Episode 3: Gynaecological Cancers & HPV   

TRANSCRIPT

Speakers: 

Host: Olivia Moir

Guest: Miss Adeola Olaitan

00:00:04 Olivia Moir 

Hello everyone and welcome back to it all starts here, a podcast focusing on the communication and education of topics in reproductive science and Women's Health. 

I am your host, Olivia, and we are back here today again at the Institute for Women's Health here at UCL. 

And today we are going to be talking about reproductive cancers. So just to note at the beginning of the episode, obviously this is a pretty heavy topic, but as with every episode, really important information to share. So buckle in and join me today for this discussion with the wonderful Miss Adeola Olaitan, thank you so much for joining us today, Adeola. 

00:00:49 Olivia Moir 

She is a consultant gynaecological oncologist. She specialises in the diagnosis and treatment of cancers affecting women's reproductive tracts. So just to make the distinction early on, reproductive tracts specifically and that does not include breast cancer as part of reproductive cancers. But it does include ovarian cancer, uterine or endometrial cancer, cervical cancer, vaginal and vulval cancer. 

She was appointed consultant, gynaecological oncologist at UCLH in 2002 and has been clinical lead of the Gynaecological Cancer Centre at UCLH and involved in various national and international projects for raising awareness and prevention of these cancers. So today we are going to broadly discuss the five different types of reproductive cancers as well as her clinical work in treating and preventing them. And of course, we will also touch on some common misconceptions in the field. 

00:01:51 Olivia Moir 

So it is such a pleasure to have you with me here today, Adeola. And I think to get started, why don't we talk a little bit about or hear a little bit about where it all started for you? 

00:02:01 Adeola Olaitan 

It's an absolute pleasure to be here. So as you alluded to in your kind introduction, I trained as a gynaecological oncologist in Bristol actually. And then I came to UCLH as a consultant and my interest really stems from the fact that a lot of these cancers are completely curable if caught early enough, and I'm passionate about trying to prevent women from dying from potentially preventable and entirely, in most cases, treatable cancers. 

 

00:02:31 Olivia Moir 

That's wonderful. So I think to dive into it, I mean from our discussion, I didn't even realise that there were five different types of reproductive cancers. So if we were going to start it off, I know that I'm sure we could be here for hours talking about them and all of the distinct qualities of each. But maybe you can give us a broad overview of these five different types. 

00:02:55 Adeola Olaitan 

OK, quick anatomy lesson. So I'll start with the commonest in this country, the commonest is endometrial or womb cancer, which is the cancer of the cells that line the cavity of the womb. So that's where babies grow, essentially. This cancer is linked to in the vast majority of cases, estrogen, and if you have a high proportion of estrogen compared with progestogen, these are the two hormones of the female menstrual cycle. Then you're at higher risk of womb cancer and the things that predispose to that are, well, the most common is obesity because a lot of people don't realise that as well as being made in the ovaries, estrogen is made in the body fat, and if you have a lot of body fat then you have a lot of estrogen which puts you at significant risk of womb cancer.  

The other common predisposing factor is polycystic ovarian syndrome, which is quite a common syndrome, but it can be associated with obesity and also, ladies, with polycystic ovarian syndrome may not ovulate, and yet only produce progesterone if you ovulate. So they have a lot of estrogen both from their ovaries and their body fat, and therefore at higher risk of this cancer.  

It tends to be a disease of post menopausal women, but not exclusively, and the early warning sign is postmenopausal bleeding which must never be ignored, although 90% of women with postmenopausal bleeding will not have womb cancer. 

00:04:30 Adeola Olaitan 

So that's womb cancer in a nutshell, in order of frequency in this country, the next one is ovarian cancer. We refer to ovarian cancer to mean ovarian and fallopian tube cancer, cause they're treated the same way. Now this is a cancer that's quite difficult to diagnose because the symptoms are insidious and they can mimic symptoms of benign disease, so it's often a little bit of abdominal discomfort, some bloating, some change in bowels, which can be put down to irritable bowel syndrome when people self diagnose and the consequence of this is that a lot of ovarian cancers are diagnosed very late on 75% are stage 3 and 4, which is a lot harder to treat. 

00:05:14 Adeola Olaitan 

Then the next in frequency is cervical cancer and that has become, quite, well, not rare, but it's not a common disease here anymore. And that's because of the success of the prevention strategies, which we may talk a little bit more about. But this is a disease of young women and it is the commonest cancer in women under the age of 35, it will often present with bleeding after sex, which you may see referred to as post coital bleeding, but again I must emphasise that most people who bleed after sex will not have cancer. But it's a symptom that mustn't be ignored. 

00:05:50 Adeola Olaitan 

A lot of women when they're first diagnosed with this cancer because of their young age may not have had children yet and would be desirous of fertility. And I think it's really important that you let your caregiver know that because there are all sorts of things we can do to support these wishes. 

00:06:10 Adeola Olaitan 

Vulval cancer. A lot of people say vagina when they mean vulva. The vulva is the skin on the outside of the genitalia, and it's like skin anywhere else in the body, so it has this. It can suffer from the same cancers as skin elsewhere in the body, but vulval cancer is not particularly common, and it often will present with discomfort, itching or a lump and any discomfort mustn't be ignored. You shouldn't self diagnose and say I've got thrush and treat. Get somebody to have a look at. 

00:06:42 Adeola Olaitan 

That vaginal cancer is so vanishingly rare that all I'm going to say about it is if it's a low vaginal cancer, we treat it like vulval cancer. And if it's a high cancer, we treat it like cervix cancer.  

So that's a whistle stop trot through all the gynae cancers.  

00:06:59 Olivia Moir 

That's wonderful. And you did that so well, I feel like I learned so much in that 5 minutes of explanation. So thank you for that. 

00:07:08 Olivia Moir 

OK, So what I got from that is there's obviously warning signs of the different types of cancer, but these warning signs are also common outside of cancer, so don't panic. But do get yourself checked if you do have any of these warning signs, fantastic.  

So then something that I think I've gotten from our conversations previously and and even now is this idea of prevention and I mean in the field of cancer, I think the best and really any field, prevention is the best form of medicine obviously. In this field, specifically reproductive cancers, what can we do? What are the different types of prevention? Are they specific to each different type? Are there overarching themes? 

00:07:59 Adeola Olaitan 

Well, they're overarching themes because the thing that helps keep us safe from cancer is having a good functional immune system. And the thing that keeps your immune system functioning well is good diet and exercise. So that applies to all cancers. But again, if I think if we go through the gynae cancers specifically, I alluded to the fact that obesity is a risk factor for womb cancer. So I think it's important as much as one can to maintain a good body weight. And everybody knows that obesity, if it's at risk of cardiovascular disease, fewer people know that it is a risk factor of cancer. And very often the first time a woman knows that her weight is a risk factor is when she's sitting in my room with a diagnosis of womb cancer, by which time it's too late. So I think it's important for the public to be aware.  

I know it's not easy because, I mean, if it was easy to lose weight, nobody would be obese. But there are all sorts of things that people can do to help themselves. 

00:08:56 Adeola Olaitan 

Then ovarian cancer and also womb cancer can be related to a familial predisposition. If you have inherited abnormal genes from your parents, that can put you at higher risk. In particular, the Braca genes, which people may have heard of, there's BRCA 1 and BRCA 2 gene which increased the risk of ovarian cancer and breast cancer, and I think it's important to be cognizant of your family history and if there's a particular history of breast and ovarian cancers in young women, premenopausal women, then you may be eligible for screening for the gene. And you should talk to your GP about it because you can be monitored.  

Unfortunately we don't have a good screening test for ovarian cancer, but if you're of an age, you may consider having your fallopian tubes and ovaries removed to protect you from this cancer. 

00:09:53 Adeola Olaitan 

The most preventable one by far is cervical cancer, and that's because we know what causes it. Most cervical cancers are caused by virus, which is called the human papilloma virus, abbreviated to HPV. Now, HPV is a family of several viruses. It's the same ones that cause warts on your fingers and your feet. They're denoted by numbers, and there's some HPV types, in particular, HPV 16 and 18, which increase the risk of cervical cancer. 

These don't cause any visible lesions, so you wouldn't know you had it except you got checked. And the good news is we've got a vaccination against it, which reduces the risk of acquiring HPV in the first instance. And we've also got a screening test to determine if a woman has HPV so that she can then be checked for cell abnormalities. 

00:10:44 Adeola Olaitan 

A lot of people get HPV, 4 out of five people will get HPV of some stage, and in most it's a transient, harmless infection and nothing to be concerned about. But persistent HPV infection increases the risk of cervical cancer and therefore women with persisted persistent type of infection needs careful watching to look for lesions which are not cancer, but if left undetected and untreated can increase the risk of developing cancer and sometimes a little treatment might be offered.  

00:11:15 Olivia Moir 

Absolutely. And I think I mean HPV separately, I think we wanted to talk about some misconceptions in that area. I mean, I definitely have some questions that you know, have come to me through my friends, family and I just have for myself on that topic. 

00:11:31 Olivia Moir 

But in terms of HPV, I mean I think so. I was vaccinated when I was a child. I think I was maybe 11 years old and I can't remember if there's one or two vaccinations. But you do get vaccinated in school. It's a huge programme like, I'm from Canada, so it's across Canada, but I believe they do that in the UK as well.  

So if you have that vaccine, I mean similar to I think COVID, For example, people got the vaccine and then still present with a positive test for these different things. I mean, what's happening there even when you get a vaccine for HPV and then you get it later down the line, is it helping in some way? 

00:12:07 Adeola Olaitan 

Really good question. So HPV vaccine doesn't give you 100% protection. You're right. It's best given to young school, school age children and in this country is given between 11 and 13. Mm-hmm. Used to be two days is now. It's a single dose. So again, easier to comply with if you get the vaccine. Under the age of 17, it gives you an 83% protection against cervical cancer, which is vast, but it's not 100%, so it's important to understand that even if you've been vaccinated, you still need to go and be screened when you're of an age for screening. 

00:12:43 Olivia Moir 

Right. And an 83% across your entire life course? 

00:12:47 Adeola Olaitan 

Yeah. I mean it's an it's a single vaccine. There's no boost. OK. So yes, that vaccine protects you forever, really. 

00:12:56 Olivia Moir 

OK, got you. And then in terms of also just vaccines against this, so is there space do you think in in other fields? So as you said, there's different types of HPV, the types of HPV that cause cancer, you still can get screening for HPV, which can help you lead to preventing cancer diagnosis and that kind of thing in terms of the other cancers. 

00:13:22 Olivia Moir 

Are there any vaccines related to those types that could be helpful or help in preventing let's say? 

00:13:29 Adeola Olaitan 

I'm gonna answer your question in a too filled way. Actually, cause you reminded me of something I didn't see, which is the the vaccines against cervical cancer also protect against genital warts. OK, they they have the within them, they have the, the, the the antigen against the vaccine that warts also vulval cancer can be HPV related. OK, so if you're vaccinated against HPV, it reduces your risk of vulvar cancer. Unfortunately, we're not at an age where any of the other gynaecological cancers lend themselves to vaccines. But a lot of people are working in this space, and it may be something that happens. 

00:14:08 Adeola Olaitan 

In the future. 

00:14:09 Olivia Moir 

OK. 

00:14:09 Olivia Moir 

Interesting. So we talked about lifestyle, we talked about vaccination and then we talked about screening and I think also hereditary kind of concerns. So those are the two different types of cancers that are. 

00:14:21 Olivia Moir 

Related to or you can be screened in terms of. 

00:14:24 Olivia Moir 

Genes. 

00:14:25 Adeola Olaitan 

Related yeah, you can get genetic screening. OK and then that will raise awareness and then you can have a discussion with your geneticist or your genetic counsellor about whether you wish to have risk reducing surgery for these cancers. 

00:14:38 Olivia Moir 

OK, amazing. And then I think stepping more now into your actual clinical practise, I mean. 

00:14:47 Olivia Moir 

As you said, you see women of all different types of ages presenting with all different, you know concerns and and different reasons that they've landed in your office. Do you find that there are common questions that people have about these different types of cancers that you've talked about, different other misconceptions beyond HPV that you've experienced in your clip? 

00:15:08 Adeola Olaitan 

Yes, I I think one of the interesting ones is that people think that if they've had cervical screening done, it protects them against all kind of ecological cancers, which of course it doesn't. It's really important that it's just screening for cervical cancer because I've had people diagnosed with wound cancer. And how did this happen? I had a negative smear. 

00:15:27 Adeola Olaitan 

Six months ago. 

00:15:29 Adeola Olaitan 

That's one of the aspects and the other one very much is a lot of soul searching. Why me? You know? Have I done anything wrong? I mean, the truth is wanting four of us or one in two of us, depending on what statistics you read will get cancer. Hmm. And you could have the most exemplary lifestyle and still get cancer. 

00:15:49 Adeola Olaitan 

That I think it's really important for women to move away from self blame. I think it's important for women to be aware of the factors that increase the risk so they can protect themselves. 

00:15:59 Adeola Olaitan 

But you know, I think it's very difficult kidding with a cancer diagnosis without actually blaming yourself for thinking that's something you could have done differently. 

00:16:07 Olivia Moir 

Definitely. Yeah. And I think on that note of prevention as well. I mean, so much of that is knowledge and education of. 

00:16:17 Olivia Moir 

What can go into cancer and what can go into causing it and? 

00:16:23 Olivia Moir 

Yeah, I mean, I guess I think I wonder about how we can do better in terms of education of it and and over. 

00:16:33 Olivia Moir 

Your life course, I mean, especially in a young age, like we're getting these HPV vaccines when we're kids. And I feel like it was almost a bit hush hush as the reason to why, I mean, I certainly just remember going and popping my arm down having to sit for 10 minutes in case you pass out and. 

00:16:52 Olivia Moir 

And and that was it and you know. 

00:16:54 Olivia Moir 

I'm. 

00:16:55 Olivia Moir 

Now here sitting across from you. However many years later, asking you what that vaccine was for. So I think it's it's about you. 

00:17:03 Adeola Olaitan 

Know you've completely touched on a bugbear of mine. I think that it's really important when children get the vaccine that they're told in an. 

00:17:12 Adeola Olaitan 

Age appropriate way why they're getting the vaccine and so that when you are then 25 and the letter lands on your door inviting you for screening you. And I'm like, what's this about, you know? So yeah. And I think there are lots of missed opportunities for. 

00:17:13 

MHM. 

00:17:22 Olivia Moir 

Yeah. 

00:17:26 Adeola Olaitan 

Or public education, for example, when a woman goes for her screening test, which is checking to see if you've got HPV or the precursor solutions for cervical cancer, that again is an excellent time for this the Screener to check on the women's General Health check on understanding contraception, irregular bleeding, etcetera, and explain what the test is about. 

00:17:45 

MHM. 

00:17:47 Adeola Olaitan 

So that when you get the letter saying you've tested positive for HIV, you don't totally freak out and think, Oh my God, what is this? So you're absolutely right. I think that there are a lot of opportunities for one to one public education that perhaps are not being taken advantage of. 

00:18:04 Olivia Moir 

Yeah, definitely. 

00:18:06 Olivia Moir 

And then it reminded me as well in terms of the different types, I mean we've focused a lot now on HPV and cervical cancer. But in terms of contracting these different types of cancer is cervical cancer the only one where it's something you can? 

00:18:22 Olivia Moir 

Sort of, I guess. Catch from someone. Let's say someone passes HPV onto you. It's sexually transmitted to you, is that? 

00:18:31 Adeola Olaitan 

Yeah. I I I do want to move away from the language of sexually transmitted because I think it's stigmatises it if we consider that four out of five people. 

00:18:37 

Hmm. 

00:18:42 Adeola Olaitan 

Have HPV at some stage. 

00:18:44 Adeola Olaitan 

Age. I prefer to say it's sexually associated. It's passed on by some sort of sexual activity and you don't actually have had. You don't have to have had penetrative intercourse to get HPV, skin to skin transmission. So it's not a narrative on people's sexual behaviour. It's just out there. And even if you've only ever had one sexual partner, you can still get HBV. 

00:19:03 

MHM. 

00:19:05 Olivia Moir 

Mm-hmm. Definitely. So then in terms of the other types of cancer as well, do you? 

00:19:10 Olivia Moir 

I think would it be safe to say that those are not types of cancer that are associated, let's say with you know, behaviours? 

00:19:18 Adeola Olaitan 

Well, I it's. 

00:19:19 Adeola Olaitan 

Volvo Cancer can be HPV right related, but there are also HPV, unrelated Volvo cancers. So you're right, those are the two cancers and mainly cervix really that are associated with an infectious agent. Yeah, the others are. 

00:19:32 Olivia Moir 

Not amazing. OK, not amazing. But you've clarified that. So thank you. 

00:19:39 Olivia Moir 

OK. And then so we've talked about clinical work and then in terms of research interests, I was really interested when we talked about that briefly beforehand about your different interests in this field and the different work that you have done and that you would like to do. Maybe you can talk about. 

00:19:59 Olivia Moir 

Kind of your passions in terms of research. 

00:20:02 Adeola Olaitan 

Indeed. 

00:20:04 Adeola Olaitan 

I said that cervical cancer has become a very uncommon cancer in this country, but worldwide it's still one of the commonest cancers and about 75% of the burden of cervical cancer rests in the developing world. The reason is poor access to vaccination and screening and. 

00:20:23 Adeola Olaitan 

If we are going to achieve the WHO's vision of eliminating cervical cancer, we're going to have to work a lot harder at making tests and screening achievable to other countries, which may mean having to think outside the box. 

00:20:39 Adeola Olaitan 

You know, a lot of what's done in the developed world is expensive and unachievable, and therefore, to keep striving after that is is, is is guaranteed failure. So one of the things I'm looking at with other colleagues is affordable tests and also very much public education because you. 

00:20:58 Adeola Olaitan 

We think public education is perhaps not done as well as it could be in this country. It's a lot worse in countries where. 

00:21:06 Adeola Olaitan 

Anything below the waist is not spoken about and I think destigmatizing that is really important. So that's one of the things that I've been working on and continue to work on. 

00:21:16 Olivia Moir 

Mm-hmm. Definitely. And I I think something as well that you mentioned to me that I thought is just so true is what works in the Western world in terms of, as you said, access to healthcare and and different plans that can be. 

00:21:32 Olivia Moir 

Used to roll out, for example, vaccination plans and that kind of thing will not necessarily work in other countries because of the infrastructure available and the resources available. 

00:21:45 Adeola Olaitan 

Absolutely. I mean, vaccination is good example. So it's the reason why it works so well in this country. So you give it at 11 to 13. 

00:21:53 Adeola Olaitan 

All children at school at that age. In some countries, girls never go to school, so you're never going to catch them and actually decide to say in some countries girls are already married by that age and may even have had their first child. So it's about thinking how can we protect those girls. And one of the things I think may be interesting for the future because a lot of developing countries have a very strong. 

00:21:55 

MHM. 

00:22:14 Adeola Olaitan 

Infant vaccination programme. 

00:22:16 Adeola Olaitan 

And it may be that giving these vaccinations as part of the infant vaccination programme would be better than trying to delete until girls are, you know, pubescent and you know you may have lost those goals then. 

00:22:29 Olivia Moir 

Yeah. 

00:22:30 Olivia Moir 

Definitely. And I that reminded me as well about one question I had around like ages so. 

00:22:36 Olivia Moir 

You get the vaccination 11 to 13. My kind of assumption with that didn't look this up. So just correct me where I'm wrong is that you're waiting until. 

00:22:48 Olivia Moir 

It's old enough that they're still young enough before they start being sexually active to continue the lifespan of the vaccine. Is that the idea? 

00:22:57 Adeola Olaitan 

Totally, I mean cause as I said before, there's no booster dose, right? I think work from the first people who were vaccinated just about 30 years ago shows that the immunity is sustained. Mm-hmm. But also, you manifest a better immune response. The younger you are. Mm-hmm. So, for example, I said if you give the vaccine under the age of 17. 

00:23:18 Adeola Olaitan 

It's a. 

00:23:20 Adeola Olaitan 

83% protection. But if you give it after the age of 20, the protection drops to 6%, so you know the key message is get it while you're young. It still protects people and it's actually licenced up to the age of 45. So if you missed it at school for whatever reason. 

00:23:28 Adeola Olaitan 

Hey. 

00:23:37 Adeola Olaitan 

Or. 

00:23:39 Adeola Olaitan 

Haven't been vaccinated. Is still worth considering because vaccine. 

00:23:45 Adeola Olaitan 

Conferred immunity is better. It's stronger, longer lasting, and stronger than natural immunity alone. 

00:23:52 Olivia Moir 

OK, interesting. And then testing from the age of 25, why is that like I assumed it would be sort of like economical for the country? 

00:24:03 Olivia Moir 

And that's why it would be that we wait until women are 25 years old to start screening them for. 

00:24:08 Olivia Moir 

Be the why is that that? 

00:24:11 Olivia Moir 

We wait till 25. 

00:24:13 Adeola Olaitan 

Because. 

00:24:14 Adeola Olaitan 

Below the age of 25, a lot of people will have transient changes in the area of the cervix that we're interested in, which actually clear up on their own. And if you intervene too early, there's a danger that you then treat too early, and this although the treatment for these pre cancerous lesions is safe. 

00:24:34 Adeola Olaitan 

There's no treatment that doesn't have potential side effects, so it's about doing no harm. But I and and and you know, any screening prevention programme must do no harm, and therefore that's that's the reason why the age of 25 was chosen. 

00:24:48 Olivia Moir 

OK, really interesting. 

00:24:50 Olivia Moir 

Well, I mean that is all my questions. I think summed up, I'm sure I'll think of others, but. 

00:24:57 Olivia Moir 

In terms one final one, I think that's good to close on. As you mentioned as well about like in terms of reach, research, future future directions that you would hope for that in terms of adjusting the plan for the country and making it as. 

00:25:12 Olivia Moir 

Precision to the country as possible is probably the best way to go. Do you have any kind of future aspirations or goals in terms? 

00:25:21 Olivia Moir 

In terms of the clinical work itself and and specific to your work that you are hopeful to see maybe specific to you or or the field in general? 

00:25:31 Adeola Olaitan 

Is this leading to the work that I do here or or everywhere? 

00:25:36 Olivia Moir 

I think a bit of both. 

00:25:38 Olivia Moir 

Let's go with. 

00:25:39 Adeola Olaitan 

So I'm just gonna say something which is not answering your question, cause I think it's really important that we see one of the risk factors for cervical cancer is smoking right and and I think that women need to know this cause everybody knows smoking causes. 

00:25:51 Adeola Olaitan 

Lung cancer reduce your risk. Stops making now back to what do I want to do? I would I I mean, you know, for me. 

00:25:52 Olivia Moir 

Hmm. 

00:26:01 Adeola Olaitan 

Success looks like I don't have a job anymore because women are protected and they're not presenting with incurable cancers. Hmm. I think we're still more than a generation away from that, but I think we should still strive in that. 

00:26:17 Olivia Moir 

Direction definitely. I mean this has been such. 

00:26:21 Olivia Moir 

An informative session for me and I really appreciate you coming on and I'm sure all of the listeners do as well. So thank you so much adeola. It's been great. 

00:26:29 Adeola Olaitan 

To learn from you, you're welcome. Thanks, Olivia.