Preventing Women's Cancers
Dr. Valena Wright, oncology surgeon specializing in women’s cancer, shares her stand for prevention. In a world where cancer seems out of control, she shares her own story of losing one sister and nearly another to cancer and what she’s doing to prevent this heartbreak from impacting other families.
Referenced in the Show
“It’s Time You Knew, the Power of Your choices to Prevent Women’s Cancer” by Valena Wright
Articles tracking cholesterol, homocysteine, blood pressure being more correlated to lifestyle?
Dr. Valena Wright’s Bio
Valena Wright, MD is a women’s wellness expert and board certified gynecologic oncologist at Beth Israel Lahey Health and Hospital in Boston, MA with over 25 years of experience. She is a member of The American College of Obstetrics and Gynecology, The Society of Gynecologic Oncology, and The American College of Surgeons, and was previously President of the New England Association of Gynecologic Oncology.
Valena completed her medical training at Dalhousie University in Halifax, Nova Scotia as well as postgraduate training at Brigham and Women’s Hospital, an affiliated Harvard teaching hospital. She has been recognized numerous times by Castle Connolly Regional Top Doctors List, Boston Magazine, North Shore Magazine, and as an Exceptional Women in Medicine. She teaches as an Adjunct Clinical Associate Professor of OB/GYN at Boston University School of Medicine.
When her sister, Debbie, passed away from Stage IC ovarian cancer, it strengthened Valena’s medical philosophies to encourage proactive cancer prevention in women to hopefully avoid a cancer diagnosis altogether.
Valena is a proud mother, sister and advocate with dual US and Canadian citizenship.
Full Transcript
Sarah Marshall, ND: Welcome to HEAL. On today’s episode, Dr. Valena Wright, oncology surgeon specializing in women’s cancer, shares her stand for prevention. In a world where cancer seems out of control, she shares her own story of losing one sister and nearly another to cancer and what she’s doing to prevent this heartbreak from impacting other families. I’m your host, Dr. Sarah Marshall.
(music)
Sarah Marshall, ND: Welcome to Heal. We've got Valena Wright, a medical doctor from Boston who, you know what, 25 years of experience in the field of gynecology and obstetrics, is that right?
Valena Wright: That's right. Except I am sub-specialized and I practice in gynecologic oncology.
Sarah Marshall, ND: so awesome, really specifically.
Valena Wright: Yeah, we do obstetrics and gynecology first. And then as a fellowship, we do three more years in training to deal with women's cancers, surgical treatment, chemotherapy, diagnosis, screening…
Sarah Marshall, ND: Yeah. So like your day to day, are you more office visits? More OR? Both? Like, what does that look like?
Valena Wright: So typically I operate two and a half days a week and the rest of the time I'm in the clinic, seeing patients doing follow-up and also we're a teaching hospital. So we have residents and fellowship program as well. So time spent in the lab doing what I love dearly surgical simulation to make surgery safer for patients so that, you know, our trainees practice not on you.
Sarah Marshall, ND: That's nice. Yeah, I would. I'd be okay with that if they had some other practice before. Yeah, that's awesome. Oh my gosh. It's so funny. So I had some wild experiences in naturopathic school. You know, we, we have a semester of minor surgery. It's not a big, you know, there are some ND’s actually that, that's their jam and they get like way into doing minor surgery and they want to do a lot of procedure. I was the opposite. I was like, I want to talk nutrition. I want to talk about emotions. Give me the heart stuff. Give me the internal biochemistry. I resisted GYN like, unbelievably like, like when we had actually learned gynecological exams on other women, I just didn't even want to, it, it was the funniest thing.
And then I got to all the procedural stuff. My other classmates were like, this is fascinating. And I was like, Ooh, like it was not my jam, but now, you know, 15 years later I think about it. And I'm like, what would that be? Like if like, instead of just being in the office all the time, I'd be like, yeah. And then on Tuesday I cut this person open and I removed it from it.
Like, it's, there's a little kid in me. That's just fascinated by what we can do surgically. It is just amazing. Like, so i love, yea...
Valena Wright:Yeah. I mean, I love what I do. And in the last, so I'd been doing it for 25 years and I have to say in the last 10, 15 years now we have minimally invasive surgery. It's so much less traumatic.
It's amazing to see a patient get up and walk off. The O off the clinical ward the next day after you've done a hysterectomy and many of our patients don't even stay overnight now. That’s incredible different from when I started in the hospital for sometimes a week after hysterectomy, right? Yeah.
Sarah Marshall, ND: So my dad actually ran a computer software company and I don't know exactly what timeframe like they were in business around 40 years and somewhere around halfway through the majority of what they were doing was medical technology.
And he, his company wrote software for some robotic prostate surgery where they would use robots to implant the seeds in the correct place, the radioactive seeds for treating prostate cancer and like, you know, being able to have virtual operations where, you know, the robots in one place and the surgeon is potentially not even in the same city. And that was when I first started learning about some of that cutting edge, all inside of increasing effectiveness and decreasing the invasion and the trauma on the body and like it's yeah, it’s a whole world.
Valena Wright: Yeah. The first transatlantic operation, the patient was in France and the surgeon was in New York, did cystectomy, but don't do that in the United States because it's illegal to not be present in the operating room. The technology can do as possible. And I specialize in robotics and it's, it's really amazing how the instrumentation and optics has changed so much. Many people don't really understand the difference sometimes between open surgery, laparoscopic surgery and robotic surgery.
And it's never a robot truly doing your surgery. It's the surgeon. It's just a tool, right? But, you know, one of the advantages of the robotic system that I use is, is it gives you three dimensional vision. So you have two cameras, one to each eye. So what you're seeing in your operative field is what you see in world life, in real life. You have that third dimension. It's not like you're operating off a television screen, which is your 2-dimensions… you have your depth perception. So having that allows you to go from point a to B with more accuracy and your brain doesn't have to adjust for that loss of depth perception. In most simple operations, you know, we we've been doing what we refer to in the trade as straight stick surgery instruments are resisted, like they are in a robot.
So when we do robotic surgery, the surgical instruments are like the human wrist and have seven degrees of motion. So they can move like your wrist, which a typical surgical instrument can't. It can rotate on this long axis and open and close, but it can't move like your wrist. And that's really what made robotics great cause you could, you can now operate in a very tight space. That's, you know, an inch and move your wrist around in that space rather than, than trying to move an instrument in your body that you need.
Sarah Marshall, ND: That is so cool. I love it.
Valena Wright: You consume in, you consume out...
Sarah Marshall, ND: Yeah. And that's what that, that was a bit, my dad and I were talking about is how much more precision was actually, they were able to utilize the robotic surgery for, so then you can get these tiny little processes done without having to open up the whole body and do you know, more potential damage just to get into these little spots. And it's awesome. I mean, I say it like a total layman, cause this is way outside of my range house but..
Valena Wright: What are they advantages of being a woman?
Is that for gynecologic surgery, is that when we do a hysterectomy, the top of the vagina is quite a large space. So in other specialties and operations on men, they don't have a vagina. So you can actually take the specimens out that way, which keeps our incisions really nice and small on the abdominal wall. We take out these very large masses
Sarah Marshall, ND: from these tiny little... that's really fascinating. Totally. We have a very easy exit area. Yeah, that's so cool. So one of the, you know, the real, like one I'm just already adore you. And I'm so excited to have you here and your knowledge and your breath and your experience is awesome.
And specifically though, we're here, cause you just recently published a kick ass book, “It's time, you knew the power of your choices to prevent women's cancer”. And like, you know, I have flirted with the idea of starting to get into the specialty of naturopathic oncology. Like I've had thoughts about what do I want my legacy to be about?
What do I really want to, you know, become an expert in? And it's so massive. It's such a huge area that it's not yet presented itself. I've done adjunctive care, supportive care, symptomatic care around people pre, during and after a cancer treatment. But this is just a whole area that even as a doctor, I watch myself be kind of intimidated and scared about, and like, I don't know, just go talk to the experts, you know? And so I just am so excited to be able to have this conversation with you to bring some light to an area. Particularly what I got from reading your book is this piece that I think, I mean, as a, just as a woman, as a human being, I have this too, like, all right, we live in a toxic world.
I know that there's DNA transcription issues. I probably should eat better. I probably should exercise more, but basically if I'm going to get cancer, I'm going to get cancer and I'll just deal with it then. Like it's not, it's not something I feel like I have a lot of power to like proactively, whereas like diabetes, I don't feel that way at all about diabetes. I'm crystal clear. I'm like, Oh yeah, no, I manage my blood sugar this way and insulin this way. You know, and like, it's not a problem. Like I don't have anything but cancer it just really does feel like a, a game of roulette. And then I read your book and I'm like, huh, maybe not so much.
Valena Wright: Good. Glad you read my book. Thank you for reading. And like in each chapter I tried to put a little box warning type thing about myths and false beliefs. And people feel like cancer is inevitable and there's nothing they can do to prevent it. And I think part of the reason for that is sometimes we can't predict who will get cancer.
And some people do everything right, and still develop cancer. But the majority of cancers, more than half of cancers have knowing risk factors and modifiable lifestyle changes that can be made to decrease the risk. It's not going to entirely eliminate the risk because we're complex human beings. It's not just one thing, but there are things we can do that definitely decrease our risk.
And you know, the most, some of the most important things are our lifestyle. Number one, smoking still causes the most preventable cancer deaths in the us. Right. And so when I think about it and try to speak to the topic, you know, screening, people need to know what screening tests are available for them and take part in screening and up related to abnormal screening tests.
So screening is number one, and then next is symptoms. So if you have symptoms, don't ignore them, know the warning signs. And if you generally are diagnosed early the prognosis is going to be so much better than if you ignore your symptoms and come in late, when you may need more complex treatment to attempt to cure, because in general, most cancers are, are easier to treat when they're diagnosed early.
And then finally vaccinations.
Sarah Marshall, ND: Yeah, you're right. We were in our little pre-conversation. I'm ready to out myself about my biases and vaccination sample.
Valena Wright: I think a lot of people are are unaware that we have a screening test for lung cancer now.. Low dose chest CT and lung cancer is a high on the list and affects many women who aren't smokers. And so, you know, there are, there are things we can do to try and to decrease, decrease our cancer risk.
Sarah Marshall, ND: Yeah. Yeah. So like when we talk about, so I love like generally we can say screening, but it's still like, okay, what's the action. Cause one of the things I got from your literature was like how to advocate for yourself and actually be able to request certain things that maybe aren't gonna re you know, your doctor may not know or think to, or for whatever reason, be the one to bring it to you. And so like what, what are some of those screening opportunities? What does that look like?
Valena Wright: Right. So for women's cancer, unfortunately the only really true screening test is for cervix cancer. And historically that's been a pap smear.
Now this is controversial, but. We know so much more now than we did when pap smear was first introduced back in the 1950s. Right. And basically a pap test takes a sample from the cervix and looks at the cells and divides those cell types into normal, atypical precancer, or cancer and it's a pretty intense process to make sure everything goes right.
And part of the success of pap smears, historically having it done every year now, guidelines depending on your age and other things vary. And the guidelines get confusing because they change so often. And the American cancer society, this July just implemented the recommendation of primary screening with HPV, not with pap smear.
So knowing your HPV status, whether you test positive for high risk HPV is important because HPV is what is present in all HPV related cancers,
Sarah Marshall, ND: Is that like getting like a, an immunological titer for HPV. Would that be the test? Is it a blood test?
Valena Wright: No, it's not a blood test, it's a swab. Often right now we do this thing called co-testing, where you do a pap in an HPV test based on your age.
So we have to understand the biology of the disease to screen for it well. And so HPV really wasn't discovered until the 1980s and before that people thought there was a sexually transmitted infection as the etiology of cervix cancer. And there was a lot of stigma with that diagnosis because of that.
But we know that's now HPV is associated with more than 99% of all cervix cancers. Oh my gosh. It's not just cervix cancer. So HPV is associated with cervical cancer. It's sort of, we call it lower genital tract. So the cervix, vagina, vulva, anal, and in both in men, more commonly than women, oral pharyngeal or cancers of the back of the throat.
So there's five different cancers that can be associated with HPV. And so HPV stands for human papilloma virus. Almost... It's the most common, sexually transmitted infection in the United States. 80% of the population will have it at some point in their life. And most of the time people are asymptomatic. In women we know we have it because they go in and get tested or screened. Right. And then if you test positive that strata, stratifies your risk into a higher risk group and you'll be triaged differently, right? So depending on your gynecologist's office and what's available for screening, they may not be able to offer you that yet as the primary screening tests and the guidelines are dependent on age So the new guideline, interestingly increased the age.
So it used to be at age 21, you should have a gynecologic exam and a pap. So now we don't screen though for cervix cancer up until age 25, because cervix cancer younger than that is exceedingly rare. And we're getting a lot of positive test results from HPV that was low grade or a strain not associated with cancer and young women were having procedures done that could impact future fertility. The, you know, there's always a downside to screening sometimes... the psychological anxiety, invasive procedures that are uncomfortable. And you know, all of, all of the negative things of screening. HPV is in the majority of people who contract it is a transient infection. Meaning you'll clear it on your own with a healthy immune system.
So the risk is really, if you have persistent HPV over time. And that's why women in their late thirties, forties, fifties, that's…
Sarah Marshall, ND: That's when it starts to be. Yeah.
Valena Wright: Right. Yeah. Even in young women who have an abnormal pap test, like one of it's called squamous epithelial lesion, you have the lesion and they divide it into low grade, high grade.
But generally, if it's just low grade, we've followed that now for up to two years, whereas before we used to treat it, and the reason is a lot of people will clear it with a healthy immune system and so treatment’s unnecessary.
Sarah Marshall, ND: And that's where like my brain is like exploding. Cause I mean, already as a naturopath treating low grade and latent viral infections is a, is a common part of my practice because it's stuff that gets missed all the time and it keeps our body a little suppressed and people don't really know they're even going on.
You don't know this, but my podcast listeners do last summer, I was diagnosed with chronic fatigue syndrome and my Epstein-Barr virus titer was off the charts and I had anemia and there was a whole bunch of stuff it was kind of a collision of incidences and then both for my own self. And then with COVID now, I mean, it's like every CME course I'm taking is conversations about long-term COVID, long-term viral infections and all these things we can do about it.
So I'm like, Ooh Valena, we got to partner up because you put them on the two year waiting list, send them to me and I can help boost all these things, their immune systems that they're that much more likely to clear the infection, you know, like, and I think that's where, you know, I'm really excited about as integrative medicine is becoming more mainlined and the possibility of nature paths and holistic practitioners and lifestyle practitioners, all being under the same roof as surgeons and, you know more conventionally trained medical doctors that possibility of these discoveries we're making of what the body's capable of. And then I have a whole world of what we could do to even further support that in, you know, juice that person's body up to be able to take care of having a better shot at clearing it naturally, you know, with no implications of future cancer.
Valena Wright: Yeah, no, I agree with you wholeheartedly.
I think surgery should be the last resort, right? You know, most of the time a surgery goes well, but sometimes it doesn't and some, you know, complications can have devastating consequences that can last a lifetime. So when you do surgery, you really want to make sure it's indicated number one and that you choose your patients wisely, right?
So for people that have HPV and abnormal paps and were in that waiting periods, the most important things are number one, no smoking, cervical carcinogens are secreted in cervical mucus. And so that's part of the reason that smokers are at higher risk for not just lung cancer, but cervix cancer and bladder cancer, so no smoking.
And then unfortunately some of the patients require and you know, suppressive therapy because of a disease process. A lot of the patients I follow in sort of the high risk setting, cause I'm in a tertiary care and sub specialized are patients who have had transplants and they almost all end up with HPV infection because their immune system is suppressed so they don't have organ rejection. And so we have to tolerate low grade viral infections and just screening to make sure they don't progress into cancer because just because you have a HPV positive test result, you may never develop cervix cancer, but you should know that you're HPV positive and get the appropriate screening so that you don't.
We have a long disease free interval where you're asymptomatic and we can screen, and we can detect a cancer before it becomes symptomatic. And so part of the success and the reason cervix cancer rates have dropped is that we have a screening test. We have a way to treat pre-cancer and we have a vaccine.
Sarah Marshall, ND: Yeah. Yeah. And one of the other big areas that, that stood out for me in your work is around listening to your body and trusting, you know, when there's something up and you've got some personal experience with cancer too, in your, in your history and your story, that's probably pretty connected. Like you said, connected to like what the book is about, but that idea of like, not ignoring the symptoms in our body and to be able to take a stand for ourselves of really wanting to get something fully checked out.
And so will you talk a bit about that?
Valena Wright: Sure, so unfortunately ovarian and fallopian tube cancers, there's no screening test for either of those cancers. And many women falsely believe that they're protected by having an ultrasound or a CA one 25. And that's just not true. You can have a normalcy of one 25 and still have ovarian cancer and you could have a normal ultrasound, or you could have an abnormal ultrasound and not have ovarian cancer. It's just not the sensitivity and specificity in numerous research studies has, has never gotten to a point where it's something we can apply to the general public. But what we do know about those cancers, anyone with a personal history of ovarian cancer needs to have genetic testing because 10% of the time they'll have a gene mutation that predisposes them to that.
And so Mary Claire King, the geneticists that discovered the BRC one and BRC two genes and said, all women at age 30, consider genetic testing. And that doesn't mean you have to go ahead and have like risks, reducing mastectomies, and it keeps an ovaries out, but it's just an awareness.
Sarah Marshall, ND: I did have one client that her sister had really severe ovarian cancer.
And as soon as that popped up, the whole family got tested and they started going through and they found like, I mean, her genetic propensity was, I think she was hitting the, I can't remember specifically, but it was in the realm of like, she pretty much ticked all the boxes and they were like, yep. And she did do, I mean, she was already working with me.
We were working on other things in her health as it was. And we just went through the whole conversation about like what this makes available. And she chose to do a preventative partial hysterectomy where they took out her ovaries and left her uterus. And you know that, but that was a big conversation that we talked about, all of it, you know, and she had really strong family history.
Valena Wright: So it can be life-saving. So in my personal history, and this is part of, I think it's the first chapter in my book. It's time, you knew my older sister, Debbie developed ovarian cancer. She had a cyst that was diagnosed when she was overseas in Germany. And didn't think too much of it because prior to menopause, when we're still menstruating, every month, you do create a cyst, which I think is part of the confusion for women.
Because when you obviate prior to ovulation a cyst is there in the ovary, you ovulate the cyst resolves, gets absorbed and that happens every single month. So, you know, people will think a cyst is abnormal, but it's part of the normal physiology. And the ovary is so complex. It's like more than 20 different types of ovarian cancer.
I mean, that's how difficult it can be, but my sister and didn't follow up immediately when she returned to Canada, she had a follow-up ultrasound that was very concerning and the ovary had grown to 20 centimeters in size and she then underwent surgery and was diagnosed with ovarian cancer. And so she, you know, she had a genetic testing and didn't test positive for BRC one or B RCA two, but there's many other genes that increase your risk and our knowledge of genetics expand.
So if you were tested for example, 10 years ago, you need to be retested. I mean...
Sarah Marshall, ND: and even still we're in our infancy and we know a lot more than we did 10 years ago and it just keeps growing.
Valena Wright: Yeah. And so of the types of ovarian cancer, serous, S E R O U S is how you spell that that's serous ovarian cancer is the most common type and that's what my sister had and it's tends to be hereditary.
So I had risk reducing removal of my tubes and ovaries. I was supposed to menopause. I didn't see the downside. I see so many women suffer and die from ovarian cancer because we don't have very effective treatment. You know, more than half of the women they'll live with it, almost like a chronic disease for a while, but many women die from that diagnosis as did my sister, unfortunately.
And so I have two other sisters, so one had a hysterectomy and ovaries and tubes out for non cancer reasons, you know, prolapse or other issues. And then my youngest sister is a naturopathic and like, didn't really want to be invasive or, yeah. And she was she's my youngest sister. And so she didn't want side effects of menopause either. So, you know, my older sister lived for several years before passing away from ovarian cancer. And as my sister saw that, and she got closer to menopause, she decided to have risk reducing surgery, and they diagnosed fallopian tube carcinoma in situ, which is the earliest stage. It's a precursor to invasive fallopian tube cancer, which is notoriously difficult to diagnose.
So basically having that surgery to saved her life. And during the process, you know, my doctor told me, you know, you don't need to have your tubes and ovaries out. You don't test gene positive, but independent of that, depending on family history and other cancers in the family you may decide to elect that, but you need to speak to a specialist and genetic counselor to make that decision.
I don't want people to get the false idea that they all need to have their tubes and ovaries out. Important because having tubes and ovaries out early and having early menopause increases by 10% all cause mortality, cause their ovaries are important, right. They help us with heart disease and other process all of these other things.
Sarah Marshall, ND: They're protecting us a lot of ways. Yeah. Yeah.
Valena Wright: So, you know, we would never have done those interventions if my oldest sister hadn't been diagnosed and passed away from ovarian cancer. So knowing your family history really important and family history can be limited sometimes because of small family size, some families don't talk about cancer.
It's better than it was, but you can't come in and say, Oh, don't tell my mom, she has cancer. She won't be able to deal with that mentally. Right. And so there's still a stigma about a cancer diagnosis and having the conversation. So it is important to know your family history. And to consider genetic testing, you know, a lot of primary cares, there are screening tests that you fill out, check the box type thing, and it will triage you to whether or not you should see a genetic counselor. So it's important to consider those things if there is a lot of cancer in your family history, and there are things to do besides surgery, for example, being on a birth control pill dramatically drops your rate of both ovarian cancer and uterine cancer.
The one thing I wanted people to know too, is that with the research on women who are BRCA 1 and BRCA 2 positive cancer patients, when they did risk reducing surgery and removed the fallopian tubes, they found a very early stage fallopian tube cancers. And so what happens, the cancers arise in the very distal and the end of the fallopian tube and they exfoliate cells onto the ovary where they then implant and grow and that it would be called ovarian cancer historically. So a lot of what we call the ovarian cancer in the past is actually fallopian tube primarily. Fallopian tube primary site can be microscopic. I had a surgical case where a general surgeon called me in because there was an apathy and large lymph nodes around the aorta, which drains the tube and ovary and the biopsy at the time of surgery suggested a GYN primary.
And so they called me to just take a look at the tubes and ovaries when the patient was asleep and she was post menopausal. So I took them, took them out with the family's permission and she had an early fallopian tube cancer that would never have otherwise be found. Microscopic, you know, people think sometimes we miss it, but we can't see microscopic cancer out. We can't do that. So it can be life-saving. So having the knowledge though that cancer can start in the fallopian tube, it's changed our practice as gynecologic surgeons because we no longer tie tubes, we removed the tube, that decreases your cancer risk dramatically. Right? Because you read moves that can create it. That's fascinating.
Sarah Marshall, ND: That's fascinating. I had no idea that's. I mean, this is definitely new enough. It certainly wasn't presented us to any of our oncology courses that we took in med school. And that was, you know, a little more than a decade ago, 12 years ago. So that's pretty remarkable. Yeah, so let's talk about the vaccine.
And so I was outing myself before we start and just saying like, you know, I'm always looking for the places where I notice in myself, an ungrounded bias, an emotional response or reaction to something. And in my practice, I don't really have to have a whole lot of conversations about vaccines until this year with COVID.
You know, I'd have people, occasionally come to me, we talked about the flu vaccine and things like that, but it's just not been my area of focus and I don't have a pediatric practice. And so I get questions here and there and mostly send them out to people. And I just watched myself, as I was reading your book, literally have an emotional response that I checked myself, I knew it was just purely emotional being like, blah, what do you mean the vaccine for HPV? And all these girls should get… and how is it preventative? What, how do we know? And what's the data? It was so funny to watch my brain fire. So I'm so excited to actually be here having this conversation, because I also think like, you know, I'm a naturopath and the leaning of this whole program has been in the more naturopathic genre.
And honestly, I've watched a war breakout, unfortunately in my own profession, over the COVID vaccine, some people are just adamantly against it and other people are adamantly for it. And there's just like the actual data. The discourse, the good conversation gets lost in the righteousness. You know, and, and any client that's ever come to me about any vaccine, I always have a big conversation about like, look, here's what I know.
Here's what, I don't know. Let's go look to the data. Let's talk to the experts like in that way. But it was just so funny to watch myself be like HPV vaccine. How am I even having this person on the podcast? What am I thinking? It was so funny. And I was like, no, this is perfect because I want to learn from you. I want to grow in this area. And I know this is something that's probably resonating with a lot of my listeners that they would just automatically shut off to it versus actually do the looking, right? Actually investigate. So let's talk about it. What do you know?
Valena Wright: There's so much bias about vaccination, especially about HPV, and you bring up sex. As soon as you say sex people's brains function differently. In the United States when HPV vaccination was first introduced, women were targeted. Not, not boys. It was only for girls. And there was the bias that my son doesn't need the vaccine because he doesn't have a cervix. There's actually a paper published that shows that.
But some people thought, Oh, the boys don't need vaccination. Right. But that's obviously not true. And so now we vaccinate both boys and girls Ideally in pediatric age groups before they become sexually active, because that's when they get the most benefit between ages nine and 11, you can vaccinate up until age 26, but that just got extended by the FDA in 2020 because of HPV related oral pharyngeal cancer in men.
And so you catch up vaccination all the ways to age 45 now. It is new because right now there's more men with oral pharyngeal cancer than there are women with cervix cancer diagnosed each year. The other paper that was just published as a large paper published on the Swedish population. And it showed rates of invasive cervical cancer in women who were vaccinated, unvaccinated and at what age group they got vaccinated and the lowest, I mean, it's not a Cyril elimination of cancer with vaccination, but it's dramatically lower and most successful in people who got the vaccination in you know, the lowest age groups like nine to nine to 11, there's a dramatic drop in the rate of cervix cancer.
So, and that's, you know, in developed countries where we have screening tests, where we treat precursor lesions and we have HPV vaccination that's where we see the most success. Cervix cancer is actually the most common cancer in women worldwide because many developing countries don't have that type of resource to prevent cervix cancer.
So we're fortunate we live in areas that we do, but having said that there's pockets of the population that don't have access to that. Like some of the Southern States in the U S have rates approaching that in developing countries because they're not participating in screening being treated or getting vaccinated.
So it really has few side effects, you know, local reaction and discomfort in the arm is most common. You know, there's all this controversy, you know, about other impacts. Like if you're, if you vaccinate your children, there'll be sexually more promiscuous… There is no data to support that… I mean,
Sarah Marshall, ND: that's just part of our weird relationship to sex and sexuality and not, yeah.
Valena Wright: Right. And you have to, you know, I have patients in my office with high grade, cervical dysplasia or cancer, and they haven't had the vaccine and they said, well, I'm not at risk. And I'm like, you can't see the HPV virus. 80% of the us population gets exposed at some point in your life. Most of the people are asymptomatic and it's only about 2% of people end up with invasive cervix cancer.
But it's such a simple thing to do. And it's not just cancer prevention. The vaccine also vaccinated against HPV type six and 11 which is what causes genital warts and genital warts are like little cauliflower skin, growths or wards on the genital skin, both in men and women. And it can be symptomatic. They can cause itching burning. They can be socially, obviously upsetting for people and their partners. So you get the added benefit of being protected from that as well.
Sarah Marshall, ND: Yeah. I've actually run into kind of a remarkable traumatic impact of genital warts in, in my patient population when people deal with it and like the real impact it has on their emotional self.
And, and that goes to point to the stigma that we have about it, but it also is like, I can get the validity of where we can prevent that, where we can make a difference in that and not have that. I mean, we can keep working on our social conversations about these things and they, they really are infections and it's just like the other infections we get and we treat them accordingly, you know?
Valena Wright: Strep throat and laryngitis and it's like, it's not a big deal. And like, you can't see bacteria and you cannot see viruses. So, you know, it's obviously when you choose partners, you want to choose partners that hopefully have your best interests are kind caring and that know their own risks. You know, the highest risks per people are people who don't know their status and don't take care of themselves.. Like if people know they're HPV positive and are decent kind people, they're probably going to tell you about that. Right. You can minimize risk obviously by using condoms, but it's not a hundred percent, you know, it's your own immune system. And people who have HPV infections and abnormal paps that we're following, it's a very common question. You're like, how do you deal and talk to your partner about that issue? And once you have an infection, it's more your own immune response that's going to determine whether you cleared or not. And your partner probably has already been exposed. So there's a really, a big risk, the risk, like with new partners or partners where you don't know their, their status.
Sarah Marshall, ND: I had, and I'm going to fling this at you and you can be like, Nope, that's a myth. But I feel like I'd read something around where any sort of bacterial bacterial vaginosis, BV, chronic BV actually also increases your risk. And to me, as a naturopath, I think about that as risk for HPV, it like increases the likelihood because your immune system's weekend or your pH is off in that area. Like it's already showing that there's some stress in the immune system. And so like that that's, I think that also a sign to take care of your immune system,
Valena Wright: right. And also to treat the HPV and sometimes too, like, I'll give they're sexually active sometimes, you know, they'll do Brazilian waxes, shave or whatever.
By doing that, you do decrease some of the natural protective mechanisms of the skin and you get like microabrasions and cracks, you know, that make it more likely you could contract an infection. So, you know, you should, if you're going to do Brazilian or wax or do those things, you shouldn't then just like have sex immediately after
Sarah Marshall, ND: Noted, give your body a little chance to heal there. That's awesome. I love it. Yeah. Awesome. And you know, one of the other things I wanted to really, you know, kind of take the rest of the time we have here to talk about is your, you had mentioned something about like the emotional connection into self care, you know, and how important, like the link between mental health and hormones and that whole side of it too as well, where we can do that.
And this is always a big question for me is like, there's sort of a social media, hot topic of like, so, you know, self care I'm getting in my, my bubble bath with my glass of wine which absolutely can be. But I even me I'm like, what does that even mean? What does self care really mean? You know, like how do we do that? So what's, what's that for you?
Valena Wright: So I guess for me, self-care means being, you're being aware of your body, not ignoring warning signs, because when we have symptoms, if we address them, we can usually find solutions or problems and be proactive to achieve better health. I think one of the tricky things sometimes to talk about is the impact of obesity and excess weight, body mass index, because it really does affect our entire body.
And it's, it's… Three times... obesity is three times more common in women than men. Exercise to be having a sedentary lifestyle, even sitting for six hours increases your cancer risk. And I think men exercise more than women. And so some of this all ties back to, to what happens at home. What's the division of labor, like is your partner helping with the kids, or is your partner going to the gym and going out?
And you're staying home with the kids and doing, you know, division of housework. All of those things, you have to really advocate for yourself and we're kind of socialized as women to take care of others, kids to care, to pets, take care of her husband. So it's really important to listen to your own body and give yourself don't be hard on yourself.
And when things are wrong to learn to speak up and not be silenced because we're just socialized that way sometimes knows that we don't address what the problems are. And then sometimes it's not just you yourself, that silence is it like, it always amazes me sometimes I see women with very strong denial mechanisms in place where they'll come in with an advanced tumor and have no pain.
And you wonder, you know, how can they even be walking around? And so our, our brain in some way is functioning to protect us from that so that we don't feel the pain because there's something that's fearful or, or that our site can't handle. And the family around us is bought into that false belief.
Right. So there's a lot of psychology that, you know, I don't fully understand. I found psych, I almost became a psychiatrist, so fascinating what the brain can do. And a lot of our decisions are unconscious almost. And so when we're busy and we're not paying attention, obviously things can sort of go under the radar.
I think it's really important to pay attention to our nutrition, our level of activity, and even going for a walk outside by yourself for like 10 minutes.
Sarah Marshall, ND: It is. It's amazing. How much of a difference, like I have one client I'm working with her right now to literally just be outside for five minutes a day.
And it's kind of amazing actually, and she's very wired as the caretaker and she runs this whole office and she has an hour commute on either side of her day. And like, you know, it's just like by the time she's kind of said and done with that. There's not a whole lot. And I'm like literally five minutes, even if it's like, and we know from you know, helping with depression or seasonal depression, or even just like mood stability.
If you can, if you can do that 10 minute walk early in the morning, early in the day, and you get direct sunlight, it helps with a whole bunch of hormone process. It helps rebalance your circadian rhythm, which also is part of a way to keep your hormones healthy for cancer prevention is good, strong, healthy, cortisol response in the morning with a good, strong, healthy melatonin response in the evening and going outside for that walk for 10 minutes, first thing in the morning can actually help rebalance those stress hormones.
Valena Wright: I agree with you a hundred percent. Like I exercise in the morning and go outside. And if I don't do it, it can really impact my mood because it changes your physiology and your physiology dictates how you feel. Exercise, you get the endorphins, those feel good hormones that help as well. The one thing too, that is really important, people often ignore is sleep.
As I know, I know some of this from experience in working in medicine with the patients diagnosed with uterine cancer. Most uterine cancer has a linear correlation with increasing weight. And so with the obesity epidemic, we're seeing a marked increase in the incidence of uterine cancer and also women getting at much younger ages than historically. Most uterine cancer, less than 5% is diagnosed before age 40, but that's changed with the obesity epidemic. And so trying to help people whose weight it's until you correct your sleep, it's going to be almost impossible to lose weight.
Sarah Marshall, ND: I, so my Heal listeners are probably like I got it already, cause it comes up on almost every episode, when we have a doctor or a healer, we talk about rest. We talk about slowing down. We talk about tuning in and we talk about sleep. Like I have a, I'm going to tell you and you guys at Heal, I'm going to just keep getting it in your heads. I frequently one of my first prescriptions to new clients is somewhere between four and eight days of bedrest.
And it, like in my favorite is when I have like the executive CEO types, they look at me like I'm nuts. And they're like, but I'm not that unhealthy. I'm like, yeah. But, and I actually did this recently for a client, and this is another thing that like, I look at this is pot kettle. Cause I have the same game going on for me about, I always have to actively work on my self care and what does that mean? And what does that mean now? Like, cause it's easy, you know, I don't have children. I have an amazing partner in my life and I have, you know, 52 kids in my practice because I have a small boutique type practice that I keep tabs on all the time. I'm taking care of my people constantly, but I did this exercise where I had someone and I'll do it for me, alright, I'll use myself as example. So I'm 40 years old and let's say I did pretty good for the first, like eight years of my life on sleep and rest. Now here's an interesting thing about me. I was asthmatic as a child and at the time they were still regularly prescribing Theophylline in which they actually don't utilize in childhood asthma anymore.
And Theophylline is a stimulant that made a difference for my asthma, but it also kind of hyper-stimulated me to the point of, I had chronic insomnia as a kid, and I just wasn't able to sleep very well. So you actually could probably say maybe I got five years in the beginning of like decent sleep until this happened.
And then by the time I was school-aged in junior high, I was already a high achiever pushing myself, double upping on things I was, you know, got into high school and I was on class treasurer, class vice-president, then I was on the captain of the team. I graduated high school when I was 16 years old, a year early.
I mean, I was just like running and gunning by the time I was 12. So if we just say 40 minus, I'll give myself those first eight years, that 32 years, times 365 days a year. I've been dragging my body through life 116,000 days. Right. Or sorry. No, 11,680 days. I've been dragging my body through life. Could I give myself four days back where it's just about my body resting, right?
Like just four days in the scope of that. Cause we usually, what I come up with is people are like, I've never done it. I mean, even when they go on vacation, their vacations, aren't a vacation, you know, like that whole thing.
Valena Wright: Oh, you know what I find fascinating. So as a surgeon and training, you know, 30 years ago, we used to be on call every other night.
So you'd be in at six, you stay all day till at six the following day, that was your day off. And then you come back and do it over again. So obviously sleep deprived. And I was an intern and I was pregnant. Like, I know how tired you can get, and it's not good for us
Sarah Marshall, ND: And I don’t know where these statistics are today, so it's possible we need to update this, but my understanding is they had actually seen and I think it came out of when they did that huge women's study in the nineties and the early two thousands that doctors and nurses that had a career of shift work that so threw off their circadian rhythm that had a higher risk for breast cancer in particular and the incidences of how, you know, one of what I got taught naturopathic schools, you know, yes, sleep is good for our brain, but it's also when our brain finally is like sleeping, our organs are busy, detoxing. The body, your liver comes online. Your gallbladder comes online. Your body is actually working really hard to recover from all of the stress you put it through all day long. And if we don't get enough hours in sufficient detox time, that's an accumulation.
Now that might be a little oversimplification of what we know now, but that's kind of a general understanding I had about where sleep is important for cancer prevention.
Valena Wright: All I know is that whenever I went on vacation, I would get sick. Then you're on vacation your body goes, okay, I have time to get sick.
Sarah Marshall, ND: Yeah, totally. Oh my gosh. So yeah, so rest and sleep and, and, and then that correlation also, and I've had similar situations where, you know, people will come to me for weight loss and it's usually, if they're already in my office for weight loss, it's not going to be any of the easy answers.
It's, they've tried all that stuff. They've already done it. Now we're actually looking at sleep, hormone, imbalances, and toxicity because they can clean up their diets and they can hire a personal trainer and there will be elevations in their health, but the, literally the weight won't come off until we get underneath.
And that's, what's actually driven me in the last two years. I've started to learn more about mold toxicity and I'm just opening that up. And I'm learning a lot about how carcinogenic a lot of mold toxins are. Now, not everyone with cancer is running around with mold. It's not like that, but there are some people with liver cancer, kidney cancer, other types of things where it's really directly related to micro toxins in the environment.
We're seeing this more overseas actually, because there's a lot more contaminated food with mycotoxins in other countries. And there's a lot more pesticide and herbicide spraying, although we're, we're right in there and how that, you know, that relationship in there, is, it's been one of the places I've started to study more about, but I see it with obesity as well.
Like clients of mine that really are like dedicated and tracking their macros and they're on top of their food and they're moving their bodies and they're getting incremental results for how much effort they're putting in. I know we got to look deeper at the physiology. What else is going on in the body?
Valena Wright: And a lot of commonly prescribed medications too, can cause weight gain. Like a lot of the women that I see with uterine cancer, they're post-menopausal many of them are on an antidepressant. Anti-histamines sometimes as well, and both of those medications can have a side effect of weight gain, right?
If people aren't taking care of the building blocks, I'd like to say like good nutrition, not processed food. Do you have to buy, you know, fresh foods without labels, things, without labels on them, concentrated sugars, limit alcohol and you have to be mindful of sleep and exercise because I'm a big fan of exercise.
You know, fortunately I grew up in Prince Edward Island and my parents, we were always active. We'd be outside, we'd be told, get outside and flight. You're not...
Sarah Marshall, ND: I wasn't allowed in the house until dinner time. And then she kicked me out again for an hour until the sun went down and then I could come in.
Valena Wright: So yeah, I'm really lucky I had those habits built in from a very early age, but with the changes in society and education, where those programs get cut, physical activity, outdoor classes, that sort of things are, you know, childhood obesity is a real problem that will impact us for, for years to come.
So I think paying more attention to these modifiable lifestyle factors like it's estimated 48% of cancer could be prevented. By by doing lifestyle modification, 48%. And instead, unfortunately our system is disease-based and we wait until people get cancer and then we're playing catch up.
Sarah Marshall, ND: And that's where, like my favorite is, you know, I say it again, I'm not a naturopathic oncologist, but if you get a watch and wait diagnosis of any sort call your local integrative medical practitioner or naturopathic doctor or health coach, because there's so much that can come out of that empowerment to those lifestyle factors, you know, and like getting yourself an action on that is like my that's.
I, I love it when people come to me and they're like, Oh, I got, I got this thing going on, but they're basically saying there's nothing to do about it yet. Which from the medical side, like I get that there isn't an intervention to do, but then it's like, yeah, use these other resources to support you.
Valena Wright: No, I think that's really true.
And, you know, we know disease, cardiovascular disease as the number one killer, and then cancer is number two. And then COVID now is number three, but a lot of the risk factors, especially for uterine cancer, that's obesity-related or the exact same risk factors for cardiovascular disease. So interesting with the diagnosis of uterine cancer related to obesity have often have metabolic syndrome.
The facts are, there are four times more likely to die of a heart attack than they are of uterine cancer. So it's really important that people understand lifestyle modification, because if people are able to change their lifestyle change, you know, drop their weight, control their blood pressure, improve their diet and cholesterol and change their risk.
They should feel better too. It's not all about prevention. It's about how you feel. Right. And so how you feel in the present and what you do every day? Are you enjoying your life or is your life really limiting it now by poor health? And it's hard sometimes for people to make the decision to act because that's, that's one of the most difficult things, right.
Is to decide. To do something and then be supported in that decision.
Sarah Marshall, ND: That's what I was just going to say is like, I think I haven't been talking about it enough, which is the importance of community around making those choices and getting community, getting accountability, buddies, getting a group of girlfriends together, getting, and sometimes it happens in the home with the spouse, sometimes it doesn't, and, and you know, sometimes it's getting the kids on board and, you know, and, and this is one thing to, to my, my mommas out there, as they often are like, are you kidding me?
You want me to remove all the sugar and all the gluten and all the dairy, like my kids are going to hate me and I'm not cooking two dinners. And I totally understood, and I have coached many of them into actually having an enrollment conversation with their kids, sharing the whole context of it and getting them on board most of the time.
We won't do things for ourselves as much, but somebody outside of us, we'll, you know, we'll think about what we're willing to do for our children. They're amazing human beings when you actually contextualize it that way. A lot of times the kids are like all over it. And the next thing you know, you're at the grocery store, grabbing something to put in your mouth and your kiddos like mom, are you sure that you're supposed to be eating that it's like built in, but it's in that community.
You know, the stats are that you make within 20% of the income of the five people you spend the most time with, and you weigh within like 10 to 15 pounds of the five people you spend the most time with, you know, in terms of how your body shape is. So like, doesn't mean you have to kick people out of your life.
I am actually not a proponent of the toxic people. Cut them out of your life conversation. I say, heal your relationships. That's my stand. But. You know, it is, it might be like that. And I actually had a girlfriend last year. She's actually the best for my exercise, accountability. And she was an athlete. She just had way more training in that world.
And she called me up last January and she's like, okay, this is it. You have to be at the gym. 8:00 AM on Saturday, you're meeting these trainers, we're doing this program. And it was the first time I ever weight lifted. I'd never like put iron on my shoulders and put up weight before. And it was amazing.
And there's no way I would have done that without her. And then without the relationship I had, it was actually a group fitness program. So like we would pick different times, but you'd see the same people you started to get to know this little crowd of people, hear their stories, cheer each other on the, get to know the trainers.
It was like, It was better than one-on-one for me because of the community around it.
Valena Wright: that sense of group. And I'm not doing it on your own all the time. Right? The American cancer society guidelines for physical activity, only 17% of Americans meet them. It's only 150 minutes of moderate exercise per week, that’s like two and a half hours.
And for children, it's more than that. Children should be physically active, moderate activity at one hour per day. Right. Which is so important for children who are growing for them to be healthy, because exercise impacts our brain function. It can correlate with cognitive abilities. So. You know, there's just so many, so many benefits, cognitively, emotionally, socially, musculoskeletal...
Sarah Marshall, ND: Detox pathways, moving the lymphatics around, getting all of that going. Yeah. That's why I got a golden retriever. I saw myself. I was already like left to mine cause I have a big old freaking workaholic gene and it's just, I just love it. I love what I do and let it go left to my own devices. I'll socialize. And then I'll work. Like, that's what I'll do. And I was single at the time and I was in the mountains and I'm watching myself and I'm like, I live in this beautiful place and I'm not doing anything about it except ski season.
That was easy. But other than like, that's only like six, four months out of the year. So I got a golden retriever, Henry. He's amazing. And literally like, I can sit on the couch, but I look at him and I'm like, yep, that's right. We're leaving. We're going out. Yeah.
Valena Wright: Great way to motivate people to get outside and go for that walk.
Right? Yeah. The other one thing I wanted to add for women in addition to like aerobic exercise, where you're moving your body. Weight training twice a week is recommended.
Sarah Marshall, ND: And that's what, yeah. I've been putting that in with a lot of people
Valena Wright: The prevention of osteoporosis. Super important. And you know, people do a lot of things to try and prevent osteoporosis, especially with a positive family history calcium, vitamin D all those things, making sure there's not a predisposition by, from some other medical condition or side effect of meds, but I think being physically active and doing the weights. If, if you're not like I see this in my patients who are post-menopausal, you know, if they, if they can't do a squat, basically, which is getting up out of a hospital bed, they're not going home. They're going to a nursing home for rehab. If you can't do a squat, you should start.
Sarah Marshall, ND: That's actually, I, this is kind of cutting edge conversations and I I'll see if I can pull the references up for the show notes. There was some articles I read in the last two years where they've started to recognize, you know, we do a lot about tracking cholesterol levels and tracking even homocysteine and your blood pressure and all these cardiac factors, which you should keep tracking those things.
But what they actually found is what was more correlative to morbidity and mortality in your seventies and your eighties and nineties was some basic physical ability to be able to do a squat, to be able to get yourself up off the floor. Like those things were more correlated to people who lived well in aged well then what your specific cardiac risk factors were, even though heart diseases are number one killer. And it's like, there's that relationship that is more correlative than causative, but in the ability to move around. And one of the things that I also put in a lot with my clients is, is what it is to feel strong and just feel capable in your body and how that helps with our mental, emotional dispositions.
And we have the sense of being able to take on the world and when we don't feel strong and we don't feel like we have that, then the psychology of that and the things that, that happens to our stomach and changing our immune system, we know that empowerment. And healthy immune systems are related. We haven't figured out all the details of it, but the studies are showing when people are empowered, they have healthier immune systems and people who are not empowered in their life, they don't experience autonomy.
You know, this was actually done out of a corporate study for work. Dr. Mario Martinez is a psychologist who got way into the study of longevity. And like tried to get into the conversation of like, you know, these groups of people in different specific geographic areas where they have higher rates of centenarians and why and where that's coming from.
And we went to the like, Oh, it's all genetics. And the research is showing it's about 30% genetics and the rest of it is cultural. And it's about empowerment. It's about autonomy. And then it's these cultural conversations of belonging and being valuable in your culture. And that we value our elders as wise elders.
And we actually like honor that and in that relationship, and then a lot of them were like, they also were physically active and they'd go out and do stuff and still play in pickleball.
Valena Wright: I think self self-efficacy is another way to say that. Right. If you are able to set goals and believe that you're able to accomplish them.
And if we, as physicians are able to better support our patients in doing that, you know, that's a win for everyone. The other thing about being physically active it improves our balance, like for our muscles and tendons and joints to be healthy, they have to move. I can't tell you how bad it is for a person to be really at bedrest.
I mean, you can, I know you said bedrest, but I have to get up at some point. We know that like, if we put a patient in a surgical ICU post-op and they're intubated, they lose 3% of their muscle mass at day. Right. So if they end up in the ICU for a week, Three times seven is 21% of their muscle mass is gone. So it’s not surprising that they end up in with physical therapy rehab, whatnot to regain that strength. So even if we train really hard, it's not something we can do off and on. It has to sort of become a daily habit and that to be successful, we have to find things we'd love to do. And that we enjoy that. Give us joy in our everyday life and being, being physically active and like having that sense of achievement for how you feel the endorphins. Like I, you know, I get too crabby, I can tell when I don't exercise.
Sarah Marshall, ND: Yeah, totally. That's awesome. Oh my gosh, this, I mean, clearly we can keep right on going, but this has just been amazing and I'm really deeply honored to have you on Heal. I know this is going to contribute to a lot of our listeners and just be able to be an amazing resource.
And I love getting my boundaries pushed and learning new things and like, it's awesome. So thank you so much for being here and we're going to have links to your book and in the show notes for people with your bio there and they can get access to your information and thank you for writing the book.
Valena Wright: Oh, thank you for having me as a guest. I think the more conversations that we have and share our knowledge, it's just better for everyone. You know, we can't be closed minded in today's world. You know, there's so much work we have to do about inclusiveness differences. You know, having to talk to the patient even.
Sarah Marshall, ND: Yeah, absolutely. Yeah. That's awesome. Thank you so much. This is such a joy. I'm so glad to be connected to you and until we get to do it again,
Valena Wright: It’s been great. Well, again, thanks so much for having me. I've really enjoyed speaking with you.
(music)
Sarah Marshall, ND: Inspired by YOU, our community of over 4,000 incredible listeners, we will be launching some courses and workshops in 2021. Be the first to know about them and other great tidbits of wisdom by joining our mailing list at SarahMarshallND.com. Thank you to today’s guest, Valena Wright for her immense wisdom and expertise. For a full transcript and all the resources (of which there were many) for today’s show, visit SarahMarshallND.com/podcast. Special thanks to our music composer, Roddy Nikpour, and our kick ass editor, Kendra Vicken. And as always, thank YOU for being here. We’ll see you next time.