Gynecologic Cancer Awareness Month

September 28, 2020

Information

September 27, 2020

Yale Cancer Center

visit: http://www.yalecancercenter.org

email: canceranswers@yale.edu

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00:00Support for Yale Cancer Answers
00:02comes from AstraZeneca providing
00:05important treatment options for women
00:08living with advanced ovarian cancer.
00:10Learn more at astrazeneca-us.com.
00:14Welcome to Yale Cancer
00:16Answers with your host
00:17Doctor Anees Chagpar.
00:19Yale Cancer Answers features the
00:21latest information on cancer care by
00:23welcoming oncologists and specialists
00:25who are on the forefront of the
00:27battle to fight cancer. This week
00:29it's a conversation about ovarian
00:31cancer with doctor Elena Ratner.
00:33Doctor Ratner is an associate professor
00:35in the Department of obstetrics,
00:37gynecology,
00:37and Reproductive Sciences at
00:39the Yale School of Medicine
00:41where doctor Chagpar is a
00:43professor of surgical oncology.
00:45Maybe you could start off by telling
00:47us a little bit more about ovarian cancer.
00:50I know that a lot of people have heard
00:53about it, but they may not know as much
00:55about it as they know about other cancers.
00:58So what exactly is it?
00:59How common is it, and who
01:01gets it?
01:03Perfect questions to start with
01:05and it is so wonderful to be able
01:07to discuss this with you today and
01:09with our listeners as it is ovarian
01:12cancer month and we're trying to
01:14raise awareness for this cancer.
01:15Ovarian cancer overall
01:18is not very common,
01:20only 1.4% of lifetime risk
01:22of getting the cancer,
01:24and this cancer is more prevalent
01:27in certain groups.
01:28Genetic predisposition plays a very
01:30important role as to some other
01:33factors that I'm sure you and I will
01:36discuss today during our conversation.
01:39But the important thing about
01:41ovarian cancer is that unfortunately
01:44it still continues to be
01:46a very deadly cancer.
01:4724,000 women get this cancer yearly
01:50in the United States and as high as
01:5316,000 women die from this cancer
01:55and the reason for that is because,
01:58unfortunately,
01:58this is a cancer that is very
02:01difficult to diagnose early.
02:03We used to say that this is the cancer
02:07that whispers,
02:08and during our conversation today
02:10I would like to prove to you that
02:13is not the case, but nevertheless,
02:15these cancers, unfortunately
02:17are frequently diagnosed at a later stage.
02:20And even though most of them respond
02:22very nicely to chemotherapy upfront,
02:24this is a very, very smart
02:26cancer and unfortunately they
02:28learn how to resist the treatment
02:30that we give them.
02:31And again, during our conversation today,
02:33I would like to discuss with you
02:35as to how the treatment for this
02:38cancer is really improving,
02:40and there's so many new treatments
02:42and new ways of management that
02:44we are using now that we didn't
02:47have six months ago, two years ago.
02:49So the
02:50outlook for this cancer looks very bright,
02:53but this is a very important
02:54cancer to be aware of because we,
02:57as women are our best advocates
02:59and we are fighters for our own
03:01lives and our own bodies.
03:02And that's why it's very important to know
03:05about this cancer and to know
03:07what symptoms to look out for.
03:09A lot to cover
03:12in this show and I'm really
03:15excited to talk about this.
03:17So let's start with risk factors.
03:19Who gets ovarian cancer?
03:21Are all women equally at risk or are
03:23there some things that really predispose
03:26some women to getting ovarian cancer?
03:28You mentioned for example, genetics.
03:32Yes, there's definitely factors that
03:34increase your risk of getting ovarian cancer.
03:37We now understand that genetics
03:39play such an important role in
03:42the old cancers most likely,
03:44but definitely for ovarian cancer,
03:46and it's not just for women who have
03:50family history of ovarian cancers.
03:52We know that there's genetic mutations
03:55that increase your risk of ovarian
03:57cancer and breast cancer and pancreatic
04:00cancer and melanoma and prostate cancer in men.
04:03When we talk about genetic
04:06predisposition and when I talk
04:08to women about their risks,
04:10I don't just ask whether somebody
04:12in the family had ovarian cancer,
04:14even though of course that itself
04:16would be a risk factor,
04:18but it's more what other cancers
04:20run in the family. Is there a
04:23family member who had breast cancer?
04:25Is there anybody who is a male who
04:27had breast cancer and those
04:30cancers are suspicious for BRCA
04:32gene mutation.
04:33There's been quite a bit in the
04:36news about the BRCA gene mutation over
04:38the past five years or so,
04:40as you remember,
04:41Angelina Jolie,
04:42who has one of these mutations
04:44and a number of different
04:46New York Times Editorials,
04:48talking about her experience
04:50with the Mutation.
04:51So it's called the Angelina Jolie effect.
04:54And now there's much more known about
04:56this mutation and about how women with
04:59this mutation have a higher risk of
05:02developing ovarian cancer and breast cancer,
05:04for example.
05:05But there's a mutation is
05:07just one of those mutations.
05:09There's many other mutations that
05:11predispose you to getting these cancers.
05:14That's why nowadays it is so important
05:16to know your family history and to
05:19know where you come from and to know
05:23what possible genetic mutations you
05:25might have that might predispose you
05:28to having higher risk of different
05:30cancers. In particular, ovarian cancer.
05:32So that's important.
05:34But you know, for women who may
05:37not have a BRCA gene mutation
05:39running in their family, or
05:42who may not have a family history of
05:44any cancers or for those who really
05:47don't know their family history,
05:49maybe they were adopted
05:51or have come from families where
05:54they really haven't gotten any of
05:56that knowledge passed on to them
05:59before people passed away,
06:01are there other risk factors that
06:03also play into your ovarian cancer
06:05risk?
06:08Yes, and so much of this
06:14is truly individualized.
06:15You know there's no formula.
06:17There's no specific check list.
06:19It is really just talking to women and
06:22kind of understanding what are their risks.
06:25What are the protective things that
06:27they bring to the table when we
06:30look for the risks of ovarian cancer.
06:33So for example,
06:34women who have had a lot of children,
06:37it is very protective.
06:38For anybody who has had five children,
06:42that decreases their risk to 50%.
06:45Anybody who breastfed each one
06:48of their five children for five
06:51years cumulatively has a decreased
06:53risk of ovarian cancer by 50%.
06:56Women who use birth control pills, those
07:00are incredibly protective for ovarian cancer.
07:03Every opportunity I get and every
07:05girlfriend that I talk to,
07:08I always tell
07:09my listeners and my patients and
07:11my friends
07:15try to use birth control
07:17pills for five years if they can.
07:20Anybody who uses birth control pills
07:22for five years decreases their
07:24risk of ovarian cancer by 50%.
07:27Anybody who uses it for 10 years
07:29decreases it for as high as 80%.
07:32Anybody who uses for 15 years
07:34decreases it for as high as 90%.
07:37So the benefit is really quite
07:39astounding as to what we can do.
07:42Women who had their
07:44fallopian tubes removed,
07:46in the older days we used to
07:49do tubal ligations.
07:50Now,
07:51in many cases we actually would
07:53take out the fallopian tube and
07:55that significantly decreases your
07:57risk for as high as 70%.
08:00The hysterectomy,
08:00even if there is some left behind
08:03that significantly decreases their risk,
08:05so there's a number of different
08:08protective factors that one can
08:10do to try to decrease the risk.
08:17There's two different ways that
08:19we now think about ovarian cancer,
08:22the traditional theory of ovarian
08:23cancer was that the more times that
08:26the woman ovulates, the more
08:28risk of developing cancer of the
08:30ovaries and that's why anytime when
08:33you are not ovulating whether
08:35it's pregnancy or breastfeeding
08:36or your birth control pills,
08:38that decreases your risk.
08:39The newer thought is that ovarian
08:42cancers might not actually
08:43be ovarian cancers at all.
08:45They actually might be fallopian
08:47tube cancers that then subsequently
08:49spread to the ovaries and that's
08:51why it is so important that
08:53if you're having hysterectomy,
08:55fallopian tubes do not have a purpose.
08:58Ovaries,
08:58of course do because they give you hormones,
09:01but fallopian tubes,
09:02the only purpose
09:04is for pregnancy so many times
09:06where women have hysterectomies
09:08their ovaries left behind.
09:10It is very,
09:11very important that the fallopian
09:13tubes are removed as well.
09:15Or, if the fallopian tubes are tied,
09:18that it gets
09:20removed rather than just tying
09:22it, because we now know that a great
09:24number of these cancers originate
09:26in the fallopian tubes. So if those
09:30are removed, then the risk
09:31is significantly decreased.
09:33All great information.
09:34Now let's suppose you've tried to
09:36minimize your risk, but still,
09:38one of the things that you
09:41mentioned is that the part of ovarian
09:44cancer that causes death is because
09:47it's caught late, and
09:50we know for many cancers that there
09:52is effective screening, right?
09:54We're heading into October.
09:56Breast cancer awareness.
09:57We all know that mammograms help us find
10:00breast cancer early.
10:02What do we have
10:03or do we have anything in terms
10:06of screening to help women to
10:09find ovarian cancer early?
10:11So that's
10:11exactly the trouble with ovarian cancer,
10:14and that's why we talk so much
10:16about ovarian cancer prevention with
10:19identifying risks and trying to do
10:21anything you can to decrease your risk,
10:24because unfortunately,
10:25we do not have as good of
10:28a test for ovarian cancer
10:30as we do for breast cancer with
10:33mammograms and there
10:36is a lot of literature that shows that
10:40there's really no benefit to doing
10:44routine ultrasounds for normal risk
10:46population because unfortunately
10:48ultrasounds even in combination with
10:51a tumor marker blood test called CA 125,
10:54there's literature that in the
10:57normal population that does not
11:00help you detect cancer early.
11:02And on the contrary,
11:04pushes women to have more
11:06unnecessary surgery.
11:07But that's not the case for high risk women.
11:11For women who are at higher risk for whatever
11:15risk factors that we discussed previously,
11:18then ultrasounds combined with this
11:21blood test called CA 125 are a benefit,
11:25but unfortunately still very limited.
11:27That's why it is so important for
11:31this ovarian cancer awareness
11:33to exist and for women to know
11:35the signs and symptoms for
11:37ovarian cancer because that is
11:39really the best screening or the
11:42best early detection and risk
11:44reduction is through awareness of the
11:46symptoms and listening to your body.
11:49And so one of the things
11:51that you said at the outset is that
11:54for many years ovarian cancer was
11:56thought about as the cancer that
11:59whispers because so many of the signs
12:02and symptoms may be things that
12:04women may shrug off,
12:06but they may not be really aware of as
12:09being potential red flags for ovarian cancer.
12:12So tell us more about those signs and
12:15symptoms that women should be aware
12:18of to be thinking about.
12:21And when should they be going
12:23in and seeing their gynecologist?
12:25For generations we used to say,
12:28there's just nothing you can
12:30do for ovarian cancer. It's what it is.
12:33You just cannot diagnose it early
12:35because there's no early symptoms,
12:38but we know that
12:39that is not the case.
12:42Multiple very good studies have
12:44been published to show that yes,
12:47the majority of women, 97% percent of
12:49women with advanced ovarian cancer,
12:52will have symptoms,
12:53but 89% of women with stage one and two
12:58cancers will also have have symptoms.
13:01The trouble is exactly how you said
13:05that these are also normal symptoms that
13:08these are symptoms of perimenopause.
13:11Is this a symptom of having a period?
13:15There's hormonal changes so the
13:17majority of the women who have the
13:20symptoms are actually completely normal
13:23and the symptoms that we're talking
13:26about is bloating,
13:29some Constipation,
13:30some diarrhea, bladder symptoms, weight gain.
13:32Clothes not fitting well.
13:34Feeling like you need to get
13:36bigger clothes because they're
13:38not fitting well around the waist.
13:40The important thing again,
13:41and this is I think the most important
13:44thing of our conversation today is
13:46the great majority of the women
13:49who are listening to this today we all
13:51experience symptoms and a great majority of
13:54these symptoms are completely normal.
13:56The symptoms that we need to pay attention
13:58to are the symptoms that don't just
14:01happen during periods or during ovulation.
14:03Those are the symptoms that happen
14:06every single day for two weeks,
14:08and also symptoms
14:10that happen together,
14:11let's say bowel and bladder symptoms,
14:13bloating and bladder symptoms.
14:15Those are the symptoms to pay attention to.
14:20We are going to dig into all of those
14:23symptoms and how we can actually
14:25make a diagnosis right after we take
14:28a short break for a medical minute.
14:31Please stay tuned to learn more
14:33about the treatment and diagnosis of
14:36ovarian cancer with my
14:37guest doctor Elena Ratner.
14:39Support for Yale Cancer Answers comes
14:41from AstraZeneca providing important
14:43treatment options for patients with
14:45different types of lung, bladder,
14:47ovarian, breast and blood cancers.
14:49More information at astrazeneca-us.com.
14:52This is a medical minute about breast cancer,
14:55the most common cancer in
14:57women. In Connecticut alone
14:59approximately 3000 women will be
15:01diagnosed with breast cancer this year,
15:03but thanks to earlier detection,
15:05non invasive treatments,
15:06and novel therapies,
15:08there are more options for patients to
15:10fight breast cancer than ever before.
15:13Women should schedule a baseline
15:15mammogram beginning at age 40 or
15:17earlier if they have risk factors
15:20associated with breast cancer.
15:21Digital breast tomosynthesis or 3D
15:24mammography is transforming breast screening
15:26by significantly reducing unnecessary
15:28procedures while picking up
15:30more cancers and eliminating
15:32some of the fear and anxiety,
15:35many women experience.
15:36More information is available
15:38at yalecancercenter.org.
15:39You're listening to Connecticut public radio.
15:43Welcome
15:43back to Yale Cancer Answers.
15:45This is doctor Anees Chagpar
15:47and I'm joined tonight by
15:49my guest doctor Elena Ratner.
15:51We're talking about ovarian cancer
15:53and right before the break Elena,
15:55you started to tell us some of
15:57the signs and symptoms that women
15:59should really be aware of in terms
16:01of trying to find ovarian cancer
16:04early because we simply do not
16:06have really good screening tests.
16:08So it's really up to women to
16:10pay attention to their bodies.
16:12But one of the things that
16:14struck me was that
16:16many of the symptoms you mentioned,
16:18a little bit of bloating,
16:19a little change in bowel
16:21habits or bladder function,
16:22a little bit of weight
16:24gain, your pants not fitting,
16:26I mean those happen to all
16:28of us all the time right?
16:30You go out for a big meal and you
16:32feel a little bloated after that.
16:35You might have a little bit
16:37of Constipation or diarrhea.
16:38Your pants don't fit right and
16:40you think Oh my God,
16:41I'm gaining weight.
16:44But should women be going
16:46to their gynecologist
16:47every time one of those things
16:49happens? Tell us more about
16:51what are really the triggers
16:52that you would say you know what
16:55this has gone on a bit too long,
16:57you really need to get to your gynecologist,
17:00you need to advocate for
17:01yourself that this is something
17:03that needs to be looked into.
17:07Yes, that's exactly correct.
17:09You really nailed it
17:11when we discussed before
17:15all of us experiencing it.
17:17It's totally normal.
17:18The key is to know what is normal
17:20for you and then be aware when
17:23something happens is not
17:25within what's norm for you.
17:27So usually what I tell women
17:29is pretty much consistent symptoms
17:31when you wake up every single day,
17:34and it's something that you are
17:36aware of constantly and that
17:38lasts for two to three weeks.
17:40That is the time to just get checked out.
17:44I'm a huge proponent that just
17:46talking to somebody or getting things
17:49checked out is of such benefit.
17:51The interesting thing is when
17:53I speak to women with ovarian
17:55cancer and then in their minds they
17:58go back to when everything began.
18:06It just wasn't considered by
18:08them to be anything that they
18:10should really pay attention to.
18:14The other important thing
18:16is that a lot of women,
18:18when these things happen,
18:19actually do not go to gynecologist.
18:21Most women go to urologists because
18:23they having bladder symptoms.
18:25They go to a gastroenterologist because
18:27they're getting bowel symptoms, interestingly
18:30a lot of women go to chiropractors
18:32because they having this discomfort
18:34and they're trying to make that better.
18:36So we actually do
18:38education not just to women,
18:40but to providers.
18:41I actually do tons of talks
18:44in the state of Connecticut to
18:46different physicians and different providers.
18:48We have this designation that
18:51we created to certify physicians and
18:53providers who know how to
18:56identify symptoms for varying cancer,
18:59because unfortunately not all
19:01of this is just women symptoms.
19:03Many times,
19:04women go to the physicians
19:06appropriately because they know that what
19:09they are experiencing is not normal,
19:11and that provider checks out this
19:13area, and clears that up.
19:16But unfortunately they don't
19:17piece things together,
19:19and this delay in diagnosis continues,
19:20and this is actually a very persistent problem,
19:22and something that a lot of women
19:25feel so passionate about
19:27that we started this whole program
19:29where we are doing a lot of Education,
19:31not just for women,
19:32but for providers to make sure
19:34that they know exactly what
19:35symptoms and how to identify it,
19:37and when to refer and
19:39when to order an ultrasound.
19:41But you know,
19:42at the end of the day this should
19:44not be yet another thing that
19:46we don't have to worry about.
19:48You know it's important to know
19:50your body and listen to your body.
19:52It's important to be your advocate,
19:54but at the end of the day
19:56we need to assure that providers
19:58also know the symptoms and know how
20:00to piece things together and
20:02take best care.
20:05But I can imagine that many
20:07providers are thinking
20:09hings are common and so really
20:11having patients say,
20:14I agree that things are common,
20:17but this isn't common for me,
20:19so I think that while you're quite
20:22right that it's important that providers
20:24really know the signs and symptoms,
20:27it's also really critical that
20:29women advocate for themselves.
20:30So Elena is the first step in diagnosis
20:33getting an ultrasound or CT?
20:35What should women expect
20:37when they go to their family doctor
20:40or their gynecologist or their
20:42GI doc or somebody
20:45with these vague symptoms and we're
20:47trying to rule out ovarian cancer.
20:49Yeah, so the important
20:51part is to be seen by a gynecologist
20:54and to do a pelvic exam.
20:56Those are always very important
20:58and there's a lot of information
21:00that we as providers can get
21:02out of a physical examination.
21:04Pelvic examination. Second step would
21:07be together just an ultrasound.
21:09You know cat scans and mris are
21:11usually not necessary and actually
21:13not the best test for these at all.
21:15So we would get as a trans
21:18vaginal ultrasound.
21:18And usually we would not do tumor marker
21:21unless we have two 2 markerS called CA
21:24125 and it is not a great test.
21:26There's a lot of times that is
21:28falsely positives or false negative
21:30so we won't order it always.
21:32We order it in circumstances,
21:33but only after the ultrasound.
21:35So that's what you would expect.
21:38Great and
21:39let's suppose you do that.
21:40You've been having these vague symptoms.
21:43You go to your doctor.
21:44Your doctor says, you know,
21:46maybe we ought to send you
21:49to your gynecologist.
21:50The gynecologist does a pelvic
21:51exam and a trans vaginal ultrasound,
21:54and they think that they
21:55feel something or they
21:57see something in the ovary.
21:59Now, what happens?
22:01So women with ovarian cancer,
22:04women for whom we suspect of having cancer,
22:06are managed usually by team of doctors.
22:09You know, the gynecologist,
22:11of course plays a very important role
22:14and then works together with other
22:16colleagues like myself,
22:18who specializes in treatment and surgeries
22:21and chemotherapy for these cancers.
22:23So the point I wanted to make is
22:26how much better things are today
22:28than they have been in the past.
22:31We now truly provide
22:33personalized care.
22:43I now can do surgeries laparoscopically
22:45or robotically where women
22:47can go home the same day whereas four
22:50years ago they will stay in the
22:53hospital for a week if not longer.
22:56So surgically
22:57if you were concerned about ovarian
23:00cancer you would have a hysterectomy
23:02and then you would get a
23:05biopsy and we would look
23:08under a microscope,
23:09to try to identify the cells and
23:11that's how a diagnosis would be made,
23:14but everything now starts
23:16from that first step where you
23:18have surgery and again now we do
23:20everything truly in the personalized
23:22fashion where most women are
23:24now great candidates for this
23:26robotic surgery and they
23:28go home
23:30same day and they go back to work
23:33within a week and then extending to
23:36chemotherapy where we no longer treat
23:38women the same way that we used to treat.
23:41We no longer treat somebody the
23:44same way just because they have
23:46the same cancer as somebody else.
23:48We truly study
23:50their mutations and truly understand what
23:52is driving and causing the cancer in
23:55particular women,
23:56and then the treatment that we recommend
23:58and then we provide is
24:00based specifically on that.
24:02So we use a lot of targeted therapies.
24:05We use a lot of pills nowadays.
24:08You know some chemotherapies
24:09are still through IV how they used to be.
24:13But a lot of them now are just oral
24:16pills that you don't even have
24:18to come into the office to get.
24:21You can get from home.
24:23There's immunotherapy.
24:24There's a lot of these targeted achievements,
24:26again specifically for that patient,
24:28and I think that's the key to success.
24:31And more and more
24:32of these cancers are going to be cured.
24:35So that's really encouraging.
24:37I want to take a step back though,
24:39so at the point where you've gone
24:42to the gynecologist, they felt
24:44something they've done an ultrasound.
24:46in many of the cancers
24:48that we talk about on this show,
24:50the next step is a biopsy,
24:52but it sounds like that might not
24:54always be the case in ovarian cancer.
24:57Is that right?
24:58Do we always get a biopsy before surgery?
25:00Or do we kind of sometimes just say,
25:03well you're at a certain age.
25:05You can have a hysterectomy
25:07instead and that will accomplish
25:09two goals with one stone.
25:10How does that work?
25:12That's an excellent
25:12question because
25:14in many other cancers
25:15we would not proceed to surgery directly.
25:18We usually will try to get a biopsy.
25:21Ovarian cancer is the exception
25:23to that because of where the
25:26ovaries are and how they are.
25:28We never biopsy ovaries because
25:30you can rupture an ovary and
25:32potentially you can make that worse
25:35if cancer cells are present,
25:37so most of the time if something
25:40looks suspicious on the ultrasound
25:42and pelvic examination,
25:44or if women get a cat scan and MRI,
25:48or there's some sort of imaging
25:50that shows us especially suspicious
25:53we would just remove it.
25:55We would just take out the ovary
25:57and then be able to look at
25:59it at the microscope directly
26:01without the biopsy.
26:02And so when that's done,
26:04is a hysterectomy always
26:05done at the same time?
26:07Or does it matter where the
26:09woman is in her life cycle?
26:11So young woman versus an
26:12older woman, for example?
26:14Or is that just part and parcel of the
26:17same surgery?
26:18Exactly the same as what we talked before,
26:21everything is truly individualized.
26:22I have a lot of women in their
26:2530s who have had this diagnosis
26:27and I would never remove the ovaries
26:29I always allow them to continue
26:31how it was meant to be,
26:34and we certainly can do a lot of these
26:36surgeries and
26:38remove that normal ovary
26:40other things that we have to remove,
26:43but allow them to continue their
26:44normal lives and have normal fertility
26:46and be able to carry pregnancies.
26:48There's times where that's not possible,
26:50but most times with the young
26:53women we find a way to make it happen.
26:56If the woman is older
26:58then yes,
27:01of course we would remove the uterus
27:03as well and do a total hysterectomy
27:06but not the younger women.
27:08And so when you do that surgery,
27:10you had mentioned
27:13that many of these
27:15cancers are not caught early
27:17unfortunately and that's one of the
27:19things that leads to the high mortality
27:22rate associated with ovarian cancer.
27:24How many of these cancers have
27:26spread outside the ovary when
27:28their first diagnosed?
27:30What impact does that have in
27:32terms of treatment and prognosis?
27:36So at this point a lot of them,
27:39the great majority of them 75% or so
27:42spread to outside of the ovary at
27:44the time of diagnosis and because of
27:47that once we complete their surgery
27:50women need some sort of additional
27:53treatment which is usually chemotherapy
27:55or some sort of targeted therapy but
27:58myself among with many other experts
28:01who now spend so much of our
28:04time just doing surgery and not
28:06just doing chemotherapy, but really
28:08providing education to women.
28:15The future will be that more and
28:17more of these cancers will be
28:19found earlier and localized and
28:20surgery will be able to cure them.
28:23The key again,
28:24is just knowing your body and
28:26listening to your body and then
28:28seeing the physicians and seeing the
28:30providers and getting the
28:32care that you deserve, not turning away.
28:44And with that more and more of
28:47these cancers will be found early
28:49and the nature of
28:50this disease will change.
28:52Doctor Elena Ratner is an associate
28:54professor in the Department of obstetrics,
28:56gynecology, and Reproductive Sciences
28:58at the Yale School of Medicine.
29:00If you have questions,
29:01the address is canceranswers@yale.edu
29:03and past editions of the program
29:05are available in audio and written
29:07form at Yalecancercenter.org.
29:08We hope you'll join us next week to learn
29:11more about the fight against cancer.
29:14Here on Connecticut public radio.