Jamie L. McDowell

Estrogen therapy in patients with gynecologic cancer: a survey of gynecologists and oncologists in the United States

Objective: Endometrial cancer (EC) and epithelial ovarian cancer (EOC) affect women of all ages, and the incidence of endometrial cancer in premenopausal women is rising. Menopause can be detrimental to longevity and quality of life, but evidence suggests estrogen therapy (ET) is safe in these patients. The purpose of this study was to evaluate the practice patterns of gynecologists and gynecologic oncologists (GYO) in the United States in regards to prescription of ET to gynecologic cancer patients. It was hypothesized that ET is underused in this population. Methods: In 2024, a web-based survey was administered through email or postcard mailer to members of the Society of Gynecologic Oncology and the American College of Obstetricians and Gynecologists. Participants were asked demographic questions and whether they provide ET for patients with a history of EC, EOC, and cervical cancer. Results: A total of 293 participants answered questions about at least one type of cancer. When asked if willing to provide ET, 63.82% (187/293) selected “yes” for EC, 65.19% (176/270) for EOC, and 96.8% (274/283) for cervical cancer. Due to lack of heterogeneity, cervical cancer was omitted from analysis. Gynecologic oncology providers were more likely than OBGYNs to prescribe ET for EC ( P = 0.0006) and EOC patients ( P = 0.0009). Those in practice for 10 or more years ( P = 0.022), or who identified as male ( P = 0.019), were more likely to prescribe ET to EC patients. Of those who do not prescribe ET, the most common reasons were belief that hormones are contraindicated, better options exist, and risk outweighs benefits. These options were selected more frequently by OBGYNs than GYOs. Conclusion: Many gynecologists, and some gynecologic oncologists, are uncomfortable prescribing hormone therapy to patients with a history of endometrial or epithelial ovarian cancer, despite evidence suggesting its safety. This indicates a need for clinician education to ensure patients are counseled appropriately about options for treating menopausal symptoms.

Outcomes of robotic surgery in morbidly obese patients with endometrial cancer: a retrospective study

With advances in minimal invasive surgery, robotic surgery has become the widespread approach for surgical staging of endometrial cancer in the obese population. This study aimed to evaluate safety and surgical outcomes of robotic surgery in the morbidly obese and extremely morbidly obese patients with endometrial cancer. Retrospective cohort study. A total of 391 obese women undergoing robotic-assisted surgical staging were identified and included in the study. Surgical outcomes for obese patients (BMI > 30 kg/m

Utility of routine cytology in detecting asymptomatic cervical cancer recurrence

The objective of this study was to examine the utility of routine cervical cytology after cervical cancer treatment. We performed a retrospective study from 2004 to 2020, which identified 581 cervical cancer patients. Of the 581 patients, 233 were included in the analysis. The remaining 348 were excluded because of failure to enter the surveillance period, loss to follow-up, or treatment at an outside facility. The continuous data were summarized using the median and interquartile range for non-normally distributed data. The categorical data were summarized using frequencies and proportions. Comparisons between the categorical data were performed using the Fisher exact test. Of the 233 included patients, 78 (33.5%) had had ≥1 abnormal Papanicolaou (Pap) test during surveillance. Of these 78 patients, 22 (28.2%) underwent biopsy, with all biopsies negative for malignancy. Local recurrence was identified in 15 patients. Of these 15 patients, 14 (93.3%) were symptomatic at diagnosis, 7 (46.7%) had had visible disease on the physical examination, and 6 (40.0%) had normal cytology findings throughout surveillance. Only 1 case of local, asymptomatic cervical cancer recurrence was detected by Pap test alone. A subset analysis was performed to compare the rate of abnormal Pap tests between the radiation therapy and non-radiation therapy groups. Of the 233 patients, 154 (66.1%) underwent primary radiation therapy, 64 (41.6%) of whom had abnormal cytology during surveillance. Of 82 patients who did not undergo radiation therapy, only 14 (17.1%) had had abnormal cytology (P < 0.01). None of the patients in either group had underlying recurrent disease at the time of abnormal cytology. The results of our study show that routine Pap tests have limited clinical utility in the surveillance of cervical cancer recurrence. Consideration should be given to removing routine cytology from the surveillance recommendations.