Ep. 109 Hereditary GYN Cancer Syndromes: Practical Screening & Risk-Reduction Guide with Dr. Marcia Ciccone

What happens when a fully integrated healthcare system aligns training, data, and access to improve surgical outcomes? In this BackTable OBGYN episode, Dr. Eve Zaritsky joins hosts Dr. Mark Hoffman and Dr. Amy Park to discuss how Kaiser’s integrated health system enables rapid care coordination, large-scale quality improvement, and population-level research using one of the largest US datasets. --- Get the BackTable app https://www.backtable.com/app --- Timestamps 01:17 - Introduction 03:35 - How Kaiser Works07:24 - Research Using Big Data09:19 - Changing Hysterectomy Culture13:36 - Ending Racial Disparities15:22 - Handling Large Uteri17:52 - Vaginal Hysterectomy Trends20:38 - Myomectomy Reintervention Rates24:23 - Shared Decision Making26:30 - Mini Lap Versus Robotic27:41 - Hybrid Extraction Strategy29:08 - Credentialing Robotic Myomectomy30:19 - MIG Referral Pathways32:03 - Fibroids Across Asian Subgroups34:55 - Mentoring Research Pipeline36:44 - Funding Analysts Through GME40:49 - Endometriosis Disparities Findings43:59 - Mentorship Mindset --- More about this episode Dr. Zaritsky describes how a coordinated, system-wide effort transformed hysterectomy care, shifting from 80% open procedures to nearly 90% minimally invasive within five to eight years through focused training, reducing low-volume practice, and tracking system metrics, ultimately decreasing racial disparities once minimally invasive rates exceeded 90%. She also highlights Kaiser-based research on variation in vaginal hysterectomy by service area and surgeon volume, long-term reintervention rates for fibroids across procedures, increasing use of minimally invasive myomectomy, and a JAMA analysis showing differences in fibroid diagnosis among Asian subgroups with the highest rates in South Asians. The episode concludes with Dr. Zaritsky calling attention to how Kaiser’s research infrastructure creates robust opportunities for meaningful mentorship across all levels of training, supporting the development of physicians, residents, and medical students. --- Resources Minimally Invasive Hysterectomy and Power Morcellation Trends in a West Coast Integrated Health System https://pubmed.ncbi.nlm.nih.gov/28486359/ Racial Disparities in Endometriosis and Pelvic Pain Treatment Within an Integrated Health Care Delivery System https://pubmed.ncbi.nlm.nih.gov/40839882/ Uterine Fibroid Diagnosis by Race and Ethnicity in an Integrated Health Care Systemhttps://pubmed.ncbi.nlm.nih.gov/40172885/

When to test, how to prevent, and what you need to know about hereditary gynecologic cancer syndromes. Two USC gynecologic oncologists, Dr. Mona Guo and Dr. Marcia Ciccone, go in-depth in this BackTable OBGYN x Tumor Board crossover episode. --- Get the BackTable app https://www.backtable.com/app --- Timestamps 00:00 - Introduction01:37 - Why Hereditary Cancer Matters04:51 - Family History Red Flags09:01 - Who Should Order Genetic Testing11:32 - Variants and Counseling Pitfalls13:30 - Access and Remote Testing Options19:27 - BRCA1 Positive Patient Walkthrough24:52 - Risk-Reducing Surgeries29:11 - Prevention and Screening Limits32:38 - Why Ovarian Cancer Is Hard34:04 - Combining Breast and Gyn Surgery35:41 - Preop Ultrasound and CA-12536:27 - BRCA Timing and HRT Nuance42:32 - Nonhormonal Menopause Options47:14 - Lynch Syndrome Screening Basics54:22 - Endometrial Biopsy Debate56:43 - Insurance and Coverage Pitfalls59:00 - Fertility Preservation and REI01:01:41 - Cascade Testing01:02:45 - Conclusion --- More about this episode Dr. Guo and Dr. Ciccone discuss how careful family history can identify patients who may benefit from genetic evaluation and highlight key red flags, including a family history of ovarian cancer, breast cancer at age 50 or younger, and metastatic prostate cancer. They explain the role of genetic counseling, including pre- and post-test discussions and how to approach variants of uncertain significance. They then cover BRCA counseling and risk-reduction strategies, including the timing of risk-reducing bilateral salpingo-oophorectomy, ongoing salpingectomy trials, and considerations for hysterectomy. Additionally, they touch on pathology protocols, breast cancer screening, and the potential protective effect of hormonal contraception. The doctors address the limitations of ovarian cancer screening and outline patterns suggestive of Lynch syndrome, such as endometrial cancer occurring alongside gastrointestinal or urinary tract cancers. They review the Lynch workup, including tumor mismatch repair immunohistochemistry and MLH1 hypermethylation testing. Finally, they discuss practical considerations like barriers to access, Medicare coverage challenges, fertility preservation referrals, menopause management, and cascade testing in families, including the timing of testing in children. --- Resources NCCN Guidelines: Detection, Prevention, and Risk Reductionhttps://www.nccn.org/guidelines/category_2

As our patients' age progresses, so should our definition of 'recovery'. In this episode of BackTable OBGYN, Dr. Mary Ackenbom, associate professor of urogynecology and reconstructive pelvic surgery at the University of Michigan, is welcomed by host Dr. Amy Park to discuss improving outcomes for older surgical patients. --- SYNPOSIS Dr. Ackenbom shares her journey from studying finance at Ohio State to ultimately specializing in urogynecology. The conversation mainly focuses on perioperative cognitive health, particularly in aging populations, and how conditions like frailty and comorbidities impact surgical risk and recovery. Dr. Ackenbom highlights the importance of individualized patient care, early mobility, enhanced recovery protocols, and prehabilitation in improving postoperative outcomes. The episode also explores the prevalence of postoperative cognitive decline and offers practical insights on counseling and managing older patients undergoing urogynecologic surgery. --- TIMESTAMPS 00:00 - Introduction02:18 - Dr. Ackenbom’s Journey to Urogynecology04:47 - Research on Brain Fog06:18 - Personal Support and Hobbies09:54 - Age vs Frailty in Surgery13:05 - Procedures with Perioperative Complexity16:11 - Counseling on Operative Risk20:10 - ERAS and Earlier Discharge23:35 - Patient Goals and Tradeoffs27:53 - Surgical Clearance and Preop Consults33:30 - Prehabilitation Basics36:24 - Minimally Invasive Surgery Benefits37:15 - Surgical Cognitive Complications with Age41:42 - Finding the Surgery Window46:05 - Cognitive and Frailty Screening50:01 - Guidelines for Perioperative Care52:52 - Future Research 54:07 - Conclusion --- RESOURCES Incidence of postoperative cognitive dysfunction in older women undergoing pelvic organ prolapse surgeryhttps://pubmed.ncbi.nlm.nih.gov/32827107/ ACS NSQIP/AGS Optimal Perioperative Care of the Geriatric Patienthttps://www.facs.org/media/y5efmgox/acs-nsqip-geriatric-2016-guidelines.pdf

Trouble with bowel or bladder function? It might be time to partner with a specialist. In this episode of BackTable OBGYN, hosts Dr. Amy Park and Dr. Mark Hoffman are joined by Dr. Shannon Wallace and Dr. Anna Spivak, experts from the Cleveland Clinic specializing in pelvic floor disorders. They dive into the complex world of combined colorectal and urogynecological issues, discussing the importance of a multidisciplinary approach to treat conditions such as rectal prolapse, constipation, and incontinence. --- SYNPOSIS The conversation covers detailed diagnostic methods like manometry and defecography, various surgical options, and the crucial role of pelvic floor physical therapy in patient recovery. They also provide insights into setting up effective multidisciplinary clinics and emphasize the need for teamwork and administrative support in delivering optimal patient care. This episode is a valuable resource for both specialists and generalists aiming to enhance their understanding and treatment of pelvic floor dysfunctions. --- TIMESTAMPS 01:05 - Introduction05:40 - Multi-Compartment Prolapse & Second Opinions08:14 - Pelvic Floor Compartments Explained10:36 - When Internal Prolapse Becomes Surgical11:56 - Incomplete Emptying, Splinting, Fragmentation & Leakage16:55 - Fluoro vs MRI and When to Order It23:47 - Anorectal Manometry26:56 - Physical Therapy, Biofeedback, Meds, Injections, & Motility Workup29:08 - Robotic Mesh Repairs vs Vaginal/Perineal Approaches34:43 - When (and Why) to Consider Biologics36:46 - Resection Rectopexy38:10 - Treating Ehlers-Danlos syndromes (EDS) & Eating Disorders42:55 - Pelvic Floor PT After Surgery and Recovery Timelines47:29- Perineal Prolapse Repairs (Altemeier vs Delorme)49:53 - Symptom Improvement vs Retraining the 'New Normal'52:20 - Fecal Incontinence & Sacral Neuromodulation57:08 - Diarrhea-Driven Incontinence58:56 - Building a Multidisciplinary Pelvic Floor Program01:04:04 - Conclusion --- RESOURCES Pelvic Floor Disorders Consortium (American Society of Colon & Rectal Surgeons) https://fascrs.org/Web/Web/My-ASCRS/Education/Pelvic-Floor-Disorders-Consortium.aspx

From diagnosis to treatment, hysteroscopy plays a pivotal role in modern gynecologic care. In this episode of BackTable OBGYN, Dr. Christina Salazar, a minimally invasive gynecologic surgeon and associate professor at Dell Medical School in Austin, Texas, joins hosts Dr. Mark Hoffman and Dr. Amy Park to discuss the value of hysteroscopy in managing complex intrauterine pathology. --- SYNPOSIS Dr. Salazar shares her introduction to hysteroscopy and the mentors who shaped her early training. She discusses her expertise in hysteroscopic surgery and its broad applications, with a focus on the complexities of Asherman syndrome, dysmorphic uteri, and the critical role of endometrial health assessment. The conversation also covers surgical techniques, post-operative care, and emerging technologies in hysteroscopic and reproductive care. Dr. Salazar concludes by emphasizing the need for improved classification systems for Asherman syndrome and future directions in reproductive health innovation. --- TIMESTAMPS 00:00 - Introduction05:34 - Training and Mentorship in Hysteroscopy11:21 - Dr. Salazar's Practice and Techniques14:00 - Challenges and Trends in Surgical Practices18:58 - Referral Practices and Advanced Hysteroscopy21:58 - Understanding Dysmorphic Uterine Population24:08 - T-Shaped Uteri Description26:09 - Hysteroscopic Metroplasty: Methods and Risks29:17 - Innovations in Hysteroscopy32:38 - Value of Ultrasound in Hysteroscopy36:35 - Post-Operative Management and Estrogen Therapy39:23 - Challenges and Future Directions in Hysteroscopy44:23 - Concluding Thoughts --- RESOURCES The epidemiology, clinical burden, and prevention of intrauterine adhesions (IUAs) related to surgically induced endometrial trauma: a systematic literature review and selective meta-analyseshttps://academic.oup.com/humupd/article/31/6/588/8248883 Hysteroscopy Newsletterhttps://hysteroscopynewsletter.com/

Learn how ACOG turns advocacy into action, supports clinicians, and creates community. Plus, get tips on how you can get involved. In this episode of BackTable OBGYN, Dr. Sivani Aluru from Endeavor Health in Chicago shares her journey and involvement with ACOG, from her medical school days to her current role as the national JFCAC Chair. --- SYNPOSIS Dr. Aluru describes her experiences on various task forces, including the ACOG 75th Anniversary Task Force, and emphasizes the importance of education, advocacy, and community within the organization. She offers insights into the challenges and benefits of participating in ACOG, provides tips for getting involved, and highlights the ongoing efforts to address critical issues in women's health. The conversation also touches on adapting to the changes brought by the COVID-19 pandemic and the value of staying organized and connected in a demanding field. Find out what ACOG is working on, how it benefits patient care, how it benefits provider education and resources, how it builds community. Get involved! Go to meetings! There are so many roles. If you don’t get your role on the first go, try again. Showing up is huge! --- TIMESTAMPS 00:00 - Introduction03:41 - Residency and Early Involvement in ACOG07:29 - Advocacy and Government Affairs18:40 - Balancing Professional and Organizational Work24:28 - Listening to Members' Needs26:36 - Challenges and Value of ACOG Membership29:00 - The Importance of In-Person Meetings34:45 - ACOG's Legislative Advocacy and Future Plans35:48 - Advice for Getting Involved with ACOG40:16 - Conclusion --- RESOURCES ACOG (American College of Obstetricians and Gynecologists)https://www.acog.org/ ACOG CAARE Delegation https://www.acog.org/about/diversity-equity-and-inclusive-excellence/collective-action-strategy/caare-delegation ACOG CREOG (Council on Resident Education in Obstetrics and Gynecology) https://www.acog.org/education-and-events/creog/about

Some of the biggest advances in women’s health start with a simple question: why hasn’t this been fixed yet? In this episode of BackTable OBGYN, Dr. Tess Kim, a minimally invasive gynecologic surgeon at Massachusetts General Hospital and the founder of Fruits of Labor, a women's health medical device innovation company, joins host Dr. Amy Park. --- SYNPOSIS Dr. Kim’s educational journey began with medical school at Emory, followed by residency at Beth Israel Deaconess Hospital, and fellowship training at MGH. She discusses the founding of Fruits of Labor, which began with the Perry Peach—a warm compress device designed to reduce severe perineal tearing during childbirth and now acquired by Medicines360. Dr. Kim also talks about her creative process, the importance of addressing historically neglected areas in women's health, and the potential impact of her new project, Mellomallows, which aims to reduce discomfort during gynecological procedures such as IUD placement. The conversation concludes with a discussion of the challenges and opportunities in women's health innovation, the significance of supportive networks, and the role of passion and commitment in driving meaningful change. --- TIMESTAMPS 00:00 - Introduction02:03 - The Birth of PeriPeach: Addressing Severe Tearing06:51 - New Medical Devices: Mellomallows08:41 - The Creation and Mechanism of PeriPeach 11:11 - Company Development: Mentorship and Resources17:37 - Pitching Practice and Experience 19:26 - Project Funding and Working with Medicines36021:51 - Advice for Aspiring Innovators23:52 - Concerns About AI in Healthcare26:48 - Innovations in Women's Health29:06 - Challenges in Academic Medicine32:01 - The Importance of Female Innovators34:00 - Forming a Startup in Women's Health36:10 - Parting Advice for Future Innovators37:37 - The Future of Women's Health Innovations40:10 - Conclusion --- RESOURCES Fruits of Labor website:https://www.fruitsoflabormed.com/home PeriPeach website:https://www.peripeach.com/

Fibroid care: how it was, how it’s changing, and where it’s headed next. In this episode of BackTable OBGYN, hosts Dr. Mark Hoffman and Dr. Amy Park welcome minimally invasive GYN surgeon Dr. Arleen Song to discuss the evolving landscape of fibroid care. --- SYNPOSIS Dr. Song, a veteran in the field with nearly 20 years of experience, shares her journey from Michigan to Duke, current treatments in fibroid management, and the importance of personalized care. The team explores new surgical techniques, the role of medical therapies such as Ella GnRH antagonists, and the importance of patient education. They also address challenges such as access to care, the significance of research funding, and the evolving understanding of fibroid genetics and long-term management. This episode provides a comprehensive overview of the state of fibroid care and the strides being made in this vital aspect of women's health. --- TIMESTAMPS 00:00 - Introduction02:21 - Evolution of Fibroid Treatment05:50 - Advancements in Minimally Invasive Surgery08:47 - Longitudinal Care and Personalized Treatment13:00 - Modern Approaches to Fibroid Treatment21:15 - New Technologies and Procedures27:01 - Preoperative Assessment and Imaging31:15 - Preoperative Counseling and Risk Assessment33:14 - Medications for Fibroid and Endometriosis37:59 - Challenges in Access to Care38:43 - Racial Disparities in Fibroid Research42:35 - The Importance of Specialized Care49:22 - Future Directions in Fibroid Treatment

Vaginal rejuvenation is often misunderstood, misrepresented, and overdue for honest conversations in medicine. In this crossover episode between BackTable Urology and BackTable OBGYN, Dr. Nirit Rosenblum, a urology and OBGYN professor at NYU Langone Medical Center, is joined by Dr. Karyn Eilber, Chair of the Cedars-Sinai Medical Group Department of Surgery, and Dr. Ariana Smith, Chief of Urology at Pennsylvania Hospital. Together, they bring a multidisciplinary lens to one of the most misunderstood areas of women’s health. --- This podcast was developed in collaboration with: Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU)https://sufuorg.com/home.aspx --- SYNPOSIS The discussion revolves around the broad definition of vaginal rejuvenation, distinguishing between medical and cosmetic interventions. They address common misconceptions, the roles of different health professionals, and emphasize the importance of pelvic floor physical therapy and the appropriate use of systemic and vaginal estrogen therapy. The conversation also highlights critical gaps in research surrounding laser and radiofrequency interventions, underscoring the need for stronger evidence, clearer patient education, and continued advocacy around menopause care and sexual function. --- TIMESTAMPS 00:00 - Introduction02:11 - Defining Vaginal Rejuvenation04:35 - Common Procedures and Misconceptions10:04 - Insurance and Coverage of Procedures12:04 - Laser and Radiofrequency Therapies18:10 - Vaginal Estrogen and Lift of Black Box Warning19:59 - The Role of Systemic Hormone Therapy26:56 - Vaginal Rejuvenation Misconceptions32:21 - Pelvic Floor Physical Therapy and Timing of Procedures34:24 - Regional Variations in Therapeutic Availability38:40 - Gender Inequity in Healthcare40:16 - Final Thoughts --- RESOURCES Joint Report on Terminology for Cosmetic Gynecologyhttps://journals.lww.com/fpmrs/abstract/2022/06000/joint_report_on_terminology_for_cosmetic.2.aspx

Who should consider fertility preservation, when is the right time, and what are the risks? In this episode of BackTable OBGYN, Dr. Amy Park interviews Dr. Mindy Christianson, the section head of Reproductive Endocrinology and Infertility at the Cleveland Clinic, who shares how fertility preservation is evolving for patients planning families and those facing fertility-impacting treatments. --- SYNPOSIS Dr. Christianson discusses her journey into the field of fertility preservation, inspired by an early encounter with a breast cancer patient. The conversation covers various aspects of fertility preservation, including the preservation of eggs, embryos, ovarian and testicular tissue, and planned fertility preservation. Dr. Christianson elaborates on the protocols, patient demographics, and the evolving collaboration between oncology and reproductive endocrinology. The discussion also highlights technologies like ovarian tissue transplantation and in vitro maturation, as well as practical tips for healthcare providers on improving patient access to fertility preservation services. --- TIMESTAMPS 00:00 - Introduction03:34 - Understanding Fertility Preservation07:56 - Consultation Process for Fertility Preservation17:36 - Advancements in Egg Freezing Technology25:55 - Egg Freezing Recommendations26:34 - Collaboration Between Oncology and REI26:52 - Pediatric Oncology and Fertility Preservation28:58 - Ovarian Tissue Transplantation33:17 - Uterine Transposition Surgery40:05 - Gene Editing and Fertility Preservation43:01 - Financial and Emotional Aspects of Fertility Preservation48:02 - Practical Advice for OBGYNs51:12 - Resources and Final Thoughts --- RESOURCES Livestrong Fertilityhttps://livestrong.org/how-we-help/livestrong-fertility/ Resolve: The National Infertility Associationhttps://resolve.org/ Society for Assisted Reproductive Technologyhttps://www.sart.org/ American Society for Reproductive Medicinehttps://www.asrm.org/