[00:00:00] Hey listeners, I'm Sneaky in one more episode, A Bonus if you like. Overlooked is a podcast
[00:00:10] about ovarian cancer but the overies themselves have become even more fascinating to me in
[00:00:15] the course of writing this series. So this is a conversation that goes into ovarian cancer
[00:00:21] and beyond it.
[00:00:23] I think we only really in the last 23 years come to realize how important the overies are.
[00:00:30] This is Dr. Diane Miller. She was the head of gynecologic oncology at the University of British
[00:00:36] Columbia. She's retired now but has had a long and distinguished career.
[00:00:41] When I was a resident, I remember being told well you know if she's having surgery after age 45
[00:00:47] you should recommend her overies come out. Well clearly in retrospect that was absolutely horrible.
[00:00:53] But it reflects a attitude that we had towards the overies, that they were only important for
[00:00:59] making eggs and babies. Dr. Miller's team in British Columbia is credited with really moving
[00:01:06] the needle in ovarian cancer including identifying that an opportunistic self-injectomy which is
[00:01:13] a removal of your full open tubes could prevent ovarian cancer. You can read more about this on the
[00:01:19] website. In this conversation I talked to Dr. Miller about some of the questions I've been
[00:01:25] wondering about all along like why are the overies still so mysterious to us and how come we don't
[00:01:32] talk about ovarian health? Here's Dr. Diane Miller. Dr. Miller thank you so much for joining me
[00:01:45] and having this conversation. The overies are the great right of outsized importance in our
[00:01:53] overall health as well but so you know if you disagree with the statement I'm about to say I'd
[00:01:59] love to hear it, but we don't talk about ovarian health. We talk about breast health and we talk
[00:02:05] about reproductive health broadly. You have to really talk to someone for a long time for the
[00:02:10] the term ovarian health to come up and I don't think that in my conversations with my friends
[00:02:16] in general when we're talking about our health and you know we're all heading into our our 50s or
[00:02:21] already there ovarian health doesn't come up. Do you agree with that like we don't talk about ovarian
[00:02:26] health and should we? You know we don't and one of the things that I think people need to know is
[00:02:34] birth to death. Women are healthier and live longer than men and to a large part that's due to our
[00:02:44] hormonal milieu created by our ovaries right? And there are studies out there that show if you have
[00:02:51] your ovaries removed prematurely that you lose some of those benefits so I think the first problem is
[00:02:59] we've medically and with no malice of forethought. We've had a very glottied attitude towards ovaries
[00:03:08] and when I started when I was a resident I remember being told well you know if she's having surgery
[00:03:14] after age 45 you should recommend her ovaries come out between 40 to 45 you should discuss it. Well
[00:03:20] clearly in retrospect that was absolutely horrible but it reflects a attitude that we had
[00:03:28] towards the ovaries that they were only important for making eggs and babies right? And I think
[00:03:34] science has come a long way since then and we know that they are very important for a large number
[00:03:39] of things. With regard to ovarian health you know a lot of the breast health stuff and you know
[00:03:47] cervical health etc is packaged around screening making sure that there's no pathology going on
[00:03:53] etc. I know that you're aware that the big screening study out of the UK has shown that we can't
[00:03:59] screened the ovaries for malignancy. We can certainly screen them for their hormonal function
[00:04:05] etc and and a lot of that does go on women who have hormonal abnormalities like polycystic
[00:04:11] ovarian disease would be the most common one or infertility etc. There's a lot of things that people
[00:04:17] can do to look at the reproductive health of the ovaries but I guess they basically do it themselves
[00:04:25] the ovaries like they're pretty good and the other thing is to recognize that you know there are
[00:04:30] hormone producing gland basically right? And they're in harmony with all of the other hormone
[00:04:38] producing glands in our body. They're part of our endocrine system and they function in general
[00:04:45] very well. I think we only really in the last 23 years come to realize how important the ovaries
[00:04:53] are other than during health bearing with yeah. Right and I wonder if it's you know
[00:04:59] breasts are so visible and the reproductive system is so political and it feels like all these
[00:05:05] other organs or systems have a thing you know they have a place in popular culture they have
[00:05:12] visibility but the ovaries and we can't touch them we can't really feel them we can't see them
[00:05:18] they seem almost invisible. I feel like the ovaries get left behind a little bit so
[00:05:25] nobody goes around saying you know my ovaries are working great I've had regular periods and
[00:05:29] blah blah blah I mean it's not really a coffee conversation that we have and you know for a
[00:05:35] large large part of medical history it's been dominated by men and you mentioned the politicization
[00:05:43] of female genitalia. I mean even the word hysteria comes from the uterus right? So I think that
[00:05:51] I like to believe that we've moved beyond that but I think the ovaries might have suffered
[00:05:57] a little bit from paternalistic misogynistic practices of the past. Yeah just a little Dr. Miller
[00:06:06] that's great well so I don't know if I mentioned this before but the podcast is called overlooked
[00:06:12] and I would love to you know I'd love to get people talking about ovaries over coffee to be honest
[00:06:18] but I'd love to spark these conversations inside doctor's offices so that women as well
[00:06:25] just start thinking about this organ a little bit differently. I am shortly going to have my
[00:06:30] philopean tubes out among other things do I have you to thank for that Dr. Miller? Well probably not
[00:06:38] I'm not your surgeon but I think you probably have our team to thank for people thinking of taking
[00:06:46] out the philopean tubes as a strategy for preventing the worst kind of ovarian cancer, the high grade
[00:06:53] serosovarian cancer which indeed almost certainly almost always has its origin in the philopean tube
[00:07:00] not the ovary. It has been really fascinating to me to understand the role of the ovaries
[00:07:07] in the body overall so I want to ask you this question for a very long time you know and the thesis
[00:07:13] of the show as well is that ovarian cancer is a disease that has been kind of in a dark corner for
[00:07:20] a long time outcomes haven't really changed there was until recently no real movement in the science
[00:07:28] in the any technology around it. Now we're talking about genetic tests now we're talking about
[00:07:34] opportunistic self-injectimes now the needle is moving and in your long career in doing this how do
[00:07:42] you you know would you say that's a that's a correct characterization and how do you feel about the
[00:07:48] needle moving now. Well I wish I was 30 years younger so I could participate in this but I think
[00:07:55] that there's been a couple of really important things and one of them was the realization that
[00:08:04] what we called epithelial ovarian cancer was not one disease with the different colors right
[00:08:09] and that was work that came out of our center with David Huntsman and his team and I think that
[00:08:16] was the first really important discovery in it I think understanding these cancers has allowed us to
[00:08:25] really look at different treatment paradigms for different types of cancers and hopefully
[00:08:31] improve outcomes clearly the human genome project and everything that came from that and being
[00:08:38] able to understand what's going on genetically within tumors has been supremely important and will be
[00:08:45] continued to be important in terms of individualizing treatments and things like that sadly still most
[00:08:51] of those treatments don't exist that we need like we know what we need but they don't exist but they
[00:08:56] will exist and I think the thing that's most exciting is the pace and the trajectory of new discoveries
[00:09:04] in ovarian cancer so I always thought ovarian cancer is a really good cancer to study from
[00:09:10] a scientist standpoint for all the wrong reasons one is that it's usually diagnosed late
[00:09:16] and the second thing is that it usually responds to treatment and then it stops responding and
[00:09:23] the outcomes still are very poor right so if you have a new treatment it's not going to take you
[00:09:31] 30 years to see if it results in improvement in treatment you'll know that within three to five
[00:09:37] years if you've hit a ball out of the park if you were running a big pharmaceutical company and
[00:09:42] you had a drug and you think well it could work on all these cancers and blah blah blah probably over
[00:09:47] wouldn't be at the top of the list because it's not that common and you really want to treat a lot
[00:09:51] of people with your new drug but on the other hand testing it on ovary may give you the first
[00:09:56] indication that it's a really valuable drug so I think there's lots of reasons to study ovary and
[00:10:00] hopefully people take that up let me ask you was there anything that you wanted to add that I have an
[00:10:07] asked well you know obviously over the years I've been given a lot of talks and lectures and things
[00:10:13] like that so my standard finishing the lecture line is everybody wants to cure cancer but it's way
[00:10:22] better not to get it in the first place and that's what prevention is all about. You know I was
[00:10:29] ready to end the interview but my share of something this in the back of my mind that you just
[00:10:34] triggered for me I completely get it I completely get the tools that we have for prevention now as
[00:10:40] well our miles ahead of what we had before but part of me I suppose the angry woman part of me
[00:10:49] is thinking about this in this way and then this is not an optimistic way to frame it but I want
[00:10:54] to put it out there that ovarian cancer is a tough cancer and right now the best way to deal with
[00:11:04] ovarian cancer is to just remove the organs and whether we're talking about the ovaries or the
[00:11:10] philopian tubes is like remove the organs. Now if you said to a man the best way to deal with
[00:11:17] testicular cancer is to remove the organ itself that would not go down very well and so I think about
[00:11:25] like I think this is a thought that has been forming in my mind that I've articulated now for
[00:11:29] the first time with you saying that and I'm 100% all about prevention I'm going to be a walking
[00:11:36] example of prevention in three months time but I do wonder about that I do wonder that organ
[00:11:42] removal is the way to get on top of this thing which to me says a lot about how tough it is
[00:11:49] this cancer still what do you think about what I just said Dr. Miller? Well you know I can't disagree
[00:11:56] with you and I think one of the reasons that we coined the term opportunistic self-inject me
[00:12:04] is we didn't want to create a hysteria where women are lined up to get their philopian tubes removed
[00:12:11] at the time of menopause and the reason we didn't want to do that is in the big picture it's a
[00:12:16] relatively rare cancer and it's it's a rare cancer population wise clearly there are groups of
[00:12:23] women yourself included who are at higher risk that the stakes are a lot higher but knowing that
[00:12:29] there are opportunities to prevent an average risk women is great knowing that there is no screen
[00:12:35] and from the way the cancer develops my personal feeling is there's never going to be a screen
[00:12:40] that picks it up early genetic screening giving your risk ratio is going to continue to improve
[00:12:48] but it's never going to be I mean even people that carry the most worrisome
[00:12:53] mutations still only have like a 40 50 percent chance of getting the cancer and women in the general
[00:12:59] population you know the number that we would quote would be between one in 70 and one in 80
[00:13:04] which hails in comparison to a number of other cancers so we don't want to be doing harm
[00:13:10] but if there's a way that we can optimize procedures that women are already undergoing
[00:13:17] to decrease the risk of philopian tube hygraceous cancer I we just thought that that was a good idea
[00:13:24] and but I'm totally on your side I think we do not want to just be lining people up willy nilly
[00:13:30] and saying take out your tubes and we certainly don't want to be lining not and saying take out your
[00:13:35] tubes and ovaries because in that case we're actually doing harm you know so if we're going to do
[00:13:40] something that's preventive it has to not be doing harm so I think that's why I can accept that
[00:13:48] but I also totally agree with you about you know is this the only way but the other thing about
[00:13:54] ovaries that is a little different than you know testes and breasts and things like that
[00:14:00] is that they're on the inside of the body they're not something you can't you know
[00:14:05] the guy can reach down and feel his testicle and see if there's a lump in we do not have that
[00:14:11] opportunity to reach down and feel our philopian tube and see if there's a lump in it and you know
[00:14:17] sadly it doesn't matter like some of these philopian tube cancers that were discovered
[00:14:23] even before they were pre-counterous end up recurring two or three years later so it's really
[00:14:29] the best we have for right now is that perfect absolutely not for exactly the reasons that you said
[00:14:35] I mean but on the other hand having watched too many women dive ovarian cancer over my
[00:14:42] career I just think we have to do something and this is something we can do without increasing
[00:14:49] the morbidity to the woman yeah well on a professional and a personal level I'm very grateful
[00:14:55] that you exist in the world and for your work and for your team's work
[00:15:00] because it's really something it's really something extraordinary these ideas that you guys have
[00:15:05] opened up and yeah so thank you thank you oh you're welcome
[00:15:11] okay that's it for the series I really enjoyed nerding out on ovaries with Dr. Miller and I hope
[00:15:26] you did too it kind of makes me think I want to do a whole series on ovaries would you listen
[00:15:32] to that and if that's something you'd want to hear a new podcast series on write to me and let me know
[00:15:39] tell me what specific questions you have about the ovaries to overlooked pod 23 at gmail.com is
[00:15:47] our email address that's overlooked p-o-d 23 at gmail.com or find us on instagram where at overlooked
[00:15:57] pod I'd be thank you to my associate producer Jessica Martinez deos my editor Lysa so up
[00:16:02] and my engineer Eric Gomez and thanks to each and every one of you for listening and for supporting
[00:16:08] the show