PURPOSE To compare the disease-free survival (DFS) between open and minimally invasive radical hysterectomies (RH) performed in academic medical institutions METHODS Retrospective multi-institutional review of patients undergoing RH for stage IA1 (with lymphovascular invasion), IA2, and IB1 squamous, adenocarcinoma, or adenosquamous carcinoma between January 1, 2010 and December 31, 2017. RESULTS Of 815 patients, open RH was performed in 255 cases (29.1%) and minimally invasive RH in 560 cases (70.9%). There were 19 (7.5%) recurrences in the open RH and 51 (9.1%) recurrences in the minimally invasive group ( P = .43). Risk-adjusted analysis revealed that minimally invasive RH was independently associated with an increased hazard of recurrence (aHR, 1.88; 95% CI, 1.04 to 3.25). Other factors independently associated with an increased hazard of recurrence included tumor size, grade, and adjuvant radiation. Conization before surgery was associated with lower recurrence risk (aHR, 0.4; 95% CI, 0.23 to 0.71). There was no difference in OS in the unadjusted analysis (HR, 1.14; 95% CI, 0.61 to 2.11) or after risk adjustment (aHR, 1.01; 95% CI, 0.5 to 2.2). Of 264 patients with tumors ≤ 2 cm on final pathology (excluding those with no residual tumor on final pathology), 2/82 (2.4%) recurred in the open RH group and 16/182 (8.8%) in the minimally invasive RH group ( P = .058). In propensity score matching analysis, 7/159 (4.4%) recurrences were noted in the open RH group and 18/156 (11.5%) in the minimally invasive RH group ( P = .019). Survival analysis revealed an increased risk of recurrence in the minimally invasive group in propensity-matched cohort (HR, 2.83; 95% CI, 1.1 to 7.18) CONCLUSION In this retrospective series, patients undergoing minimally invasive radical hysterectomy, including those with tumor size ≤ 2 cm on final pathology, had inferior DFS but not overall survival in the entire cohort.

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Maternal HPV infection is not an independent risk factor for preterm birth or pregnancy-related hypertension.

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Diabetes mellitus has reached epidemic proportions in both the United States and worldwide with most authorities reporting a doubling in the prevalence of diabetes over the last 20–30 years. While this epidemic is closely tied to obesity, diabetes mellitus presents potential clinical challenges over and above that observed with obesity alone. From a women’s health care prospective, this rise in diabetes may impact a woman’s health across her lifespan. More specifically, diabetes impacts not only pregnancy as well as well as other medical conditions, but increases the risk for the development of various malignancies. From a gynecologic cancer standpoint, diabetes is most closely associated with endometrial adenocarcinomas, although increasing attention is being placed upon diabetes and ovarian cancer. Attention is also being placed on the potential role of metformin and its impact on outcomes in diabetics with cancer, as well as a potential preventative and/or adjunctive therapy for gynecologic cancer.

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reast cancer is the most common cancer in women, and is the second leading cause of cancer deaths. The age and incidence-adjusted estimates for new breast cancer cases in the United States for 2018 are 266 120 (15.3% of all new cancers), with 40 920 breast cancer deaths (6.7% of all cancer deaths) (1). Ovarian cancer is the fifth most common cancer in women and the fifth leading cause of cancer deaths. The estimates for new ovarian cancer cases in the United States for 2018 are 22 240 (1.3% of all new cancers), with 14 070 ovarian cancer deaths (2.3% of all cancer deaths) (2). Most breast and ovarian cancers occur sporadically. However, some women are predisposed to higher rates of breast and ovarian cancers secondary to an underlying genetic mutation, which are often referred to as hereditary breast and ovarian cancer susceptibility gene mutations.Family history is a well-known risk factor for breast and ovarian cancer, but there is a distinction between hereditary and familial cancer risks. Familial cancers occur in certain families with statistically greater frequency than in the general population. They typically do not exhibit a specific inheritance pattern and have no specific age of onset. Hereditary cancers most commonly occur as a result of genetic mutations. The majority of these gene mutations have an autosomal dominant transmission pattern (ie, first-degree relatives of an affected individual have a 50% risk of having the same gene mutation). These mutations are germline mutations that are not sex linked and can be transmitted equally from either parent. Affected individuals are at higher risk for bilateral disease, multifocal disease, and cancer onset at an earlier age, as well as for the uncommon clustering of cancers, including pancreatic cancer, melanoma, cholangiocarcinoma, and prostate cancer (3,4).Approximately 5%-10% of all breast cancers and up to 15% of all ovarian cancers are associated with an inheritable genetic mutation (5-8). The most common genetic mutations implicated in hereditary breast and ovarian cancers have been mapped to the BRCA1 (chromosome 17q21) and BRCA2 (chromosome 13q12.3) genes (9,10). The purpose of this article is to review the current screening guidelines for breast and ovarian cancers in patients who test positive for BRCA mutation and to briefly review the imaging features that are suspicious for early breast and ovarian cancers. Prevalence and Cancer RiskThe prevalence of the BRCA genetic mutation in the general population is relatively low (one in 400). However, certain populations have a higher incidence, particularly those with Ashkenazi Jewish ancestry (one in 40) due to

5504 Background: Compare outcomes between open and minimally invasive radical hysterectomy. Methods: Retrospective multi-institutional review of patients undergoing radical hysterectomy for stage IA1, IA2 and IB1 squamous, adeno- or adeno-squamous carcinoma between 01/01/2010 - 12/31/2017. Results: From 704 cases that met the inclusion criteria, 185 (26.3%) underwent open and 519 (73.7%) underwent minimally invasive surgery (MIS). Women treated with open surgery were older, had larger tumors on preoperative assessment as well as on final pathology assessment, had higher proportion of patients with IB1 stage and adjuvant therapy. Patients undergoing open surgery had longer median follow-up compared to MIS (44 vs. 30.3 months, p < 0.001). The two groups were similar in regard to race distribution, body mass index, comorbidities and preoperative histology. There were 13/185 (7%) recurrences and 10/185 (5.4%) deaths in the open compared to 42/519 (8.1%) recurrences and 26/519 (5%) deaths in MIS (p = n.s for both). However, on multivariate analysis, after controlling for race, comorbidities, preoperative tumor size, histology, grade and smoking status, MIS had higher odds of recurrence (OR 2.24, 95% CI 1.04 - 4.87, p = 0.04). On a second model, in addition to prior mentioned factors, we included lymphovascular space invasion, receipt of adjuvant therapy and vaginal margin status. Undergoing MIS remained associated with higher odds of recurrence (OR 2.37, 95% CI 1.1 - 5.1, p = 0.031). On sub-group analysis of cases with preoperative tumor size less than equal to 2 cm, there were 5/121 (4.1%) recurrence in open and 25/415 (6%) recurrences in MIS group (p = 0.34). Multivariate analysis did not show a higher rate of recurrence in MIS arm in this subgroup. In 26 cases of MIS where no vaginal manipulator was used, no recurrences were noted. In comparison 19/270 (7%) recurrences were noted in intra-uterine manipulator (V-care/Zumi/Rumi) and 22/210 (11%) in vaginal manipulators (EEA sizer/Colpo Probe) groups (p = 0.119). Conclusions: In this large retrospective analysis, patients undergoing MIS for early stage cervical cancer had higher odds of recurrence. In patients with 2 cm or less tumor on preoperative assessment, recurrence rates were similar between the two groups. Role of manipulator in increasing recurrence should be further studied in this patient population.