Sen. Patty Murray talks women’s health during visit to Fred Hutch

Glaring disparities in women’s cancers

Gynecologic oncologist and clinical researcher Elizabeth Swisher, MD, who serves as deputy director of the Fred Hutch/University of Washington/Seattle Children’s Cancer Consortium discussed “below the belt” cancers with Murray.

“We’re working on preventing and treating female cancers better,” Swisher said, going on to discuss her EDGE study, aimed at boosting access to genetic testing in both rural and urban primary care clinics.

Funded by the White House Cancer Moonshot Initiative, EDGE compared two methods of screening individuals for familial cancer risk and offering genetic testing in primary care clinics in two different health care systems. Genetic tests are blood tests used to determine if someone has a germline (or inherited) mutation that could potentially drive a cancer, such as a BRCA1/2 mutation that can cause breast, ovarian, prostate and pancreatic cancers. By getting genetic testing for cancer risk into primary care clinics, high risk individuals can be identified, and lives saved though personalized prevention plans. Genetic tests are also used to determine treatment, particularly targeted treatments like a PARP inhibitor, some of which gained approval based on Swisher’s research.

“Liz’s EDGE study is huge because it means it’s possible to take these tests which have been centralized and disseminate them into the community,” explained Nancy Davidson, MD, holder of the Raisbeck Endowed Chair for Collaborative Research and Fred Hutch’s executive vice president of clinical affairs. “So now everyone has access to these genetic tests which they can use to better their health and maybe even to make treatment decisions.”

Swisher also talked about cancers caused by viral infections, such as human papillomavirus.

“Prevention is a huge part of cancer care,” Swisher said, “but even in this country we are behind on HPV vaccination, which can pretty much eliminate cervical cancer altogether. There’s a global push to eliminate it, but we can’t even eliminate it in our own country.” Read about Fred Hutch research that laid the groundwork for the HPV vaccine.

Cervical cancer rates are actually increasing in states that refuse Medicaid expansion, Swisher said. And endometrial cancer rates are “skyrocketing,” especially in Black women, even though other cancer mortality rates continue to drop.

“There are a lot of disparities in female cancers,” she said. “Many women don’t realize that no amount of bleeding after menopause is normal. We’re trying to address awareness and education as well as design better diagnostics. All the endometrial studies were done in white women but we’ve found the tools used for diagnosing this disease have much lower sensitivity in Black women. It’s very much a health equity issue.”

These stark inequities led Swisher’s colleague, gynecologic oncologist Kemi Doll, MD, to actually build a network in order to elevate both research and patient care and support.

“When Kemi realized there was no advocacy organization for Black women with endometrial cancer, she created one,” Swisher said. “She started ECANA Women in order to research exactly why the cancer rates in this group continue to rise. We’re trying close that gap.”

Preventing metastatic breast cancer

Women have been directly responsible for moving the needle in a big way in breast cancer research, as well, per translational researcher Cyrus Ghajar, PhD, director of Fred Hutch’s Center for Metastasis Research eXcellence (MET-X) and holder of the Peter S. Lefkarites Memorial Endowed Chair.