Preventing Malignancies of the Reproductive Tract, An Issue of Obstetrics and Gynecology Clinics (The Clinics: Internal Medicine)

This issue of Obstetrics and Gynecologic Clinics of North America, guest edited by Carolyn Muller, MD, reviews the fundamentals of cancer prevention and screening which will help the reader understand the often conflicting outcomes of many studies designed to evaluate risk factors and interventions. State-of-the-art prevention strategies are presented by a distinguished group of authors who have dedicated their professional careers to the study of each of the major reproductive tract malignancies. Current clinical trials are highlighted that offer the practicing obstetrician-gynecologist with future directions into tomorrow's preventive care. This issue features articles on Strengthening Gynecologic Cancer Prevention Studies, Hereditary Ovarian Cancer, Strategies for Ovarian Cancer Prevention, Ovarian Cancer Hormonal and Environmental Risk Effect, Endometrial Cancer Associated with Defective DNA Mismatch Repair, Management of Abnormal Uterine Bleeding and the Pathology of Endometrial Hyperplasia, Cervical Cancer Prevention, Prophylactic Human Papillomavirus Vaccination, and Vulvo-Vaginal Cancers. Cover......Page 1 Foreword......Page 2 Preface......Page 4 Selection bias......Page 6 Observational studies and gynecologic cancer prevention......Page 7 Information bias......Page 8 Healthy-user bias......Page 9 Chance......Page 10 Randomized clinical trials and gynecologic cancer prevention......Page 11 Modification by risk factors and biological characteristics......Page 13 Additional challenges for strengthening cancer-prevention trials......Page 14 References......Page 15 Hereditary breast and ovarian cancer syndrome......Page 18 BRCA genetic testing......Page 19 Intensified screening......Page 23 Chemoprevention......Page 24 Prophylactic surgery......Page 25 Hereditary non-polyposis colorectal cancer syndrome-associated ovarian cancer......Page 28 Summary......Page 29 References......Page 30 The high-risk patient......Page 33 Other chemopreventive agents for ovarian cancer......Page 35 Rectovaginal pelvic examination......Page 36 Cancer antigen 125 tumor marker......Page 37 Combined tumor markers......Page 38 Transvaginal ultrasonography......Page 39 Combined screening modalities......Page 40 Proteomics......Page 42 Bilateral salpingo-oophorectomy......Page 43 Other gynecologic procedures......Page 44 Summary and recommendations......Page 45 References......Page 46 Ovarian Cancer Hormonal and Environmental Risk Effect......Page 53 General risk factors......Page 54 General protective factors......Page 56 Environmental risk factors......Page 57 Oral contraception......Page 59 Chemoprevention of ovarian cancer......Page 61 Summary......Page 62 References......Page 63 Identification of defective DNA mismatch repair......Page 67 Inherited defective DNA mismatch repair and risk of endometrial cancer......Page 71 Identifying individuals who have Lynch syndrome......Page 73 Endometrial cancer phenotype in Lynch syndrome......Page 75 Screening and prevention......Page 77 Prophylactic surgery......Page 78 References......Page 79 Management of Abnormal Uterine Bleeding and the Pathology of Endometrial Hyperplasia......Page 82 The clinical problem, risk factors, and diagnostic approach......Page 83 Clinical management of abnormal uterine bleeding......Page 87 Pathologic evaluation of endometrial biopsies and the pathology of endometrial hyperplasia......Page 89 Molecular pathology of endometrial hyperplasia and carcinoma......Page 93 The concept of endometrial intraepithelial neoplasia......Page 96 Type II endometrial carcinoma and endometrial intraepithelial carcinoma......Page 97 Future developments......Page 98 References......Page 99 Cervical cancer burden......Page 103 Cervical cancer burden......Page 105 Cervical transformation zone......Page 107 Screening test characteristics......Page 108 Specimen collection......Page 109 Liquid-based cytology......Page 110 Computerized screening technologies......Page 111 Evaluation of cytology results......Page 112 Follow-up and management of abnormalities......Page 113 New screening techniques for cervical cancer......Page 114 Carcinogenic human papillomavirus testing......Page 115 Type-specific human papillomavirus testing......Page 116 Cellular markers......Page 117 See-and-treat options......Page 118 Summary......Page 119 References......Page 120 Quadrivalent vaccine FUTURE II......Page 125 Current paradigm for prevention of cervical cancer......Page 127 Human papillomavirus awareness and vaccine acceptability......Page 129 Efficacy......Page 130 Quadrivalent vaccine FUTURE I......Page 131 Bivalent vaccine......Page 132 Safety and reproductive toxicity......Page 133 Age to vaccinate......Page 134 Cost-effectiveness analyses......Page 136 Guidelines for prophylactic vaccination......Page 137 Policy considerations......Page 138 Summary......Page 139 References......Page 140 Vulvar intraepithelial neoplasia......Page 146 Precursors to vulvar cancer......Page 147 Lichen sclerosus, lichen simplex chronicus, and squamous cell hyperplasia......Page 148 Molecular biology of precursor lesions......Page 149 Vulvar cytology......Page 150 Colposcopy and biopsy......Page 151 Topical agents......Page 152 Wide local excision, skinning vulvectomy, and simple vulvectomy......Page 153 The role of human papillomavirus vaccination......Page 154 Vaginal intraepithelial neoplasia......Page 155 Risk factors for progression to cancer......Page 156 Colposcopy and biopsy......Page 157 Topical agents......Page 158 Laser ablation......Page 159 The role of human papillomavirus vaccination......Page 160 References......Page 161 Reviews the fundamentals of cancer prevention and screening. This book features articles on strengthening gynecologic cancer prevention studies, hereditary ovarian cancer, strategies for ovarian cancer prevention, ovarian cancer hormonal and environmental risk effect, and endometrial cancer associated with defective DNA mismatch repair.