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Available evidence does not support either screening of pre- or postmenopausal women without a family history of ovarian cancer or routine screening in women with a family history of ovarian cancer in one or more relatives (without evidence of a hereditary cancer syndrome). Women from a family with the rare hereditary ovarian cancer syndrome are at high risk for the disease and should be referred to a gynecologic oncologist.

Recent randomized trials and prospective cohort studies have provided new information on the health outcomes of hysterectomy for nonmalignant conditions. These studies consistently have demonstrated a marked improvement in symptoms and quality of life during the early years after surgery. The long-term effects of premenopausal hysterectomy on ovarian function have not been established, but existing evidence suggests there is no adverse effect on risk for cardiovascular disease from hysterectomy alone. Epidemiologic studies have indicated that premenopausal hysterectomy with ovarian preservation is associated with a modest decrease in future risk for ovarian cancer and possibly breast cancer. There is no consistent evidence for adverse effects on bowel or bladder function. Hysterectomy does not cause long-term psychiatric morbidity, and psychological status generally improves. Studies of sexual function have shown varying results, with most suggesting improvement or no change in sexual function for the majority of women.

Of the many innovations in health care delivery proposed in the context of health reform for those with chronic diseases such as diabetes, the group visit model is relatively easy to implement and is effective for improving health outcomes and patient and provider satisfaction, with a neutral to positive effect on health care costs. This article describes the evolution of group visits for those with diabetes, the theory underlying group visits for patients with chronic medical conditions, and the existing evidence for the effectiveness of this model. It also addresses implementation of groups in practice, with an emphasis on the practical aspects of program implementation, integration of behavioral expertise into medical groups, individualization in various practice settings, and reimbursement issues.

Many women with leiomyomas, abnormal bleeding, and chronic pelvic pain report improved symptoms over time with nonsurgical management. Hysterectomy remains an important alternative when conservative treatment fails.

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Between 1996 and 1999, 18 academic health centers were awarded the designation of National Center of Excellence (CoE) in Women's Health by the Office on Women's Health within the Department of Health and Human Services and were provided with seed monies to develop model clinical services for women. Although the model has evolved in various forms, core characteristics that each nationally designated CoE has adopted include comprehensive, women-friendly, women-focused, women-relevant, integrated, multidisciplinary care. The permanent success of these comprehensive clinical programs resides in the ability to garner support of leaders of the academic health centers who understand both the importance of multidisciplinary programs to the clinical care they provide women and the education they offer to the future providers of women's healthcare.