for mismatch repair protein and lynch syndrome, both of which test for ovarian and uterine cancer risks.

Transcript:

One of the largest challenges that we face among gynecologic cancers is the data that we are seeing about uterine cancer. Specifically, I am talking about the most common type of uterine cancer, which is endometrial cancer, cancer of the lining of the uterus. Unfortunately, we are, in this country, seeing an increasing incidence of uterine cancers. Not only that, we are seeing a mortality rate that is twofold higher among Black women in this country compared with all other populations. This is an unmet need.

Fortunately, with advancements in cancer screening and treatment for a variety of other diseases, we are seeing some reduction in incidence and some improved outcomes. For uterine cancer, we have a call to action. We have an unmet need to increase awareness and drive forward the science related to prevention and effective treatments across all subtypes of uterine cancer, and specifically endometrial [cancer].

In addition, I think there is a recognition that we need to advance the opportunity for genetic testing, and I am talking about large-scale [testing] for all populations at risk. Thanks to the great work of many in the field and our colleagues in genetics, we recognize that genetic testing for gynecologic cancers has moved beyond BRCA. First on the scene in the hallmark of gynecologic cancer screening for many patients is a conversation about BRCA-related risk and screening and testing for BRCA mutations.

However, we recognize that the mismatch repair protein screening and lynch syndrome confers an elevated risk for both uterine and ovarian cancers, and we recognize the growing body of knowledge related to moderate penetrance genes that are associated with an elevated ovarian cancer risk. By that, I am talking about RAD51C, RAD51D, RIP1, and LB2. There is a growing body of information related to additional genetic determinants that, if screened and identified, can provide an opportunity for preventative action for many patients.

There is an unmet need to raise that public discourse and awareness about genetic testing and to carry it forward and keep up the public awareness piece commensurate with what our scientific investigators are discovering related to a broader opportunity for genetic testing and disease prevention for gynecologic cancers.