Current Opinion in Obstetrics & Gynecology最新文献

Purpose of review: The global incidence of breast cancer continues to increase and increasing efficacy of treatments has improved overall prognosis and survival with a resulting requisite focus on improving quality of life after cancer. Treatment inevitably results in symptoms of menopause and these symptoms may be more severe after cancer treatment compared to natural menopause and may pose a potential risk of early treatment discontinuation. Consequently, the global burden of successfully managing these symptoms is significant.

Recent findings: There is a discordance between randomized and observational data regarding the risk of systemic menopausal hormone therapy and breast cancer recurrence; hormone receptor status is significant to recurrence risk in this setting. The systemic absorption of local oestrogen is not a consistent surrogate marker for cancer recurrence and clinical data has not demonstrated a consistent increase in the risk of cancer recurrence with local therapy.

Summary: Nonhormonal treatments remain first-line management of menopause symptoms in breast cancer survivors to minimize the risk of cancer recurrence. However, severe symptoms not responding to nonhormonal interventions require a multidisciplinary, patient-centred approach to discuss the evidence base for hormonal treatments.

Purpose of review: This review assesses the impact of early integration of palliative care and the disparities that exist among patients with gynecologic malignancies. It also highlights the recent advances in symptom management, goals of care communication, and end of life care.

Recent findings: Although palliative care has been utilized earlier, there are still barriers to its integration both nationally and worldwide, manifesting as predominantly late hospice referrals and aggressive care at the end of life. However, there are increasing efforts to promote earlier integration and discussion around goals of care through multidisciplinary approaches. Apart from symptom burdens, patients with gynecologic malignancies experience financial toxicity that impact various aspects of their lives, leading to potentially harmful choices to mitigate costs. A growing area of interest in palliative care is the realm of psychedelic-assisted therapy, which has shown benefits in treating advanced cancer patients with depression.

Summary: While significant strides have been made in incorporating palliative care earlier, continued research in palliative care is needed to address symptomatic and psychosocial suffering worldwide.

Purpose of review: This review examines Turkey's cervical cancer screening programme, highlighting its evolution from a cytology-based approach to a more effective HPV-based strategy. The review is timely given the global push to reduce cervical cancer incidence through improved screening practices, and it positions Turkey's programme as a potential model for other countries facing similar public health challenges.

Recent findings: Recent advances in cervical cancer screening in Turkey include the nationwide introduction of HPV DNA testing, centralized laboratory systems and innovative management software. The programme has significantly improved screening coverage and early detection rates, particularly in underserved communities. However, challenges remain in areas such as training healthcare workers, raising awareness of HPV vaccination, and integrating self-sampling methods into the screening process.

Summary: The Turkish experience demonstrates that a well organized HPV-based cervical cancer screening programme can overcome significant cultural and logistical barriers and lead to improved public health outcomes. Future efforts should focus on refining triage strategies, exploring new molecular tests, and expanding the use of self-sampling to further improve the effectiveness of cervical cancer prevention efforts worldwide.

Purpose of review: To review the recent updates in the management of cervical cancer across all stages of the disease.

Recent findings: After decades of minor advances, the landscape in cervical cancer is now rapidly changing. Recent studies have reported across the cervical cancer spectrum and on different therapeutic modalities. First, less radical surgery in the assessment and management of patients with early-stage, low-risk disease has been shown to be a safe option with reduced morbidity. The role of checkpoint inhibitor therapy in combination with chemotherapy and radiation has demonstrated improved survival outcomes, moving immunotherapy to earlier lines of therapy. The options for systemic therapy continue to include checkpoint inhibitors as well as treatment with antibody drug conjugates (ADCs) in the recurrent setting. Additional research continues to focus on targeting biomarkers in this disease.

Summary: In this paper, we will review the practice-changing trials impacting early stage, locally advanced, and recurrent cervical cancer patients. Despite advances, the limited survival for these patients continues to highlight the need for access to preventive healthcare (vaccine/cytology) and clinical trials to continue to make advances.

Purpose of review: The Cancer Genome Atlas identified four distinct molecular subtypes of endometrial cancer (EC): POLE mutated, mismatch repair deficient (dMMR), copy number low, and copy number high. The goal of this review is to summarize the profound clinical implications of molecular subtyping, particularly in guiding treatment decisions for dMMR and microsatellite instability high (MSI-H) EC.

Recent findings: Clinical trials have demonstrated the remarkable efficacy of immunotherapy in dMMR/MSI-H EC tumors. Trials including GARNET, KEYNOTE-158, NRG GY-018, and RUBY have shown significant improvements in clinical outcomes for patients with advanced and recurrent disease, leading to FDA approvals for immunotherapy in both frontline and recurrent EC treatment settings.Building on these successes, recent studies, including DUO-E, are exploring combination therapies to enhance the efficacy of immunotherapy in EC. Simultaneously, trials including NRG GY-020, are investigating the potential benefits of immunotherapy in early-stage disease.

Summary: Immunotherapy therapy has revolutionized the treatment of endometrial cancer in both upfront and recurrent settings, with molecular subtyping identifying patients most likely to benefit, especially those with dMMR/MSI-H tumors.

Purpose of review: This review examines Turkey's cervical cancer screening programme, highlighting its evolution from a cytology-based approach to a more effective HPV-based strategy. The review is timely given the global push to reduce cervical cancer incidence through improved screening practices, and it positions Turkey's programme as a potential model for other countries facing similar public health challenges.

Recent findings: Recent advances in cervical cancer screening in Turkey include the nationwide introduction of HPV DNA testing, centralized laboratory systems and innovative management software. The programme has significantly improved screening coverage and early detection rates, particularly in underserved communities. However, challenges remain in areas such as training healthcare workers, raising awareness of HPV vaccination, and integrating self-sampling methods into the screening process.

Summary: The Turkish experience demonstrates that a well organized HPV-based cervical cancer screening programme can overcome significant cultural and logistical barriers and lead to improved public health outcomes. Future efforts should focus on refining triage strategies, exploring new molecular tests, and expanding the use of self-sampling to further improve the effectiveness of cervical cancer prevention efforts worldwide.

Purpose of review: The purpose of this review is to examine patient experiences following second-trimester abortion care to identify clinical interventions to improve aftercare.

Recent findings: Early validation of a five-question Reproductive Grief Screen suggests that this instrument may be useful for clinicians to identify patients with maladaptive grief responses following a second-trimester abortion. Patients want to talk with their healthcare providers about grief following abortion and desire frequent mental health check-ins. Most people will have breast symptoms following a second-trimester abortion; a one-time dose of cabergoline at time of abortion appears to be an effective intervention to prevent bothersome breast symptoms. As patient desires vary regarding disposition of fetal remains, clinicians should be prepared to discuss donation for research or cremation/ burial as alternatives to routine disposal. With significant variation in availability and cost of ceremonial disposition, clinicians and healthcare systems should identify local resources to facilitate this aspect of aftercare.

Summary: Clinical practices and healthcare systems should prioritize the aftercare experience including the management of breast symptoms, bereavement, disposition of fetal remains, and follow-up care.

Purpose of review: Stress urinary incontinence (SUI) is a common condition for which women often opt for surgical management. Synthetic midurethral slings (MUS) have been the dominant treatment for decades. Single-incision slings (SIS) have been introduced to lower the morbidity associated with trocar passage during MUS placement. Urethral bulking has been used less frequently owing to its lower cure rates. New data have recently emerged in support of single-incision slings (SIS) and urethral bulking with Bulkamid polyacrylamide hydrogel (PAHG).

Recent findings: Several studies with a follow-up ≥10 years have shown stable efficacy and complication rates of retropubic (RMUS) and transobturator (TMUS) midurethral slings over time. SIS products show equivalent efficacy to traditional TMUS and RMUS at up to 3 years of follow-up and can be placed under local anesthesia. While urethral bulking with PAHG results in lower cure rates compared to slings, satisfaction rates are high and responders have sustained improvement at 7 years follow-up.

Summary: All three types of available slings, TMUS, RMUS, and SIS, are now considered appropriate surgical options for the treatment of SUI. Although the absence of comparative data precludes a formal recommendation for one injectable over another, urethral bulking with PAHG has favorable long-term results and an excellent safety profile.

Purpose of review: Entertainment media contribute to how people understand and make sense of health issues, especially stigmatized ones such as abortion. This paper reviews the peer-reviewed literature published between 2019 and 2024 on how abortion is depicted in scripted television and film available for viewing in the United States.

Recent findings: The majority of recent studies focus on qualitative content analysis of a composite of television shows, documenting the myriad ways that these programs reflect and are distinct from the reality of abortion access in the United States. The quantitative studies find small but significant increases in abortion knowledge related to exposure to television abortion plotlines, but no increases in support for abortion postexposure. No studies track the impact of exposure to multiple abortion plotlines at multiple points in time. Only one study included a sample of entertainment content creators to understand their motivations for creating abortion plotlines.

Summary: Media depictions of abortion are often rife with misinformation, and may influence the U.S. public's general knowledge and beliefs about abortion. More research is needed to understand possible relationships between television and film abortion content and its impact on viewers.