A Review of the Current Cervical Cancer Screening Guidelines.

For many decades, Pap smear screening has been synonymous with well-woman visits. Although Pap smears have greatly decreased the rates of cervical cancer, current guidelines support less frequent screening. This commentary reviews the currently recommended strategies for cervical cancer screening.

A case-control study of robot-assisted type III radical hysterectomy with pelvic lymph node dissection compared with open radical hysterectomy.

OBJECTIVE: The purpose of this study was to compare robotically assisted hysterectomy (RAH) with open (ORH) type III radical hysterectomy in the treatment of early-stage cervical cancer. STUDY DESIGN: The outcomes of 51 consecutive patients who underwent RAH were compared with the outcomes of 49 patients who underwent ORH. RESULTS: There were no differences with regard to patient demographics. There were significant differences between the groups with regard to operative blood loss (P < .0001), operative time (P = .0002), and lymph node retrieval (P = .0003), all of which were in favor of the RAH cohort. All patients with RAH were discharged on postoperative day 1, compared with a 3.2-day average hospitalization for the cohort with ORH. The incidence of postoperative complications was 7.8% and 16.3% for the RAH and ORH cohorts, respectively (P = .35). CONCLUSION: Robotic type III radical hysterectomy with pelvic node dissection is feasible and may be preferable over open radical hysterectomy in patients with early-stage cervical cancer. Further study will determine procedure generalizability and long-term oncologic outcomes.

A comparative study of 3 surgical methods for hysterectomy with staging for endometrial cancer: robotic assistance, laparoscopy, laparotomy.

OBJECTIVE: The purpose of this study was to compare outcomes in women who underwent endometrial cancer staging by different surgical techniques. STUDY DESIGN: Three hundred twenty-two women underwent endometrial cancer staging: 138 by laparotomy (TAH); 81 by laparoscopy (TLH) and 103 by robotic technique (TRH). RESULTS: The TRH cohort had a higher body mass index than the TLH cohort (P = .0008). Lymph node yield was highest for TRH (P < .0001); hospital stay (P < .0001) and estimated blood loss (P < .0001) were lowest for this cohort. Operative time was longest for TLH (213.4 minutes) followed by TRH (191.2 minutes) and TAH (146.5 minutes; P < .0001. Postoperative complication rates were lower for TRH, compared with TAH (5.9% vs 29.7%; P < .0001). Conversion rates for the robotic and laparoscopic groups were similar. CONCLUSION: TRH with staging is feasible and preferable over TAH and may be preferable over TLH in women with endometrial cancer. Further study is necessary to determine long-term oncologic outcomes.

Incidence of symptomatic deep venous thrombosis with epoetin alfa or darbepoetin alfa treatment of anemia in patients with ovarian or primary peritoneal cancer.

OBJECTIVES: Recombinant epoetin alfa and darbepoetin alfa (r-HuEPO) have been shown to be safe and effective treatments for anemia, but recent reports have suggested an increased risk of thromboembolic events when these agents are used to treat chemotherapy-induced anemia among patients with breast or ovarian cancer. We examined the possible risk of such events among patients with ovarian or primary peritoneal carcinomas and chemotherapy-induced anemia. METHODS: We retrospectively analyzed data over 10 years from women at one hospital with ovarian or primary peritoneal carcinoma and chemotherapy-induced anemia. The incidence and odds ratio for development of deep venous thrombosis, unadjusted and adjusted for baseline differences and risk factors, was assessed between patients who had received r-HuEPO versus no treatment for anemia. RESULTS: Of the 364 women, 90 had received r-HuEPO and 253 had not. The incidence of deep venous thrombosis was 6.7% in the group that had received r-HuEPO and 5.1% in the group that had not (unadjusted odds ratio, 1.31; 95% confidence interval [CI], 0.48-3.55). After adjustment for differences in age, body-mass index, prior thromboembolic disease or cancer, and tobacco use, the odds ratio for developing deep venous thrombosis with the use of r-HuEPO was 1.35 (95% CI, 0.49-3.75). CONCLUSIONS: The use of r-HuEPO was not associated with an increased risk of deep venous thrombosis in this population. A randomized trial is needed to further explore this issue and to detail the safety and efficacy of these agents in patients with various other cancers.

Fertility-sparing surgery for ovarian low malignant potential tumors.

OBJECTIVE: Ovarian low malignant potential (LMP) tumors have an excellent prognosis when treated by surgical resection. Conservative management usually involves leaving behind the uterus and contralateral adnexa to allow future childbearing. The purpose of this study was to determine the outcome of women treated with fertility-sparing surgery. METHODS: All patients diagnosed with ovarian LMP tumors between 1984 and 2003 were identified at three institutions. Data were retrospectively extracted from clinical records. RESULTS: Thirty-eight (15%) of 249 women with LMP tumors underwent fertility-sparing surgery. Twenty-three were nulliparous and four primiparous. Thirty-three (87%) underwent unilateral salpingo-ophorectomy and five (13%) cystectomy. Fourteen patients also had contralateral cystectomy or biopsy. Thirty-four (89%) were stage I, one (3%) stage II and three (8%) stage III. Most tumors had serous (55%) or mucinous (42%) histology. No patients received adjuvant therapy. Six (16%) of 38 recurred after a median follow-up of 26 months: five in the remaining ovary were salvaged with surgical resection alone, and none died from recurrent LMP tumor. Five women delivered six term infants during post-treatment surveillance. CONCLUSION: Fertility-sparing surgery for ovarian LMP tumors is an option for motivated patients. Preservation of the contralateral adnexa increases the risk of recurrence, but surgical resection is usually curative.

Consolidation therapy with weekly paclitaxel infusion in advanced epithelial ovarian cancer and primary peritoneal cancer: an extended follow-up.

OBJECTIVE: To determine the impact of weekly paclitaxel consolidation on progression-free survival (PFS) of women undergoing treatment for ovarian cancer. METHODS: All women with advanced epithelial ovarian or primary peritoneal carcinoma, treated with paclitaxel consolidation therapy from August 1997 to March 2002, were identified. Patients received weekly paclitaxel infused at a median dose of 80 mg/m(2) (range: 60-80 mg/m(2)) for a maximum of 12 weeks. A chart review was performed to assess disease status and chemotherapy-related toxicities. PFS was calculated from the date of initiation of induction chemotherapy until the date of documented disease recurrence. RESULTS: 31 women received paclitaxel consolidation therapy over the study period (29 stage III and 2 stage IV). 24 women had epithelial ovarian carcinoma and 7 were diagnosed with primary peritoneal carcinoma. The median PFS was 27 months (range: 12-62 months). The overall 2-year survival was 94%, where 17 women (55%) were without evidence of disease and 12 (39%) were alive with disease. The median follow-up was 41 months (range: 15-77 months). Over 337 weeks of consolidation therapy, 1 patient experienced Grade 3 neuropathy and 1 patient developed Grade 3 neutropenia. CONCLUSION: Consolidation therapy with weekly paclitaxel infusion is a well-tolerated regimen that resulted in a median PFS of 27 months in women who obtained a complete clinical response following induction therapy. Given the lack of side effects and the potential for extending the PFS of those treated, a prospective randomized study of weekly paclitaxel should be considered.

High-grade squamous intraepithelial lesions: abbreviating posttreatment surveillance.

OBJECTIVE: To evaluate whether the surveillance schedule for patients treated with loop excision for high-grade squamous intraepithelial lesions could be improved. METHODS: Women treated in our dysplasia clinic for high-grade squamous intraepithelial lesions by loop excision between January 1990 and December 1999 were identified. Demographic information, pathologic diagnosis, and follow-up visits were extracted from medical records. Follow-up data included all Papanicolaou (Pap) tests and/or cervical biopsies performed in our clinic after the initial procedure. RESULTS: Women (n = 705) were treated for biopsy-proven high-grade dysplasia. Of those treated, 526 (74%) had at least 1 follow-up Pap test performed in our clinics within 2 years of their original procedure. During the 2 years of posttreatment surveillance, 70 (13.3%) women demonstrated recurrent cervical intraepithelial neoplasia 2 or 3. Recurrence was highest during the first 6 months and between months 22 and 24 of surveillance. This rate was noted to be dramatically lower during months 7 to 21 of surveillance (P <.001). Increasing age was independently associated with a 1.6-fold per decade (95% confidence interval 1.29, 1.9) increase in risk of recurrence. A negative margin status was independently associated with a 0.29-fold (95% confidence interval 0.17, 0.5) decrease in risk of recurrence. Race was not shown to have an influence on risk of recurrence. CONCLUSION: A clinically and financially optimal surveillance schedule for women treated for high-grade dysplasia with loop excision would be to obtain Pap tests every 6 months for 1 year and then return to annual screening. Lengthening the surveillance intervals could be beneficial to patients, while decreasing healthcare costs, without compromising the ability to detect and treat recurrent disease. LEVEL OF EVIDENCE: II-2