Sophocles: Well, I think the trend in OB/GYN is to shift from hospital and surgery to office procedures, and I think this is going to cut down on healthcare spending a lot. Already there are OBGYN offices that have procedure rooms, where they can do hysteroscopy and small procedures and it’s faster, it’s easier, it’s less expensive.
I think the other trend globally is that there are so many more diagnostic instruments that are portable. When I started training, a colposcope was an enormous, big microscope—you know, the size of a sewing machine that you could only have in the doctor’s office. Now, we have colposcopes that fit in your hand. We have incredible high-definition cameras right in our phones that we can document things.
A colleague of mine spent 6 months in South America doing colposcopy with nothing more than a little handheld device that can then be transmitted back to clinics so that clinicians can read the cervical images. I hope the trend will be to have increasingly mobile diagnostic tools, whether it’s ultrasounds that look like laptops or colposcopes that fit in the palm of our hand, so that we can get out to underserved populations both in the United States and globally. I think if we can do that, I think that will improve perinatal mortality and obstetrical diagnosis, but also in terms of diagnosis of cervical lesions.
Cervical cancer is more of a global issue than it is an American issue. We “only” have 40,000 cases of cervical cancer a year, but the truth is there’s no reason to have any cervical cancer in the United States. And what I find is the only cervical cancer I see are women who are not getting in to a clinician, either because they live in rural areas, or they’re choosing not to be educated about the need for regular evaluation of the cervix. So we have technology—it’s just a question of getting it in the hands of rural clinics or getting to those populations who aren’t getting OB/GYN care.
I think that’s a big one. I think as our population in the United States ages the demographic is going to demand a need for more post-menopausal attention to urinary issues, bone loss issues, cardiovascular disease. And I think OB/GYNs—we are a strange breed of primary care physician and surgical subspecialists, but we’re going to have to go with the times and understand that as more of our patients get older, we cannot just assume they’ll find their way to a urologist. We have to be asking them about symptoms of genitourinary syndrome, of menopause urinary incontinence, recurrent urinary tract infections. We have to be proactively thinking about the bone loss and the cardiovascular disease, and I think we’re going to need to partner with the American Heart Association and have a powerful initiative to try to screen for these things.
So I think those are the main issues that, going down the road, if I look at the next 10 to 20 years in OB/GYN, I think we are going to be forced to address. The last thing is really ovarian cancer. This has really eluded us, evaded us. We have mammograms, we have breast molecular imaging, we have increasingly good ways to diagnose and treat breast cancer. And we’ve made, I think, wonderful strides in the world of breast cancer diagnosis and treatment.
As I said, pap smears and the link to HPV as a viral ideology have really made cervical cancer a rare disease in the United States. But ovarian cancer remains very difficult to diagnose. We diagnosed at late-stage, and pelvic exams, pelvic ultrasounds biomarkers have all proven inadequate.
So I think that’s sort of our last great frontier: that we truly need to find a better way to find ovarian cancer.