Dr. Karyn Hansen greets a Seasons reporter in the conference room near her office at the Karl J. Krapek, Sr. Comprehensive Women’s Health Center at Saint Francis Hospital and Medical Center, a state-of-the-art building connected to the main hospital by a walkway and bridge stretching across Collins Street. The gynecologic oncologist has changed out of her scrubs for the meeting and instead dons a classic navy cardigan over a cream-colored blouse and grey wool pants. Twenty minutes into the interview, however, she is called to the OR and is back in her scrubs, ready to consult on a complicated, robotic-assisted laparoscopic hysterectomy.
Back in medical school, it was the excitement of surgery that lured Dr. Hansen; in fact, she initially thought she wanted to work in trauma. But once she got to her first clinical rotation—obstetrics/gynecology—during her third year of medical school, she knew she had found her calling. “Ob/Gyn suited me. It had the surgery, but it also had the continuity of care,” she says. Dr. Hansen was drawn to gynecologic oncology in part because of its added emotional component. “I’m a frank and realistic person, and I try to be really honest with patients about their prognosis and what we can and can’t do to help them,” she says. “I like to give my patients some autonomy even in a bad situation, to allow them to make decisions that are right for them as individuals.”
Dr. Hansen says she appreciates the longstanding relationships that oncologists have with their patients. “Sometimes that’s because they have the type of cancer that is curable, and they follow up with us for surveillance. Other patients have the kind of cancer that is treatable, but not curable, and therefore get treated on and off for many years,” she explains. She says the most difficult part of her job is telling people they have advanced-stage cancer, particularly when they are not emotionally prepared for it. “The most rewarding part,” she says, “is even in those hard situations, feeling like your patients and their families really trust your opinion and advice.”
Dr. Hansen, who grew up in New Hampshire and went to college in South Carolina, says she took a non-traditional route to medicine, working first as a pharmaceutical sales rep and then attending graduate school to study microbiology before heading to the University of South Carolina School of Medicine. She met her husband, Jonathan Shepherd, a urogynecologist also at Saint Francis, while she was a third-year medical student and he was in South Carolina finishing his residency. She continued on to Magee-Womens Hospital at the University of Pittsburgh Medical Center for both her residency and her gynecologic oncology fellowship, while her husband was completing his urogynecology fellowship and then faculty appointment there. After completing her training, she and her husband decided to pursue positions on the East Coast to be nearer to family. Saint Francis proved a good fit for both of them.
Though ovarian cancer is not a particularly common cancer—there are only about 22,000 cases diagnosed in the United States per year (compared to more than 250,000 cases of breast cancer)—women with ovarian cancer compose a large proportion of Dr. Hansen’s patients. “Although it is often not curable, ovarian cancer is highly treatable,” she says. “Women get treated and then may not have evidence of disease for a while, then they recur, and we treat them again. People can live quite a long time, even with advanced ovarian cancer,” she says.
Still, ovarian cancer is the most deadly gynecologic cancer because it is usually diagnosed at a late stage, as women rarely show early symptoms, and there is no good screening tool. This is why it is so important for women to know their family history, according to Dr. Hansen. Women with a first-degree relative who has had ovarian cancer (and related cancers such as fallopian or peritoneal), as well as those with a strong family history of breast cancer, are typically referred to a genetic counselor who can determine whether they would benefit from testing for genes like BRCA1 and BRCA2 that put them at a higher risk for the disease.
The majority of women with ovarian cancer don’t actually carry those mutations, but having such mutations increases ovarian cancer risk significantly. According to the National Cancer Institute, 11 to 17 percent of women who inherit the BRCA2 mutation and up to 39 percent of women with the BRCA1 mutation will develop ovarian cancer by age 70, compared to 1.3 percent of women in the general population. Carriers are usually advised to undergo risk-reducing surgery, which typically involves removal of the ovaries and fallopian tubes after they are finished with childbearing. On the medical side, researchers are increasingly trying to target treatment to specific genetic mutations for a more individualized approach. Recent research has also led to the understanding that most of what we call “ovarian cancer” actually originates in the fallopian tubes.
Cervical and endometrial cancers
Cervical cancer is even less common than ovarian, though recent research suggests that rates are on the rise. “We have better screening techniques for cervical cancer—like the Pap smear—and it’s also potentially preventable, thanks to the HPV vaccine,” says Dr. Hansen. The majority of the approximately 13,000 cases of cervical cancer diagnosed nationally each year are caused by the human papilloma virus (HPV), she says, and the Centers for Disease Control and Prevention now recommends that all females—and males—receive the vaccine when they are 11 to 12 years old. (HPV is transmitted sexually and can also lead to vulvar, vaginal, penile, anal, and oropharyngeal cancers). Unfortunately, says Dr. Hansen, approximately 50 percent of people who are eligible haven’t had the vaccine. Regular Pap smears and annual pelvic exams are critical for the early detection and prevention of cervical cancer. When a Pap smear reveals abnormal cells (also known as cervical dysplasia), the gynecologist removes those cells and thus eliminates the chance of them ever developing into cancer. “And most cervical cancers, if diagnosed early, can be cured,” Dr. Hansen says.
Endometrial cancer is the most common of the gynecologic cancers with about 60,000 new cases diagnosed annually. There are two types of endometrial cancer, says Dr. Hansen. One is high-grade and, like ovarian cancer, tends to be aggressive. But the vast majority of endometrial cancer cases, she says, are low-grade and the result of hyperstimulation of the endometrial lining.
“Endometrial is the fastest growing type of gynecologic cancer,” says Dr. Hansen. “As society gets more obese, we are seeing more endometrial cancer occur and in younger women than we had seen before.” She explains that adipose (or fatty) tissue results in the production of extra estrogen, which stimulates the endometrial lining. Obesity, in fact, is a well-established risk factor for endometrial cancer. According to Dr. Hansen, for women whose endometrial cancer is diagnosed early, surgery is often the only treatment they’ll need. Treatment typically involves a minimally invasive hysterectomy including removal of the tubes and ovaries.
The most common sign of endometrial cancer is postmenopausal bleeding. “Any change in bleeding is something to talk to your gynecologist about,” she says, noting that abnormal bleeding could also be a sign of cervical or ovarian cancer. Benign causes, such as polyps, can lead to abnormal bleeding, too, so this symptom is not always cause for alarm, she adds, but you should still consult your doctor. Dr. Hansen stresses the importance of regular gynecologic check-ups.
Educating future physicians
Teaching was an integral part of Dr. Hansen’s fellowship training, and one of the reasons she was attracted to Saint Francis was because it provided her with the opportunity to continue teaching residents and medical students. “I help teach the residents who are part of the Ob/Gyn residency at Saint Francis Hospital, as well as medical students from some of the local medical schools like Quinnipiac and UConn, and I really like that part of my job,” the doctor says. Residents and medical students accompany her on her rounds and join her in the operating room. “I hope that as I’m here longer, I will move into a more defined role in resident and medical student education,” she says.
Lori Miller Kase is a freelance writer living in Simsbury.
Photographer Seshu Badrinath of Avon specializes in intimate, natural portraits of families and children; seshuphotography.com