The Dawn of Precision Health for Women

Megan B. Fitzpatrick, MD received her MD degree from the University of New Mexico School ofMedicine in Albuquerque, NM. She then completed AP and CP residency training and a surgicalpathology fellowship, with a focus on gynecologic pathology, at Stanford University. Her researchand professional interests are in women’s cancer diagnosis and surveillance, including cervicalcancer screening program implementation, device development, and diagnostic test validation inlow resource settings. She is currently an assistant professor at the University of Wisconsin School ofMedicine and Public Health.

How does precision health differ from precision medicine?

When we talk about precision anything, we’re usually referring to precision medicine, which usually deals with individuals who already have a disease and asks if we can personalize the treatment, so it’s often talking about molecular targets. Precision health is a little bit broader. It includes personalized ideas, but it really expands that into lifestyle and education. One of the things I think about a lot is early disease detection. I think that precision health is more all-encompassing and more holistic, talking about the person and the environment, both of which play a role in health, versus personalized medicine, which would focus on what we’re going to treat with when you get a cancer, for example

Why is it important to pull women’s precision health out and look at it separately from other areas of precision health?

I think we’re still learning a lot about that question and what makes women unique. Actually, women were not included in some clinical trials initially because of the exact things that we now want to understand—because they could be pregnant or breastfeeding, and because their hormone cycles could influence the results. I think the intent was initially good in trying to protect women and fetuses, but it’s left our understanding of what influence the menstrual cycle has on all sorts of systems—from biological processes to metabolisms of drugs to reference ranges at different times of the month—lacking. Women’s precision health is definitely more complex and there are a lot of layers to understand. But that understanding is extremely important, and we’re just starting to learn some of the ways in which it can be very important.

What is FemTech, and in your opinion, what is the most exciting area currently advancing in that space?

FemTech is a bit of a blanket term. It refers to incorporation of things that are specific to women into the tech market and innovating around that. For example, having a breast pump that can fit under my shirt so I can continue working while pumping has been helpful from a personal standpoint. But I think the idea of understanding early markers of diseases that are specific to women, like ovarian cancer, is an exciting prospect. I also think there’s a lot of interesting work being done to expand our understanding of the menstrual cycle as an insight into health. This information is relevant as a runner, for example, in knowing what phases of the cycle to prioritize sprint workouts and when to eat carbs—little things like that that help you understand your own body and be empowered to optimize your own health.

What role does at-home testing play in precision health?

I think at-home testing reinforces the idea of taking your health into your own hands. The idea that you perform the test yourself changes the paradigm of how we’ve thought about clinical medicine or health. There is a move to understand your own body and your own health and be engaged in those decisions, and I think self testing is an integral part of the ability to be involved in what’s going on in your own body and understanding that in an intimate way.

Monitoring health with wearable devices is an important aspect of FemTech. Could it ever become an issue of women getting bombarded with too much data about their health?

I think there is going to be some sort of happy medium for each individual person, which may involve choosing a few parameters to focus on. The way a lot of these technologies are built can be overwhelming, so I think there’s room for simplification. The amount of data available has expanded so much that now I think it’s a matter of helping to curate information to help people understand it and then do something about it. There is a lot going on in the molecular space that we’re just beginning to understand, and I think the next phase is trying to understand what it all means and translating that information to something that is relevant or actionable to an individual person. There is just so much data and I get overwhelmed too; for example, I don’t bring my cell phone with me running if I don’t need to because I think there’s an important role for mental space.

In your vision of the future of precision health for women, how will the role of health care professionals change?

I think it already is changing—it has been ever since patients have had access to a lot of information. Ideally, patients and providers come to shared health decisions through information transfer and informed consent. But I believe that the team shared decision will be even more important as increasingly more information is available. And it probably won’t just be the doctor involved, but really an entire care team. I’m a pathologist, so while I don’t directly see a patient, we have tumor boards where physicians involved in care such as radiologists, surgeons, oncologists, and pathologists discuss the case as a group. We take the patient’s wishes into account and discuss how we can best serve their wishes while also taking into account recent evidence-based practices for their individual case.

How does your own research intersect with precision health for women?

The aspect of my research that fits the most in this area is self-collected human papillomavirus screening. We used a community-based model to offer cervical cancer screening to rural women that wouldn’t otherwise necessarily have access in rural Zimbabwe. We had community health workers from their villages do the education and offer the testing and then help the women connect to follow up care. I think the principles are pretty similar to FemTech in offering self-collection since this is an example of how to empower women to play an active role in their health.