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[music playing] [music playing] welcome to caucus new jersey i'm steve adubato you know gynecological cancer can be extremely difficult to detect which is why women need to be aware of the warning signs joining us here in the studio to discuss this very important health issue we have susan seguine who is an endrometrial cancer survivor and we also have doctor mira hellmann is a gynecologic oncologist at robert wood johnson university hospital ruth dugan is president of the board of trustees at gilda's club of northern new jersey and finally melissa donahue is a lisenced clinical social worker and certified sex therapist throughout this program you're gonna see websites that are gonna be extremely helpful uh susan i want to get this right the kind of cancer that you are a survivor of i want to say it the correct way endometrial

endometrial? which means? the lining of the... uterus ...uterus you know right out of the box seriously is we are talking about five types of gynecological cancers doctor right? essentially and just having this discussion right here as i was getting ready for this show i always think i know something about the shows we're doing i know nothing about this i mean less than nothing am i alone in how little i know and how little most people know about gynecological cancers? no because there are five types there are basically five types of gynecologic cancers it is an area in medicine that i feel as you stated is really doesn't get the same attention as some of the other fields of medicine do and therefore patients and people the general population has a they have a less of an understanding of what's involved with it how to look for it when you need to see the doctor for what screening tests they need to undergo to help detect these kinds of things um

we're talking about the reproductive system? correct can we go through the five cancers we're talking about we're talking about cervical mm hmm ovarian uterine vagina and vulva correct there are... one more prevalent than any other? so in terms of prevalence uterine cancer is the most common gynecologic malignancy in the united states as it is in most developed countries around the world but if you look at third world countries cervical cancer actually is the most prevalent cancer and it is associated with many many deaths a year this is something that we've managed to control in the united states with something that i feel a lot of women actually are aware of which is pap smears which is a screen test that came out which significantly helped detect cervical cancer before it developed into well pre cervical cancer how oftern for a pap smear? so the reccommendations keep on changing the most recent reccommendation actually which is something that susan and i were discussing before

the reccommendations for screening is once every three years once every three years? beginning? t is now beginning at the age of 21 21? correct it used to be at the age of 18 or at the onset of sexual activity okay but that has recently changed in addition now there has recently been a statement that came out in terms of cervical cancer screening looking at screening for hpv which is? which is hpv is human papillomavirus which is the culprit in the majority of cervical cancer cases that develop i thought there was a vaccine for that there is a vaccine for it the vaccine is something a tremendous intervention that has recently been approved not recently actually a couple of years ago been approved by the fda in terms of preventing cervical cancer despite that there are unfortunately a lot of people who do not get the vaccine it is not a requirement like some immunizations are for pediatric care it's not a requirement it's something that's optional and there's some debate about this? and there's a lot of debate

about this let's open up the discussion by the way again this program part of all of our health and medical programs designed simply to provide valuable information to our audience in public broadcasting and our audience on fios as well you'll see websites throughout this program use those websites to get additional information susan your journey describe it oddly enough i ended up with a cancer which was not one that i would watch for i didn't even really understand like you about endometrial i was very careful and went to my gynecologist and we watched ovaries we did the pap smears any history in your family? yeah well not of gynecological cancer but of both parents deceased of asbestos related cancer so i was always very careful and i reading a magazine about a bloated belly and it started me on a long journey that they watched ovaries they did testing but i have a point that i feel near and dear about that i skipped a whole year i had great pap smears i had great mammographies and i missed a year i go back and i have an endometrial

stage one cancer so i women have to go and no matter how suddenly the symptom or what the feeling or what they read they need to follow through and see their doctor that's the message you want to share? i do that's why you came on this program it is becuase i feel that women should i have a thing about the tranvaginal sonogram i think women should have them i think it detects many of the cancers it might be debated with the doctor but i just feel women have to be diligent and pay attention and find a doctor that will listen to anything that they say that is a problem and by the way a sonogram this internal sonogram? yes that... is that required? is that preferred what? look more debate more looking at each other ell it would be i just feel that that started me on the road to in your experience? in my experience in watching and being very diligent reaction? i think that susan has excellent points i think that she is a hundred percent correct in trying to get the message out there for women to be diligent about their healthcare cause women are the ones who are gonna be the

best advocates for their healthcare and to discuss whatever they're feeling or they're going through with their doctors. that beind said once the issue is presented to the doctor there should be a thorough investigation performed by the physician the appropriate tests ordered everyone is different? everyone is different but you must have your physician totally engaged and involved in your case and if you do not have that situation and you're deciding for yourself what you think and diagnosing yourself that is not what we're advocating here you're saying what you believe was the best course for you? and i don't think women should think anything is too trite or small to tell their doctor i think you should anything that's out of the ordinary... we all agree on that that you should tell your doctor and find a good doctor that's gonna listen to you let me pull you in here and i promise we're gonna talk about the other piece of this which is the emotional psychological and the potential sexual issues associated with after the fact mm hmm when someone has one of these five gynecological cancers there are real issues associated with that gilda's club? well to get to this

conversation i actually just wrote an op ed and i'm really upset with all of the mixed signals that women are getting about screening whether it's their breasts whether it's a physical exam and now they've just come out and said well you know we don't think that that absolutely is appropriate but yet something like that you would have felt a bloating you may have felt an abnormality in the vagina the mayo clinic tells you that those are good things to do and now we have people saying well maybe not and i really feel that a lot of these reccommendations give cover to insurance companies to then perhaps not cover these exams and leave women in peril because all of these years we've been saying screen screen screen screen and now we're saying well sometimes screen sometimes don't screen i don't think... what should the average woman do right now watching on public broadcasting? i think she should be diligent she should screen she should have her mammographies at an earlier age than they're reccommending because at an earlier age than they're reccommending because of gilda's club eleven percent of the population is under 50

with breast cancer say that again? eleven percent of the population that comes to gilda's club is under 50 and they have breast cancer and by the way explain for those who do not know what gilda's club is and why it is so special named after the late great gilda radner it's named after gilda radner she of course passed away from ovarian cancer but prior to passing away she realized how effected her friends and relatives were by her illness and she said there needs to be some place where everybody can go that is in a non clinical setting where we can deal with these whether it's member to member support group whether it's just a diversion writing down memories yoga hmm whether it's wellness and then of course bereavement is... sure... a whole part of it ...is all part of it quality of life melissa let me bring you in by the way again several websites we're seeing throughout this program listed by our teriffic producers behind the scenes because we know at public television our job is to give you information your

job is to take it and go to the next step that's why those websites are so valuable let me ask you we can have an ongoing discussion about early detection being your own best advocate finding the right physician all those things and they're all important but a woman does have one of these gynecological cancers she is being treated there are real... there's a real impact on her physiologically emotionally and psychologically that has implications for her quality of life which is in part her sexual life no? yes talk about it well aside from the body image issues whatever type of treatment that she undergoes a lot of the treatments that are involved with gynecological cancers do leave a woman in a situation where they could be put into menopause if they were not already there and there are side effects related to that by going into it in such a drastic measure rather than a gradual measure where they're feeling vaginal dryness there could be pain during intercourse there could be lack of desire there could be tearing of the

outside by the vulva the vaginal opening and a lot of these reasons make people not want to engage in vaginal sex and it can also ffect intimacy in a relationship so here's my question doctor to what degree with all of the clinical challenges with all of the fear and anxiety associated with the initial diagnosis that a woman faces when you or one of your colleagues has to give the news that a woman faces is dealing with cancer and again all different stages all different circumstances every case is different do you feel most of your colleagues are prepared for and in fact have such a discussion about the social emotional psychological and sexual implications a and b when? so i agree that this is a major major factor in what women go through i mean there are so many emotional things that women go through when they have a diagnosis of cancer let alone hearing the word cancer that's in and of itself a

what kind of things go on? very traumatizing a lot of women hear just the word cancer and they automatically shut down and they don't hear anything else beyond that do they hear death sentence? some women and it depends what their personal experiences have been whether they know people who have gone through cancer treatments what sort of cancer treatments something they've read something they've seen a lot of people almost everybody has a certain association with cancer on some level p.s. yours was not great for other people in your family correct? no okay it made me... you had people pass away from cancer correct even though that's not your attitude no you had that experience and it's a delicate balance between living your life and paying attention being diligent but you did not have a great experience with other people? no in spite of your positive attitude i could have used the gilda's... okay but go ahead pick it up doctor and you know this goes something i believe that you wrote actually in your op ed when you were talking about because i happen to see that could we tell people so people can find it on the internet? what was the op ed? it was i actually talked about the necessity for support... where was it published? it was in the bergen record it was in the record? okay

um under your name? yes good when people see your name up again look in www.northjersey.com www.northjersey.com look under your name that is the website for the record go ahead doctor i'm sorry so you know there's an array of emotional experiences that people go through some of them automatically shut down some people jump to the worst conclusion and you know often times that why when we see people it is... people are encouraged to bring family members with them bring other people with them so everybody hears a little piece of something that hopefully it can be put all together. now in terms of the sexual dysfunction that is associated with gynecologic malignancies i mean that is a tremendous burden on a lot of patients who go through cancer treatments and non cancer treatments i mean... how do most physicians deal with it? it's very challenging to deal with how do most physicians deal with it? think it's individual it depends on the physician it is certainly something that most diligent physicians try to address in terms of detecting it treatment is extremely difficult because as you know

it is multifactorial many issues play into it and it is something that requires a lot of attention both from a psychological standpoint from a medical standpoint from an emotional standpoint that really you need an integrated system to address got it i understand it's complex and difficult i just wonder if most physicians are actually trained i mean should a patient be expecting the physician the gynecological expert the clinician to be doing that or is it... should it be coming from somewhere else? what did you... go ahead i have a wonderful physician who pushed me in that direction id it in a more lighthearted way but really brought it to the surface because i was terrified and you really in my position i don't want to think about anything like that because you're just worried about that whole system just shutting down i was just saying that to our producers i was saying come on worried about sex? and they're like no i bet a lot of women at some point would and you were thinking... it's hard to think of that you're thinking of it totally different your organs there that... well once you knew you were gonna be okay to some extent

were you sitting there saying wait a minute if i could just... well i had a wonderful physician who pushed... prodded me in that direction and said [laughter] don't worry about it and come on jump back on the wagon and live a normal life is that what you call it? jump back on the wagon? [laughter] well that's how i took it [laughter] [laughter] am i used? [laughter] oh god did she say to... is that a clinical term? doctor? jump back on the wagon? [laughter] yes yes [laughter] that's how i heard it [laughter] think... as long as the patient understood it that's all that counts you're a very good communicator i can tell your message is very clear so she understood and then you did what you needed to do? jump in and jump in go ahead well what i wanted to say is that you know when we talked about this prior as a group that it's a brave new world and it's come... you mean before i came into the studio i think is what you mean but go ahead [laughter] it's a brave new world in terms of... in january everybody's going to be required all physicians are going to be required to indicate and to acknowledge the amount of distress that a cancer patient has but wait a minute it's required by whom? by the aca the affordable care act the affordable... hold on the new federal healthcare act

yeah otherwise known as obamacare by some is going to have... it's gonna require physicians to do what? well that they measure their distress and then help people deal with it and that's why we as an organization are talking to all of these hospitals and attempting to provide them with it because this is something we've been doing for ten years we have a proven method but... that's a lot to expect of a physician doctors and they can't do it they have 15 minutes 20 minutes with the patient they can't possibly... and so what we're hoping to help is to help them meet that need well let's talk about patients here what should patients melissa what should patients be bringing to the table to have a conversation with the woman's physician? with a man or a woman be it you know the gynecological specialists what should they be asking? well i think there needs to be some honesty from both parts from the patient and from the physician where there needs to be a dialogue about sexual function you know what symptoms are you...instead of

just saying you know how are you feeling today is what a doctor would say to a patient you know the doctor should be asking you know is there any pain during vaginal intercourse you know really? of course why...? that's the conversation starter? why not? that's some ice breaker [laughter] are you serious? like that direct? well sometimes doctors will ask patients are you sexually active and some people are shy and uncomfortable based on their religion based on their culture the family they grew up in it's a private conversation sure they won't say what they're doing cause they're embarassed whether they're married or not married well what do... see i'm switching it on you now okay you're saying what you believe the physician could be saying and i'm asking a different question say the patient is not convinced that the physician is going to start that conversation uh huh what could the patient do to facilitate and move the conversation forward if the patient is thinking about it and feeling better about the health side and saying listen think i've got a good shot here i'd like to have this conversation what could the patient do? i think they need to be honest with their symptoms i mean

having pain during intercourse i'm feeling very dry down there what can we do about this they need to talk about all their symptoms not just you know nausea or vomiting or fatigue or any other side effects that they may be feeling some chemotherapy or radiation they need to be honest about all of their symptoms is it harder for most women and i don't know if there's a study that shows this i don't know if you sense this anecdotally is it harder do you think for most women dealing with one of the gynecological cancers we're talking about to have this conversation with a male physician or a female physician? the silence is deafening i think it depends on the person you just think it's person to person? i think it depends on the hysician i also think it depends on the patient but i think what shuts people down is that they have someone that they bring these symptoms to and they either give them bad advice or they give them non medical advice or they don't know what to do and then patients are left wondering you know is this supposed to be normal am i

supposed to just live like this? and if they appear uncomfortable i mean that's the first sign you're just not gonna continue this conversation u see...? do you...? i know it's case by case so i'll bring you back in... do you think most of your colleagues are prepared for ready and know how important this conversation is? absolutely you do? absolutely we happen to be fortunate that where i work women are given the opportunity patients? patients are given the opportunity to address this on multiple levels i feel and susan correct me if i'm wrong but this is my impression to address it both with our nursing staff who speaks... when you say "it" address "it" address an issue that may arise be it sexual dysfunction be it anything else but specifically a comfortable environment that we have our nursing staff that is very approachable we have the physicians who are very approachable and i feel like there's several

levels which allows the patient access not just the physician? correct so if someone maybe is feeling they're talking about their chemotherapy they're talking about the radiation therapy all these big medical things they're like ah my sex whatever my sex life is my sex life i'll deal with it they have someone in between on that level also who maybe they are a little bit more comfortable with at least bringing up the topic who will then address it fully the doctor will say you know what his has been an issue she didn't really want to bring it up with you can you take it further? would...? go ahead as a physician you brought you did bring that into the conversation where like i was she drove it? she did and in a whole health in whole life not just you know... a part of the bigger picture? yes the bigger picture that this... you have to go on with your life and i want you to be well in all aspects what does that do for you? oh well it put me on the right road and put me in the thinking that that was the way that i was safe and okay and i have to go back to my normal life and i guess carry that... how are you feeling today? cause you look fabulous wonderful thank you thank you

thank you you know maybe because i'm a guy and guys are so incredibly self centered um or maybe it's just me how would you feel if your sexual functionw as impacted? well you're about to... [laughter] yeah [laughter] ah you... yeah we... we had this conversation with our producers all of whom are talented women we have great crew guys who are mostly men but i had this conversation with our producers before we got in here and i said if i were i lieve i don't know but if i were diagnosed with prostate cancer i... first question would be largely about prognosis odds what do i have to do? ife and death. i want to believe that soon thereafter i'm asking the other questions about would just call it because it's pbs performance related issues the ability to... terry our floor manager is giving me smirking performance related issues i would want to talk about that

now i don't know if that's more of a guy's... i don't know but i'm surprised that women don't bring it up more and what does a guy do in a situation his partner is facing this and he wants to bring it up but it's not... he's not the one going through it he doesn't want to be self centered but he's with her and he wants to be with her he doesn't know what to do he wants to support her but he's thinking hey what about us? she's like well that's not your problem i'm the one... no you're looking at me why? yeah cause the operative word is partner i mean if they're truly partners they will bring it up and for a guy you know people... guy's measure themselves by physical performance much more so and it's obvious and you know if you're not performing and for women that's not necessarily the case and so another doctor male physician would say don't worry you know or he would give you the odds on and you would discuss it but the performance level is so totally different i think

and the experience is so different well women aren't feeling like they're failures if they're not able to have sexual intercourse because they have gynecological cancers you know it's more of an intimacy issue where it's not necessarily the physical hands on penis in vagina it's more of a emotional relation the touching the cuddling ps there's a whole chidrearing issue here for women of a certain age and situation mm hmm which makes it even more complicated yes but i feel that's a whole separate area oh that's a different subject i'm sorry i'm sorry i shouldn't have brought that up sorry i shouldn't have brought that up i'm just saying... i think that this is such a huge factor and gong to what you were saying i agree with you i think males have a completely different view on it than females as everybody knows that women have the emotional aspect of it the intimacy aspect to it how it effects the relationship i'm in so multifactorial whether... are we simpler? men? um no just different so... couldn't you equate that with breast cancer? thanks for saying yes i appreciate that breast cancer in women it's more overtly sexual that

might cause a dysfunction y i don't i don't... in the time we have left bring it back to it i'm sorry what advice do we have for women right now in the couple minutes we have left the websites will continue to be up women gynecological cancers five again could we do it again cause you might have just tuned in at any point cervical overian uterine vaginal vulva right? there are obviously clinical physical issues there are emotional psychological sexual issues there are support organizations like gilda's club mm hmm right there are professionals in your field as well finally doctor advice for women right now we're saying listen i don't need that test i think i'm good you say? .. the best advice i can give to women in support of what susan said as well is you are the best advocate for yourself if you need to find a physician who you can relate to and you can talk to and you need to be aware of everything that's available to you going back to major topics there has been that we've been discussing for a few seconds... go ahead the past however long in terms of sexual dysfunction overall well being it is really really important that a woman feels a

finds a doctor that she feels comfortable with a doctor who has access to state of the art technology and the latest developing treatments that are available out there such as minimally invasive surgeries things that will not interfere with a woman's self image as much as a major incision would and things like that to be able to get herself the best care that's out there you have all done a tremendous public service for women all across the region i want to thank you so much thank you thank you too the preceding program has been a production of the caucus educational corporation celebrating over 25 years of broadcast excellence and thirteen for wnet njtv and whyy funding for this edition of caucus new jersey has been provided by td bank the new jersey education association berkeley college new jersey natural gas qualcare inc johnson and johnson and by njm promotional support provided by new jersey monthly the magazine of the garden

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captioning sponsored by macneil/lehrer productions >> woodruff: the c.d.c. ramps up ebola guidelines to keep healthcare workers safe, we get an update from director thomas frieden. good evening, i'm judy woodruff. >> ifill: and i'm gwen ifill. also ahead this tuesday, we go inside the heated georgia senate race that's dividing a once-red state >> woodruff: plus, start-ups vie for success in silicon valley, but what happens to the ones that can't make it? >> kind of like zombies, that's actually what they're called here, startup zombies, a company that's not succeeding or