SPRINGFIELD – Dr. Nada Kawar, who represented her native Jordan in the shot put both at the 1996 and 2000 Olympic games, had plans to be an orthopedic surgeon.
However, a rotation in obstetrics and gynecology in her third year of medical school at Washington University in St. Louis, Missouri, changed her focus to women’s health. She went on to a residency in obstetrics and gynecology at University of California San Francisco Medical Center and a fellowship in gynecologic oncology and breast surgery at Brown University/Women and Infants Hospital of Rhode Island that taught her “how entwined” breast and gynecologic cancers can be.
Her extensive training as a gynecologic oncologist — she is board certified in obstetrics and gynecology and gynecologic oncology, and certified in breast disease as well as breast surgery and in the fundamentals of laparoscopic surgery — qualifies her to both diagnose as well as provide surgical and medical treatment for women’s cancers, including cancers of the breast, uterus, ovaries, cervix, vagina and vulva.
Kawar, who was an undergraduate at the University of California in Los Angeles when studies were emerging on inherited risks for women’s cancers and how they can overlap, now practices at Mercy Medical Center’s recently opened Center for Breast Health and Gynecologic Oncology, formerly its Breast Health Center, under Dr. James Frank, and feels “very lucky” to have the one-stop location adjacent to the Sister Caritas Cancer Center for her patients who sometimes have overlapping cancers.
“This vision of seeing everyone in the same building, sharing resources, imagining my career in a different way – I am very lucky to be here,” said Kawar, noting that inherited mutations in certain genes can put a small percentage of the population at risk for breast cancer as well as ovarian cancer and cancer of the endometrium-uterus.
“I have already seen lots of patients who have both cancers of the breast as well as gynecologic. Here, they can come to one space, see one doctor or other doctors and do not have to go to other locations.”
She sees such an approach where a physician like herself provides comprehensive care for female cancers in one location as “all about women’s cancer care.”
Kawar added patients at the center have access to a genetics counselor who can help determine cancer risk based on inherited factors and treatment options that range from surgery to reduce such risk to minimally invasive surgeries as well as radical procedures for those with malignancies.
She said that as medicine evolved “over the last century that there was this sort of arbitrary separation of breast surgery into the field of general surgery where gynecologic oncology evolved within a subspecialty of gynecology and obstetrics.”
“There was this separation and finally care of breast cancers separate from gynecologic and pelvic cancers,” Kawar said.
“Breast cancers are mostly uniquely female, although some men get breast cancer, it is a very much a woman’s cancer.”
The greater prevalence of breast cancer and the growing number of disease survivors, Kawar added, has helped generated much greater publicity and funding around it than cancers of the reproductive organs that are much less common though can be related.
Kawar said patients are most often referred to her by their gynecologist after an imaging study indicating a tumor or some other abnormality.
She said the most common gynecologic cancers she sees in patients are uterine cancer, which is often found early due to abnormal bleeding or pain and has a high five-year survival rate when detected in the localized state; ovarian cancer which she termed “much more deadly” as it is often detected when the disease is more advanced; and cervical cancer that is often caused by exposure to certain strains of the human papillomavirus and for which there is now a vaccine to help prevent.
Screening for cervical cancer can be done by the HPV or Pap test and the five-year survival rate is very high when detected at the localized stage.
Risk factors for uterine or endometrial cancer, Kawar said, include metabolic syndrome, whose conditions include high blood pressure, obesity and diabetes, but just how this syndrome contributes to the development of the cancer is unknown.
She said too much of the hormone estrogen without the presence of progesterone can also pose a risk.
Kawar said hereditary breast and ovarian cancer syndrome, often related to certain mutations in the BRCA1 or the BRCA2 gene, can elevate an individual’s risk for both as well as other cancers.
She noted that there is “no good screening test for ovarian cancer” and one recommendation for women with a known inherited risk for the disease is “risk-reducing surgery to remove the Fallopian tubes and ovaries after child bearing years.”
She added, “The symptoms of ovarian cancer are normally very vague – urinary symptoms like urgency or frequency, abdominal pain, feeling full quickly – these usually cause women to ultimately seek care and are often have their symptoms mistaken for stomach problems or indigestion and with a diagnosis of ovarian cancer quite late because of that.”
“Anyone with a strong family history of breast or ovarian cancers should seek genetic counseling and possibly genetic testing because that is one way to become aware of the risk for ovarian cancer,” Kawar said.
“Other risk factors include infertility – not being able to bear children – and age. It normally affects women age 60 and above.”
Kawar said not all women referred to the center end up being treated for a malignant condition, but surgery is sometimes needed because of a concern for cancer.
“When a woman is referred to me with a pelvic mass found on imaging, I will talk about the possibility of cancer with the goal of surgery to remove the mass and determine diagnosis and if it is cancer, to recommend the appropriate treatment which may include more extensive surgery or chemotherapy,” Kawar said.
“I often treat women for endometriosis which is a benign condition but can mimic cancer in the problems it causes and might require a large-scale surgical approach. I often see women for uterine bleeding that may end up being polyps and not necessarily cancer.”
Kawar noted that this is Gynecological Cancer Awareness Month, and next month brings Breast Cancer Awareness Month.
“September brings awareness of all the problems of the gynecologic cancers and the importance to survival of catching them early,” Kawar said.
“With a lot of emphasis on breast cancer in October.”
The American Cancer Society estimates this year that 42,170 women will die of breast cancer, and some 33,602 will die of cancers of the genital system.
These include 13,940 of ovarian cancer, 12,590 of uterine cancer, 4,290 of cervical cancer, 1,350 of vulva cancer and 1,450 of vaginal and related cancers.