A panel of Mount Sinai experts led by Stephanie V. Blank, MD, Director, Gynecologic Oncology, Mount Sinai Health System, discuss the innovative technologies, treatment options, and integrated support services available at The Blavatnik Family – Chelsea Medical Center at Mount Sinai. The Center was designed with the goal of creating a space for women that is welcoming and comfortable, while also providing the most advanced, comprehensive care. The Center treats the full spectrum of gynecologic cancers and non-cancerous gynecologic conditions, as well as breast cancer and non-cancerous breast conditions. Women’s Cancer Program The Blavatnik Family – Chelsea Medical Center at Mount Sinai 325 West 15th Street New York, NY 10011 Referring physicians, please call 1-844-MD-CANCER Hello, everyone. Hi. Thank you so much for joining us today. We're so pleased were able to get together virtually during this unprecedented time. We hope you're just is excited as we are. We have a lot to cover over the next hour. So let's begin. Um, next side, please. Here's an overview of how our our together together will go first. Our Panelists are going to introduce themselves. And then we will tell you about our very special women's cancer program at the Blavatnik Family Chelsea Medical Center at Mount Sinai. Then we'll address our clinical trials program. Talk about the safety precautions were taking due to co vid and following that, we'll just give an example of a patient's, uh, that would be referred to our center. And finally, we'll answer as many of your questions this time permits during our live Q and A session next slide. Please. I am delighted that my colleagues air here with us today. Joining me are Dr Samantha Cone, Dr Valentine Kolev and Dr Christians. Alex, Um, I'll first introduce myself. My name is Stephanie Blank, and I am the director of gynecologic oncology for the Mount Sinai Health System. I'm a professor in the department. Obstetrics, gynecology and reproductive science at the Icahn School of Medicine at Mount Sinai and the director of women's health at the private Nick Family Chelsea Medical Center at Mount Sinai. Thank you. I'm excited to be here. And next we have Dr Samantha Cohen. Hi, I'm Samantha Cohen and thank you for joining us. As Dr Blank mentioned, I worked at the Chelsea Medical Center. I also work in Brooklyn. I'm the director of gynecologic oncology at Mount Sinai, Brooklyn, And I've been in Mount Sinai for most of my career, which is about 18 years now. So it's great to have you. Thank you for joining us. Thank you. Um, Dr Kolev. Hello, everybody. My name is Valentin Color. I'm an assistant professor off gynecologic Oncology, the Department of Upsetting and Gynecology at ICANN School of Medicine. I see patients also at the Chelsea Center, Blavatnik Family Center and I also trained to China and and being a China for most of my career. Fantastic. And now doctors L'eggs. Hello. I'm Christians. L'eggs and similarly, I am assistant professor through Mount Sinai and worked at the Blavatnik Family Cancer Center. See clinics there I also work through Mount Sinai Hospital in Mount Sinai West and thank you everyone for joining us today. Thank you. Now I'm going to hand the program over to my colleague Dr Cohen to tell you about the Blavatnik Family Chelsea Medical Center at Mount Sinai and are very special Women's cancer program. Were located it on West 15th Street, Manhattan, between 8th and 9th Avenues, right across from Chelsea Market. Dr Cohen. Okay, so the Blavatnik Family Chelsea Medical Center is part of the Mount Sinai Health System, and it was specifically designed with the goal of creating a space for women that is welcoming, comfortable and unique. We established our women's cancer program here within our Chelsea facility, with a distinct purpose. To provide the most advanced comprehensive care by our team of women's health specialist in a soothing environment. Our program focuses on gynecologic cancers as well as non cancer gynecologic conditions as well as breast cancer and non cancer breast conditions. What's special about the Blavatnik Center? As you can see from the pictures, we designed the center with your patients in mind. It is small, intimate and comfortable. It has the latest equipment, including three d mammography. It has fully established and equipped operating rooms so that our outpatient surgical procedures can be done right here. It has a modern infusion suite for patients who need chemotherapy and other in, uh, infusion treatment. In addition, we have an amazing wellness and support staff and programs that focus on our patient as a whole person. So basically, patients could get everything they need right here. And I will now turn over to Dr Cole EB to discuss what conditions we treat as part of our women's cancer program and to give an overview of what is a gynecologic oncologist. We provide services, and we are specialized in treatment of gynecological cancers, which are cancer. So the female reproductive tract and that you can see from the list includes ovarian, uterine, cervical cancer, flopping cured cancers, also vaginal of over cancers. We also treat non oncological conditions that, you know benign disease is off the gynecological system, including pre cancerous conditions. Cervical dysplasia, pelvic masses very insist fibroids. We also at the center provide the full spectrum of breast services for breast cancer and noncancerous breast conditions as infections, pain in large lymph nodes, breast sticking again lumps fibra cystic disease the way that we provide Carrie, we use a multi disciplinary approach for treatment off our patients, where we use the full spectrum of specialties on site. We do have hematology, oncology, radiation oncology. We have our own lab, and also we provide diagnostic services in terms of imaging. We do treat our patients on site and this way that makes it very convenient for the patients because they provide and they received all of the care at one place. Also, we provide genetic counseling services and nutrition and nutrition services, a za part of the whole multi disciplinary approach. We all are specifically trained in gynecologic oncologist. And if you're wondering what that maybe, uh, we initially completed residency and upset I'm gynecology. And consequently to that we undergo a fellowship in gynecologic oncology. That is, in addition, in three years off of training that includes the full spectrum of oncology treatment training, including surgery, chemotherapy. And that's what with the goal to provide a specific care for female. Yeah, many ecological cancers, the gynecological coverages you can look at. Um, there's a captain of the team of the multi disciplinary approach we coordinate the care that ISS it's all entirely, including the surgical planning, the actual surgery, the chemotherapy and radiation therapy, all the patients that presented a multi disciplinary tumor boards where the plan it's made and every patient gets individualized plan treatment plan based on the specific condition including, you know, operative finding stagings, genetic predisposition. Now we'll speak about the clinical trials program here at the Blue Bionic Family Chelsea Medical Center, and I have to say we're really proud of our clinical trials program. We have multiple trials across all of our main disease sites and just for the ovarian, uterine and cervical cancers. Um, and AR trials really cover the gamut. We have a massively expanded program. Our trials include treatment for our main cancers, as well as prevention trials, trials where we look at molecular findings in the tissue or circulating tumor DNA, Um, some about decision making in quality life and reproducing surgeries. Um, through trials, we have access to novel therapeutics, sort of the latest and the greatest in cancer treatment, and this includes things like immunotherapy, um, and targeted agents and these air just different than chemotherapy. This is a completely different way we have a We have ways to treat cancer that are completely different than ever before. Um, and the thing that's really important about trials and really exciting about trials is it really moves the care of our patients forward, um, trials or how we advance science. And we wear really proud to be able to offer our patients enrollment in clinical trials. Um, so that's about trials. Um, now I'm going to turn it over to doctors Alex, who is going to talk about the safety precautions were taking due to the cove in 19 pandemic doctors. Alex. Yes, great, thank you. So we have many safety precautions that have been put in the place for our patients since the development of the Cove in 19 Pandemic. So prior to a patient's appointment, their pre screened over the phone for symptoms of the coronavirus as well as any recent travel and then all patients, visitors and staff are also screened upon entering the building. It's a patient screens positive at the screening desk. They're brought to an isolation room and are further evaluated by the clinical team. At that time, we have spaced appointments, so we have fewer people in the building at any time are waiting. Rooms are purposely not overcrowded, and as employees of Mount Sinai each day we get our temperature checked in a test toe, having no symptoms. An additional precaution is limited. Visitors in the building currently visitors air only approved for patients for whom a support person has been determined to be essential to the care of the patients. Patients who have plan have an end of life discussion with their clinical providers and patients coming in for an initial consultation to the office practice. In addition to screening patients prior to their office visits, all patients receiving side a toxic chemotherapy agents are required to have Ah Covad test two days prior to their treatment visits. Additionally, stations they're required to have covert tests at a minimum of five days prior to any surgical procedure. Great. Thank you. Thank you so much. Yeah, we do a lot to make sure, um, that our patients are safe. We know that our patients are very concerned about their safety, as with their families. Um, now, I thought I'd provide provide an example of a patient cared for here at our center, sort of describe a little bit of what we offer. So this is a woman who was in her early fifties and she went to her gynecologist with some abnormal bleeding. The gynecologist did an ultrasound, which shows a polyp and hydro Sal pinks basically a mass in the fallopian tube. Andi, that gynecologist that wanted to take her for a laparoscopy and a history Oscar p um, to address both of these issues. Um, this was in February of 2020 on placement of the laparoscope. The gynecologist noted that there was a lot of scar tissue that the the tube really couldn't be mobilized. It also aborted that portion of the procedure. Did the history Oscar P. And that was negative. Um then four months later, the patient continues toe have abnormal bleeding, of course, Cove. It hit during this time, but that's not part of the story that's just happened to have happened. The patient then had a second history Oscar P. On, but this history Oscar p. She had a fragment of serious cancer and Apollo again, eso she was referred to our center on Gwen. She came here. She really had this. This discharges really typical of tubal cancer like high drops to be a pro fluent. It's like this watery, bloody discharge so pretty high, um, concerned this was actually a tubal cancer, and in fact, we checked to see a 1 25 and it was like 1000. We did a CT scan, Um, and it showed a mass on the over on the Alexa as well as some disease in the momentum. So the patient was quickly taken to the operating room on, but had a stage three C fallopian tube cancer on discovered well from surgery. Now, importantly, this patient had absolutely no family history. But we did do genetic testing on her as we do for all of our patients with this kind of cancer. And she was found toe have a BRCA one mutation. Um, she has four Children, and all these Children are now being tested, and they're actually being sent to a new program. We have the Center for Cancer Prevention and Wellness. This is that, um, Union square on bare, all getting tested, and they'll they'll undergo appropriate screening or risk reducing procedures. Um, and this patient is also hooked in with the breast surgeon who will be following her when she's done with her treatment. Um, in terms of her treatment. She is now 56 of the way through her chemotherapy, and she's actually she's using what these cold caps that we have to help prevent hair loss on. And after this treatment she'll be able to go on a part inhibitor, which is a targeted therapy, Um, something that really works well and women with Brcm mutations. And this should really extend her life. At least it seems four years longer than if she weren't on that medication. Eso It's kind of, I thought, this is a good story patient to talk about because it gives a good idea of the type of patient we should be seeing. If you have something going on that just doesn't make sense, we're happy to give you our two cents. We really work to expedite care. We'll get your patients and as quickly as possible and and take care of them as quickly as possible. And we provide everything is, Dr Cohen said. In our center. Um, this story also just really hammers home the importance of genetic testing as well as the downstream effects. Genetic testing will now switch gears and allow all of you to send in, um, some questions. If you have any questions for us, um, you can, uh, send them. Go to slider dot com and use the code health to submit that question to our event. Um, I'll read through as many as I can, Aziz time permits, and I'll ask our Panelists to ask Thio answer them. Um, while we're waiting for questions to come in, I will just start with a few questions that we often get asked by our patients. And just so you know, our panels do not know they're going to be getting asked these questions. Um, Dr Cohen, Uh, do I really have to get my son or daughter vaccinated for HPV? Mhm. So, yes, you dio and we have really, uh, you know, level one evidence to support HPV vaccination. That's covers many, many years of collecting results on all the Children that have been vaccinated in very successful vaccination programs, mostly not in the United States but in other countries. And we're hopefully going to follow suit. Um, here. But you know, we know from the studies that have been published, I mean, for example, There was one meta analysis that was published in the land set that was covered 65 studies that represented 60 million people who had been vaccinated. And it was at least eight years of follow up. And we know from this study and others that the incidents of high grade cervical dysplasia in these patients was decreased by over half. So we know that the HPV vaccine works. We know that it reduces the cancer causing HPV subtypes, subtypes. We know that over time we will see, um, a decrease in the number one cancer that it causes, which is cervical cancer. But also, you know, the other cancers that are found in men like Lauren Trail cancer. So it's also a very well studied vaccine, as I mentioned, and the, you know, in sort in terms of the safety profile has been well studied. So it's very important that all Children get vaccinated. Thank you for that amazing answer. Thank you. Um and that actually spurred some questions that came in. And Dr Kula, I'm going toe address this to you. It's kind of more than one question. I apologize for that. So, first of all, um, what do you think about the HPV vaccine for women in their thirties and forties on? Gonna ask all of these and I'll remind you. Sorry. Then what about for people that already have dysplasia? And if somebody has had the vaccine gets dysplasia, do you re vaccinate? So thirties and forties already have dysplasia and re vaccination. Okay, uh, so one of the time. So in terms of the thirties and the forties, Initially when the vaccine was released, the study, the way that it was performed, it was in a population that was up to the age of 27. And that was the initial FDA approval that, you know, women should be vaccinated up to the age of 27. However, last year, I believe it was last year, beginning of last year that was expanded, actually to the age of 42. So, technically, you know, we do recommend vaccinations to be performed in the thirties and forties. The I think the confusion in the past has bean, you know, different in terms of recommendation reimbursement for the vaccine. And initially, the insurance companies reimburse We're reimbursing the vaccine off the age of 27 but that was not are like country education that the vaccine will be administered after that age, then, uh, in terms off giving the vaccine to the patients that I have already developed this pleasure. The data actually shows that, you know, once the virus has established and there's already displeasure, giving the vaccine doesn't have a curative effect is not going to remove it. However. Also, there's data to show that there's some protective effect of the vaccine in terms off the progression of the disease. And again, this is not the contraindications having having the having the displays. That doesn't mean that a woman cannot get the vaccine. And in the last question about the vaccination, once we believe that the immunity that is developed from the vaccine one is established, we don't have any data to show that. Actually, we have to re vaccinated if the initial vaccination was administered properly with three consecutive uh, vaccines. And so at this time we would not recommend re vaccinations to the patients have already have received the vaccine. Thank you, Dr Kula, and I'm sorry for the compound question. Never a good interviewer technique. Eso Here's another question that came in and I'll address this to doctors. L'eggs on baby. You can expand upon it. It's a yes, no question, but you'll expand upon it. Um, it says, Can I send a woman to the Center for Cancer Prevention? If she has a close relative with a family history of ovarian cancer but negative genetic testing, So would this type would this type of person to be appropriate to be seen by us? So I think, Yes, um, from multiple reasons. First, uh, you know, we always welcome If there's a patient that you're caring for, who wants additional information that you feel like you're not, may be able to provide, uh, your level of expertise. We're always here to assist in any way we can, and sometimes I think, even just have a reassuring visit. Thio discussed with the patient their specific risks, um, and things that they could be doing even just to minimize risks and taking a good family history to better understand that, to make sure that their genetic testing isn't necessarily outdated, Um, and that, you know, understand what testing has been performed for that patient and just to help with an exam. If that's going to provide you or and or the patient more reassurance again, we're happy to help however we can. Excellent. Andi, I'm gonna ask this question of myself on DNA, That is. Do you see men with B R. C? A mutations? Um, so actually, I would say I personally don't see man. I definitely ordered B r. C A testing on men. Um, but I would say a man with a BRC mutation should probably go to the Can't Center for Cancer Prevention and Wellness again, the program that is at Union Square. It's a new program as well that we work very closely with, um, Dr Cohen, Another question for you, Um, sort of along the same lines s Oh, you know, I find that this is a question. It's not me. Patients don't necessarily want to know if they have a genetic predisposition to cancer because they feel like there's nothing they could do about it. So how do you address a patient that feels this way? So I always start by talking to the patient about and generally speaking at medicine. You know, we only do tests that we can have a an outcome that is positive in terms of improving their quality of life, improving their quality of life, improving their health outcomes. So we don't offer tests and we don't pursue things. Generally speaking, where we can't do something positive, Thio help them live a long and healthy life and that when I usually speak about it in that, um way, I think patients generally sort of come around on bond more specifically, especially in our Bracha patients. You know, I speak to them very in specific details about, you know, by knowing the results of this test, how the different ways that we can help them, um, prevent, you know, prevent ovarian cancer by doing the risk reducing surgery at the age appropriate time. And also I talked to them about breast cancer screening That's enhanced, and it certainly they fall into a different algorithm of screening and care if they test positive for a bracket mutation. And usually after we've had that discussion, I think for most patients, um, it goes a long way, and they do, um, feel more comfortable with undergoing testing. Excellent. Um, here's a question for Dr Cole F. Um, if I'm referring a patient to be seen by your team. What records or recent testing do they need? Well, I mean, we ideally, we want all the all of them. All the recent testing and imaging that they have on. It really depends the reason for the referral and why the patient has been referred to our center. But, you know, we try to obtain all the records prior to the visit and our team on the back and works on obtaining or relative records, regardless off where they were done in the outside institution in a private office. Eso By the time the patient comes to visit us, we actually have reviewed the records and the reason for the visit and be prepared for the patient in a way. And even sometimes if we feel based on the referral that something is missing would try to obtain some of imaging or lab results before we even see the patient. Excellent. Um, doctors L'eggs. What should I do If I'm not sure whether someone should be referred? Teoh, a gynecologic oncologist. Eso I think you can always reach out to us and inquire before sending them. Um, you know, I there's multiple ways to get in touch with anyone of us, and we're always happy to help figure out if you're patient, kind of meet criteria to need to be seen by us or if we can help in any way. But I think most of the time when you are wondering if a patient should be referred to a sub specialist, that sometimes can be the telltale sign that there's something there that's making you concerned, that you may want our assistance. And again, we're always here to help in whatever way we can. Thank you. Um, Dr Cohen, Um, my patients get scared when they hear they need to see a cancer doctor. Do you have any advice? So I think that's one of the unique parts about our center characteristics. As I mentioned in the beginning, it's a very inviting place. There are many types of different types of patients that come there for other problems besides cancer. Other diagnoses besides cancer, Um, and I think if you can talk to your patients about you know that part of it, that we just see complicated gynecologic problems, not just cancers, and, um, in addition to that, you know, it's a very warm and inviting place I think that helps patients sort of have the courage. Thio, come visit us. Thank you. Um, Dr Kula, this question is just for you. What is the difference between laparoscopic and robotic surgery? There is no difference. It's just it's the same surgeries, just the tools that they're utilized. They're both minimally invasive surgeries. With Robert, there's, you know, more freedom off movement with articulating instruments and three D cameras utilized for a better visualization with the traditional laparoscopy. You know, the traditional way of using and manually controlling the camera and using the laparoscopic instruments. But the procedure by itself is exactly the same procedure. Using different tools, we do utilize all of them. We dio robotic surgery, laparoscopic surgery and some, you know, they have their advantages and disadvantages. I personally think that robotic surgery is easier to perform in patients with high B. M I. It's just the way that you know the system works. It makes it more economically effective for some complex procedure. The argument is that the robot makes it easier. But on the other hand of approx, copy and the robot is exactly the same procedure. The way that it's performed the same steps are utilized. Oh, from the patient's experience. I don't think there's a difference for the patient, and then it's Sometimes it is provider preference in certain cases, but we do use both modalities. Right? Um doctors L'Eggs. Can you talk? There is some question questions about Uncle Fertility. Um, can you talk a little bit about what type of services we have? Yeah, So we have practitioners that come to Chelsea as well, who worked particularly with Uncle Fertility. So for patient populations that are concerned about future fertility and have a diagnosis, or maybe even a presumed or possible diagnosis, that we're able to utilize these services to better counsel our patients prior to undergoing a procedure or any type of cancer treatment which may affect their fertility, we always have consultation with certain specialists who can really guide us in regards to options available for each individualized patients with regard stock of fertility. Perfect. Thank you. We also have a question here about the Center for Cancer Prevention and Wellness, which I mentioned before for, and I'm sorry we didn't prepare a slide on this, So I'll speak slowly because I guess somebody else speak slowly here. Um, there is a general number, which is 1844 m d cancer. Um, and again, that's a the cancer. The Center for Cancer Prevention and Wellness. But there's also an email and and that email is Union Square CCP W at mount Sinai dot org's. Um, I'll say that again. In case you're writing it down, it's Union Square CCP W at mount Sinai dot org's. Um all right, where am I? Dr. Cohen? How early do you think is? You know, at what age do you think? Um um, that's going to say Children. But younger people, What age do you think is the right age to genetically test, say, a daughter of a woman with the BRC a mutation. So I would recommend well could either. You know, for some reason, there's a close family member with a very early cancer. Um, let's say, for example, in the early thirties, then I would recommend testing. Uh, you know, it's somebody in their early twenties, in other words, 10 years younger than the cancer on set in the close family in the close relative. But that being said, um, the SDO and ACOG recommend that in terms of the breast cancer screening for these patients who have, for example, Bracha mutations. We do want to begin that screening between the age of 25 to 29 Um, and specifically alternating breast Emory with mammography. So if you don't have a family member that, um, is a close relative that had cancer that would, you know, cause you to test them earlier than age 25 I would say at least consider testing them by age 25 so that between age 25 29 they can begin the breast cancer part of it. Right. Thank you for that. Um, and again, sort of along those lines. Um, Dr Kolev, what do you do? You see, people, um that have variants of uncertain significance, right? Yes, we dio And, uh so the various symptoms significance of the issue with that is, you know, there is some rearrangements in the gene for, for example, for bracket gene. And this basically means that this rearrangements have not been a associated with cancer development or increased risk for cancer. We dio you know, when initially when they started mapping out the DNA and start mopping up the bracket jeans. They're actually quite large. And then certainly arrangements in the genes were found to be uncle genic in terms of developing cancer and then certainly in the genes have not been associated with increased risk for cancer. And that's where the unknown significance comes because it is rearrangement of the sequence. But we don't know if that actually has any clinical significance. As of right now, we do not treat these patients at having a mutation that is Uncle Genic, and we do not treat them differently than the general population. Great. Thank you. I doctors Alex. This will be our last question unless one comes in and the next couple a little bit of time. Um, there's a question here. Doctors l'eggs about other members of the health care team. You know, who else do patients see when they come to our center? Aside from the physicians? Yeah, so that's a great question. So we have a multidisciplinary team that helps us care for our patients within each of our individual clinics. I think most of us utilize a nurse practitioner as well as a nurse help see our patients to obtain histories. Some of us also sometimes have a resident or fellow in with US or medical students for clinic A. Well, uh, in addition to that, patients who may need additional resource is we have a social worker and a nutritionist on site who often are able to see our patients. Same day, if any, um, needs arrived that their services could be utilized. Um, And those air, Really, I think the primary sources for us of who sees our patients and their typical clinic of it. Thank you. And thank you Panelists for fielding so many questions. Um, now I think we're going Thio close up the program and let everyone get on to their evening. It's been an absolute pleasure sharing this information about our women's cancer program with you and helping to provide further awareness around gynecologic cancer. Oh, I didn't say it is gynecologic cancer Awareness Month. So just be aware of that again. Thank you for your time. And we really enjoyed this afternoon. Thank you. Thank you. Thank you.