Optimum screening interventions for gynecologic malignancies.
The availability of screening modalities and improvements in prevention have reduced the risk of developing some cancers over the last few decades. Methods for optimal screening of gynecologic cancers are still being investigated. Cervical cancer is the only gynecologic malignancy for which a screening modality is widely accepted and recommended to all women. Annual screening of cervical cells has been shown to reduce the incidence of cervical cancer by 78%. Unfortunately, more than 50% of cervical cancers occur in women who have not been screened optimally. In the year 2000, an estimated 12,800 women developed cervical cancer. Of these women, 89% were seen by a physician but not screened. Vaginal cancer is associated with a similar etiology, pathobiology, and symptomatology as is cervical cancer. Vaginal dysplasia and cancer can also be detected by the Pap test, but the prevalence of the disease is low. Endometrial carcinoma is the most common gynecologic cancer. The widespread availability of outpatient biopsy devices has been the most significant advance in the early diagnosis of corpus cancers. Ovarian cancer is the gynecologic malignancy associated with the highest death rate. No modality has been shown as an effective screening method for this cancer. Women with a family history of ovarian cancer may benefit from combined modality screening; prophylactic oophorectomy should be offered to those with hereditary ovarian cancer syndromes. A complete physical examination by the physician offers the best method for early detection of vulvar cancer. Awareness and implementation of recommended screening guidelines for gynecologic cancers by primary care and specialty physicians can decrease the incidence and mortality of cervical cancer. Including the genital tract in the complete examination of the female patient could decrease markedly the mortality from the other gynecologic cancers.