Despite Great Strides, Much Work Remains in GYN Cancer Outcomes and Care

Ginger J. Gardner, MD, FACOG

Memorial Sloan Kettering Cancer Center

Foundation for Women's Cancer

Every 5 minutes, another patient in the United States is diagnosed with a gynecologic malignancy, totaling nearly 115,000 new patients annually in the country and 1 million new patients worldwide, explained Ginger J. Gardner, MD, FACOG.

Gardner, a gynecologic surgeon at Memorial Sloan Kettering Cancer Center, as well as the chair of the board for the Foundation for Women's Cancer (FWC), said that it’s because of these numbers that the field needs to level up on raising awareness, empowering research for, and creating innovative solutions in gynecologic treatment and outcomes.

These staggering statistics have led to waves of clinical research with novel therapies and surgical techniques, ultimately transforming the field into one with improved outcomes.

“We are at an exciting time when we think about the position that we're in in gynecologic cancers and the opportunity for patients to gain access to exciting new drug development that can empower a promising future for their clinical outcome,” Gardner said. “That is a dynamic space.”

That being said, more work still needs to be done.

In an interview with CancerNetwork^®, Gardner spoke to the unmet needs that exist in gynecologic cancer, highlighting the progress that has been made, and pointed to where research needs to focus next.

CancerNetwork: You are passionate about the need for more research and advocacy for patients with gynecologic cancers. What drives you in the gynecologic cancer field, and where does that come from?

Gardner: Gynecologic cancers are, in some situations, on the rise in this country. The reality is, that every 5 minutes, another patient in this country is diagnosed with 1 of the 5 gynecologic cancers. We're talking about uterine cancer, ovarian cancer, cervical, vaginal, and vulva cancer. That totals approximately 115,000 new patients each year and 1 million worldwide. An important topic for all of us to talk about is: where are we in terms of raising awareness about the 5 gynecologic cancers? Where can we empower research and support funding to create new solutions for the disease prevention and treatment of gynecologic cancers? How do we promote everyday conversation about gynecologic cancers across all physicians, allied health members, patients, and communities?

The reason is in the numbers. As a gynecologic oncologist, I’m a bit of a biased audience. This is so important that I’ve dedicated my work with patients to this important cause, and yet I’ve taken on the role to advance this conversation at a national and global level through the FWC, so that we can empower research, education, and awareness about gynecologic cancers.

What are the biggest unmet needs that we’re not addressing in the gynecologic cancer field, but we should?

One of the largest challenges that we face among gynecologic cancers is the data that we’re seeing about uterine cancer. Specifically, I’m talking about the most common type of uterine cancer, which is endometrial cancer—cancer of the lining of the uterus.

Unfortunately, in this country, we are seeing an increasing incidence of uterine cancers. Not only that, but we’re seeing a mortality rate that’s two-fold higher among Black women in this country compared with all other populations. This is an unmet need. With advancements in cancer screening and treatment for a variety of other diseases, we’re seeing, fortunately, some reduction in incidents 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 the subtypes of uterine cancer, specifically endometrial.

In addition, there’s a recognition that we need to advance the opportunity for genetic testing. I’m talking about large scale 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. Certainly, 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 the Lynch syndrome catchment confer 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’m talking about RAD51C, RAD51D, PALB2—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 so 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.

[Finally, regarding] cervical cancer: the expanded FDA approval for HPV [human papillomavirus] vaccine for disease prevention is now for women in their 40s. While originally approved for women up to age 26, there has been expanded approval for preventative HPV vaccination for women in the subsequent decades, and the importance of PAP smear screening and regular gynecologic exams for patients who may be at risk for some of your lower genital tract cancers.

What is the mission of FWC? Is there anything would like to highlight about it—perhaps the fundraising efforts you are spearheading?

I’m very honored to serve as the chair for the FWC; we are the foundation of the Society of Gynecological Oncology [SGO]. As a gynecologic oncologist, our scientific home is SGO, and the FWC is our outward-facing arm—our public-facing presence to raise awareness, and patient education, and empower research for gynecologic cancers. Our mission as the FWC is to eradicate gynecologic cancers and to do so is so that everyone thrives—our patients, our scientists, our researchers, our gynecologic oncology providers. This is a team effort, and we all need to work together to deliver on that mission.

The FWC was established over 33 years ago now, and all our programming centers on empowering and supporting research, improving and making accessible patient education, and raising awareness about the 5 gynecologic cancers. We celebrated Gynecologic Cancer Awareness Month in September; we certainly come together for Cervical Cancer Awareness Month in January, and Uterine Cancer Awareness Month in June.

In my opinion, this needs to be an everyday conversation. For Gynecologic Cancer Awareness Month in September, we rallied together with our allied health providers, our nurse practitioners, and physician assistants. In Charlotte, North Carolina, we led an incredible walk through the greenways of Charlotte and had wonderful hosts from Atrium Health, Drs Wendel Naumann and Jubilee Brown, who were out to cheer and support. We had a beautiful community event to raise awareness about the 5 gynecologic cancers, and to help support research and raise funds so that we can find new solutions and empower the future for all patients to either not even have these diseases to begin with or if diagnosed, to be able to have cutting-edge treatments and move towards a cure.

What clinical trials are you either working on now or that you’re excited about in gynecologic cancers?

In gynecologic cancers, it’s a complex space across all 5 of the primary tumor types. Then within each of those, we have subset sub-diagnoses in terms of individual histologic subtypes and molecular characterization of many of these tumors that we treat. It is hard to parse out 1 single trial at the exclusion of all others, but we are fortunately seeing a groundswell of increasing availability of clinical trials for gynecologic cancers; this includes opportunities for disease prevention. I’m thinking about the phase 2 WISP [Women Choosing Surgical Prevention] trial [NCT02760849] and the TUBA-WISP II trial [NCT04294927] that are looking at risk-reducing salpingostomy with delayed oophorectomy for those identified at risk for ovarian, tubal, and peritoneal malignancies. I’m thinking of the groundswell and escalation of therapeutic trials across several of our gynecologic cancers, and this includes targeted therapies, immunotherapies, PARP inhibitors, and antiangiogenic agents.

I would also like to highlight the fact that across the clinical trials for gynecologic cancers, we’re focused on surgical innovation, and we are also focused on gaps in care. You asked previously: what are the gaps in care for gynecologic cancers? Those statistics about uterine cancer and reaching out to unmet populations and historically disadvantaged and marginalized communities are important. We have made a major effort on this through the FWC to provide outreach to communities by going to the State Fair of Illinois, going to community events where you might not expect a gynecologic cancer specialist to show up, reaching into the community, to move the message about gynecologic cancers amongst historically marginalized communities, and everyone can gain access through the FWC website.

There are brochures that are patient-facing, brochures about gynecologic anatomy, fast facts about rare tumor types, information about staging, about all the gynecologic cancers, disease prevention, and treatment options. We have videos about clinical trials, debunking the myth about what is placebo vs active treatment, and helping patients overcome what can be barriers to clinical trial enrollment.

We have all these patient education resources available in multiple languages with a fresh face, multi-dimensional, and multicultural accessibility. For the FWC homepage, one can access a whole portfolio of patient education materials that can help onboard patients about their opportunities for disease prevention, opportunities about treatment, and leverage the opportunity for enrollment in clinical trials.

A newer surgical technique in the field is uterine transposition. Could you speak on this and any experience you have seen with it?

It is such an exciting topic; I have to give credit to SGO. It was several years ago now that during our surgical session, we had an invited speaker from Brazil who shared an innovative approach to uterine transposition. This is one of these interesting areas where it’s a gynecologic procedure but can harmonize to gain benefit across other tumor types. I’m talking specifically about patients with colorectal cancer; we see a rise in diagnosis in young patients diagnosed with colorectal cancer, many of whom require radiation as a component of primary treatment.

For their gynecologic future, we recognize that those doses of radiation treatment delivered to the pelvis will cause dysfunction and ablation of ovarian function as well as future uterine function. For those young patients [who] desire future fertility, it creates a great challenge.

The invited guests to the SGO from Brazil presented an innovative concept of performing not just ovarian transposition to lift the ovary away from the radiation field but also lifting the uterus with attached tubes and ovaries up and away from the radiation field prior to the delivery of pelvic radiation.

Then, subsequent to the radiation treatment delivery, the uterus with attached tubes and ovary is reattached to the upper vagina with reconstruction in that location to thereby preserve menstrual, ovarian, and hopefully future fertility of the transposed organs back to their in situ and normal anatomic location after radiation. It is an exciting concept.

I will highlight some of our own team members here at Memorial Sloan Kettering Cancer Center, Drs Mario Leitao and Jennifer Mueller, who have taken on this opportunity to look at this technique here in New York and are seeing some exciting results, including the first live birth here in New York from a successfully transposed uterus. We are in an exciting time.

This is but one opportunity where those of us in the gynecologic cancer specialty can harmonize with our colleagues across the other cancer specialties to look at opportunities to drive meaningful improvement, not only in oncologic outcomes but in quality-of-life outcomes such as preservation of future fertility for the young [patient with] colorectal cancer.

The other important element that this topic underscores is the importance of surgical innovation. We have such an exciting opportunity with enhanced technology, forward-thinking providers, and surgeons at the table, in [connection] with our talented medical and radiation oncologists, to drive forward the best in cancer care. We must always be thinking out of the box and looking for innovations that can make a meaningful impact for all patients.

What are some of the biggest advances in gynecologic cancers so far this year? What are you excited about that is to come in 2025?

We are seeing some impact in improvement for gynecologic cancers with innovation in many of our disciplines; that includes disease prevention and innovative modalities related to treatment, inclusive of surgical innovation, new targeted therapies, refining radiation treatment, and ultimately patient-reported outcomes.

We need to keep our eye on the ball for where we’re going next. We have a call to action for gynecologic cancers. I [wear] purple for all gynecologic cancer awareness, and people are like, "What’s with the purple?"

It’s a complex space to work in gynecologic health and gynecologic cancers, because of the tumor types and the cell types, and what I’m excited about is some of the uncovering of the underlying tumor biology and molecular heterogeneity of the diseases we treat, because that informs us in terms of how we can capitalize on that expanding knowledge base to design the best treatments for our patient outcome.

It is hard to dial it into just 1 or 2 snapshots, but I am so thankful that we have this time together to talk about the importance of gynecologic health awareness and research because it is important that we raise this conversation.