CONVERSATIONS with Dr. Lisa Flowers
Emory Gynecology and Obstetrics is excited to offer the second installment of our video series, CONVERSATIONS: Moving the Field Forward.
As part of our ongoing commitment to advancing the conversations around women’s health, we asked some of our faculty to sit down for a discussion surrounding women’s health from their area of specialty.
In recognition of Cervical Health Awareness Month, we are sharing our interview with Dr. Lisa Flowers. In this one-on-one conversation, Dr. Flowers discussed her commitment to continued innovations and advancement in the field of Human Papilloma Virus (HPV) related disease and why she felt it was essential to develop a first of its' kind Lower Anogenital Screening and Treatment Fellowship Program.
Featuring: Professor Lisa Flowers, Division of Gynecologic Specialties
Calloway: I think one of the things that I find so exciting about our Department developing this new fellowship opportunity is, as you said, it's the first of its kind. As you look towards the future of what the field of gynecologic specialties could be, is there something that particularly excites you?
Dr. Flowers: Absolutely. I really want to make a difference in the field of HPV related disease, and I feel that developing this Lower Anogenital Screening and Treatment Fellowship is going to open up an area for gynecologists to be able to find the answers by which we can reduce HPV related diseases in our female population. I am very proud of this being the first fellowship of this kind. This training opportunity is based on the knowledge that gynecologists can be experts in this area because we already perform these skills. We're just applying it to another area of the body.
Calloway: Your current Fellow, Dr. Dominique Jodry is the first to experience this training, can you give us some insight into what that experience offers?
Dr. Flowers: One of the critical training components is being able to provide care and treatment for women that have complicated clinical presentations of HPV related disease. That means not only do these patients have dysplasia, pre-cancerous cells in the cervix but that they also have extension into the vagina, the vulva, the perianal area or the anus. We are working to be able to treat these co-presenting symptoms comprehensively - not just treat one area and then refer the patient out.
It’s exciting to say that the fellow is getting expertise in complicated cases using electrocautery hyfrecation for treatment of anal disease, for example. She may also be using different topical agents to treat anal disease as well as vaginal disease. Ultimately, we are talking about dealing with cases that have large quantities of disease, in multiple areas and learning how to stage the treatments so that patients have both positive and beautiful outcomes, which is important. We know how important it is for women to feel good about themselves physically and what we don't want is to disfigure women in our treatments. And because we're gynecologists and we understand how important a woman's appearance is, even in a hidden area of the body, this fellowship allows us to deal with those complicated areas and complicated cases using different modalities for treatment. Thus allowing us to debunk a lot of the stigma around the diseases we treat, which is so important to them and their self-image.
Calloway: As you look to recruit future fellows, what are you hoping they will gain through this experience?
Dr. Flowers: We are working to develop different aspects of cervical cancer screening and screenings of HPV related diseases in different parts of the lower genital tract. The fellow will be able to, first of all, learn how to screen in low resource countries. So the fellow will actually go with me to a country like Panama and do cervical cancer screening in the mountains of Panama where we have limited resources to detect cervical disease. We'll truly have a colposcope in our backpack and be able to learn how to prevent cancer in these areas.
The fellow will have all the tools needed to do research, whether it's basic science research or clinical translational research for the multiple trials that I run in my clinic. These kinds of opportunities allow the fellow to be able to identify potential biomarkers, risk factors, and social determinants that put women at risk for cervical disease or anal cancer. They will also be able to learn how to do high-resolution anoscopy and complex treatments of extensive vulva dysplasia and vaginal dysplasia.
Towards the end of the year, the fellow will take part in a high-resolution anoscopy course that we typically deliver internationally. This year, for example, will be in Havana, Cuba.
Calloway: You mentioned the clinical trials research component, can you give some additional insight into some of these studies?
Dr. Flowers: Even without having a particular question that they want to study, we already have multiple studies that the fellow can take part in. For example, one of the studies for which I am a co-investigator is the Women's HIV Interagency Study, which is a natural history study of Women Living with HIV. We are following this cohort of women, looking at HPV related disease in its presentation and the multiple ways that we can better screen them and ultimately change the standards of care in this population.
We also have the Anchor Study, which looks at Women and Men Living with HIV, age 35 and above, who have high grade precancerous cells of the anus. These study participants are randomized to treatment versus active monitoring to determine what should be the standard of care in managing these patients. These studies are cutting edge and will change the way we manage and screen women and men with anal cancer who are living with HIV. The fellow will actually be able to interact with these studies and develop the ideas they have and propose it to these large multi-centered studies. This helps them build their resume while also solidifying where their careers might go in the future.
Calloway: Can you share how this kind of training innovation could result in a more comprehensive and streamlined process for patients. Specifically, patients with complex cases who historically have to seek out multiple providers for treatment.
Dr. Flowers: Historically a patient would have come to me to treat their cervical, vaginal or vulva disease and then they would have gone to my colorectal colleagues to deal with their anal disease. What I have found by building a relationship with colorectal surgeons is that many of them will refer their patients to me to perform high-resolution anoscopy which they do not typically offer. This means I can find those lesions before they turn into cancer. I can then identify them and ideally go into the operating room with them or treat them myself.
It allows the woman not to have to leave my office. I can take care of her comprehensively, and she doesn't have to experience additional embarrassment when going to another physician. Unfortunately, these kinds of diseases are often stigmatized, and it is embarrassing for some women. What we try to do is take the embarrassment out of the picture, make them feel comfortable about the care they're receiving and not to feel like they have to go to multiple physicians to get the care that they can get at one place, which is an exciting advancement.
To learn more about Dr. Flowers or the Division of Gynecologic Specialties at Emory University School of Medicine visit gynob.emory.edu.