The co-leader of the gynecological oncology team, Elena Ratner, MD, MBA, cares for women with ovarian, uterine, cervical, vulvar, and primary peritoneal cancers. That's just how she planned it when she was a young woman.

“I always knew I wanted to care for women,” she said, during a recent conversation on "Yale Cancer Answers" (YCA) on Connecticut Public Radio. “I knew I wanted to help women with cancer, survivors, and previvors, and that passion drives me daily.

“My passion was influenced by personal experiences, such as my dad passing away from cancer when I was little, so my life has always been somewhat marked by that,” she said. “We also work with women at high risk for these cancers and those who are survivors, focusing on quality-of-life issues like menopause and sexuality.”

Following are excerpts from Ratner’s conversation with YCA host Eric Winer, MD, director of Yale Cancer Center, and president and physician-in-chief of Smilow Cancer Hospital.

What should women know about uterine or endometrial cancer?

Post-menopausal vaginal bleeding is a key symptom, and any new bleeding should prompt a visit to a health care provider, as early detection makes these cancers highly curable.

What are the symptoms of ovarian cancer that women should be aware of?

Ovarian cancer often presents with vague symptoms. This is really kind of the most important part of this conversation. Ovarian cancers, unfortunately, continue to be diagnosed at later stages. And that is a big failure for us, as a medical society. Women typically have symptoms for as long as 12 to 18 months. And there’s some literature that says women see five other providers prior to finally being diagnosed. So, we need to watch for a new onset of symptoms that feel different. It’s so hard, because everybody feels those symptoms…but for women who subsequently get diagnosed with cancer, they have multiple symptoms. It’s not just GI [gastrointestinal] symptoms many times a night, and their clothes are not fitting well, and they’re not hungry and their bladder doesn’t feel normal every single day for weeks – it’s all of those things at once.

Can ovarian cancer affect younger women?

Yes, while it’s more common in middle-aged and older women, some types can occur in younger women, especially those with genetic predispositions, family histories of certain cancer in their relatives.

What should women know about genetic predispositions to ovarian cancer?

Family history of cancers like breast, ovarian, melanoma, and prostate can indicate higher risk. Genetic testing can help identify women at risk, allowing for preventive measures.

What preventive measures are available for high-risk women?

First, the very important thing I want bring up is that one of the really good things that we can do for reduction in ovarian cancer and uterine cancer risk is birth control pills. Birth control pills significantly decrease risk of ovarian cancer and that risk reduction is profound. For any woman who takes birth control pills for five years, cumulatively during her lifetime, she can decrease her risk of ovarian cancer by 50%. Birth control pills reduce the risk of ovarian cancer significantly. Also, there are surgical options, including removing the ovaries and fallopian tubes, especially after childbearing is complete.

How has the landscape of cervical cancer changed in recent years?

Cervical cancer has dramatically changed due to advances in HPV [human papillomavirus] vaccines. These vaccines have been crucial in preventing this cancer, and we now have effective screening methods like Pap smears combined with HPV testing. As a cancer surgeon, I can see how the HPV vaccine is saving women every single day. I certainly vaccinated my daughters and I vaccinated my sons because this is not just for the girls. This is also for the boys, and not just for the sake of the boys protecting the women they’re going to be with, it’s also for their benefit [to protect against] oral and anal cancers. And I can tell you, I personally got a vaccine in my 40s when I was able to do so.

It seems that sexuality is a topic that oftentimes patients are reluctant to bring up with their doctors, maybe more so when their doctors are men than women.

The need is profound, as you said. I started a program in collaboration with Mary Jane Minkin, MD, who is an incredible menopause specialist and ob-gyn doctor. We as cancer surgeons, as medical oncologists, we do so much to treat the cancer, and as we’re treating the cancer, we need to do everything we can to support the patient’s ability to live their life in a way that’s good for them. So we have a special program that deals with sexuality, intimacy, and menopause where we take care of women actually with all cancers and even women who are previvors to help with their quality of life in these aspects. There’s all kinds of different aspects of care that we’re able to offer the women in this truly personalized approach. It might be hormones and for the women who are not able to have hormones, there’s naturopathic and homeopathic options.

How does your clinic address sexual health during and after cancer treatment?

Our clinic focuses on survivorship, addressing issues like menopause and sexuality. We offer personalized approaches and therapies to help women maintain a satisfying quality of life.

How does this personalized approach work in practice?

We tailor preventive and treatment strategies to each woman's genetic makeup and personal circumstances, ensuring the best outcomes in preventing and treating gynecologic cancers.