No abstract

To examine how frequently and confidently healthy women report symptoms during surveillance for ovarian cancer. A symptoms questionnaire was administered to 24,526 women over multiple visits accounting for 70,734 reports. A query of reported confidence was included as a confidence score (CS). Chi square, McNemars test, ANOVA and multivariate analyses were performed. 17,623 women completed the symptoms questionnaire more than one time and >9500 women completed it more than one four times for >43,000 serially completed questionnaires. Reporting ovarian cancer symptoms was ~245 higher than ovarian cancer incidence. The positive predictive value (0.073%) for identifying ovarian cancer based on symptoms alone would predict one malignancy for 1368 cases taken to surgery due to reported symptoms. Confidence on the first questionnaire (83.3%) decreased to 74% when more than five questionnaires were completed. Age-related decreases in confidence were significant (p < 0.0001). Women reporting at least one symptom expressed more confidence (41,984/52,379 = 80.2%) than women reporting no symptoms (11,882/18,355 = 64.7%), p < 0.0001. Confidence was unrelated to history of hormone replacement therapy or abnormal ultrasound findings (p = 0.30 and 0.89). The frequency of symptoms relevant to ovarian cancer was much higher than the occurrence of ovarian cancer. Approximately 80.1% of women expressed confidence in what they reported.

AVMs, both congenital and acquired, are diagnosed utilizing a range of radiographic tools. Management modalities include embolization and hysterectomy. Our patient presented uniquely with intra-abdominal hemorrhage. Previously managed with uterine artery embolization, hysterectomy became necessary because of her clinical presentation.

When the treatment of ovarian cancer did not follow NCCN recommendations, patients had a significantly higher risk of death. Women were less likely to receive NCCN-compliant care if they were younger (20-49 years), had early-stage disease, did not have private insurance, or had care provided at a nontertiary care hospital.

No abstract

Objectives: To identify functionally altered signaling pathways that drive tumorigenesis of invasive cervical cancer through integrated analysis of genomic, transcriptomic, proteomic, and clinical data. Methods: Blood and primary frozen tumor tissue were obtained from untreated women with invasive cervical cancer. Integrated analysis was done from mRNA, whole exome DNA, and miRNA sequencing data, and with DNA methylation and copy number data. A comprehensive core sample set consisted of 178 matched samples with some platform data on an additional 67 cases. Protein data were available in 155 cases. Results: Integrated analysis showed novel molecular features and defined significant cervical cancer subgroups. Key distinguishing features of squamous cell carcinomas include activation of p53, p63, p73, AP-1, MYC, HIF1A, FGFR3, and MAPK signaling, which is similar to features characterizing squamous-like cancers in general. Alterations in RTK, PI3K, and MAPK pathway were observed across both squamous cell carcinomas and adenocarcinomas. Adenocarcinomas harbor more ERBB2, ERBB3, and KRAS alterations compared with squamous carcinomas. A unique set of endometrial-like cervical cancers was identified that was predominantly human papillomavirus (HPV)-negative and had high frequencies of KRAS, ARID1A, and PTEN aberrations. Molecular diversity was observed in squamous cell carcinomas where a subset of cases exhibited an epithelial-mesenchymal transition signature derived from mRNA and protein data with poor overall survival. Several findings underline the importance of the immune system in HPV-related cancers, including mutations in HLA, amplifications in immune targets (PD-L1, PD-L2) and an immune-related mRNA signature significantly associated with survival. Novel findings such as amplifications in the BCAR4lincRNA, associated with estrogen therapy resistance, were also identified. Extensive HPV characterization by Mass Array, and by DNA and RNA sequencing shows the presence of HPV in 95% of cases. Viral-cellular fusion transcripts were observed in 83% of HPV-positive cancers. HPV integration was observed in all HPV18-infected cases and 76% of HPV16-infected cases, with integration sites found in areas that had structural aberrations and associated with increased expression of target genes. Conclusions: These findings provide insight into novel molecular subtypes for targeted therapies for cervical cancer.

No abstract

Surveillance, Epidemiology, and End Results (SEER) program. Contraceptive failure rates, utilities, and hospital costs associated with the procedures were obtained from the literature. OC risk reduction estimates were derived from Falconer et al, a Swedish case control study showing a hazard ratio of 0.35 with salpingectomy and 0.72 with sterilization procedures. To account for uncertainty, univariate and bivariate sensitivity analyses as well as Monte Carlo simulation were performed. We used a standard cost-effectiveness threshold of $100,000 per quality-adjusted life year (QALY) gained. We calculated incremental cost-effectiveness ratios (ICERs) that compared salpingectomy with TO. Results: When applied to a theoretical cohort of 300,000 women (number of sterilizations annually), salpingectomy would result in 210 fewer unintended pregnancies, 1,020 fewer cases of OC, and 660 fewer deaths from OC over 40 years. Salpingectomy would also result in an additional 12,000 QALYs. This results in an ICER of $47,535 per QALY, showing that salpingectomy is cost-effective. Sensitivity analyses showed that the complication rate from salpingectomy would have to be almost double (to 3.1%