Epithelial ovarian cancer is the leading cause of death from gynecologic cancer in the United States and is the country’s fifth most common cause of cancer mortality in women. A major challenge in treating ovarian cancer is that most patients have advanced disease at initial diagnosis. These NCCN Guidelines discuss cancers originating in the ovary, fallopian tube, or peritoneum, as these are all managed in a similar manner. Most of the recommendations are based on data from patients with the most common subtypes─high-grade serous and grade 2/3 endometrioid. The NCCN Guidelines also include recommendations specifically for patients with less common ovarian cancers, which in the guidelines include the following: carcinosarcoma, clear cell carcinoma, mucinous carcinoma, low-grade serous, grade 1 endometrioid, borderline epithelial, malignant sex cord-stromal, and malignant germ cell tumors. This manuscript focuses on certain aspects of primary treatment, including primary surgery, adjuvant therapy, and maintenance therapy options (including PARP inhibitors) after completion of first-line chemotherapy.
Epithelial ovarian cancer is the leading cause of death from gynecologic cancer in the United States, with less than half of patients living >5 years from diagnosis. A major challenge in treating ovarian cancer is that most patients have advanced disease at initial diagnosis. The best outcomes are observed in patients whose primary treatment includes complete resection of all visible disease plus combination platinum-based chemotherapy. Research efforts are focused on primary neoadjuvant treatments that may improve resectability, as well as systemic therapies providing improved long-term survival. These NCCN Guidelines Insights focus on recent updates to neoadjuvant chemotherapy recommendations, including the addition of hyperthermic intraperitoneal chemotherapy, and the role of PARP inhibitors and bevacizumab as maintenance therapy options in select patients who have completed primary chemotherapy.
Understanding of the range of barriers to colorectal cancer screening can help develop multimodal interventions to increase colonoscopy rates for all patients including low-income Latinos. Interventions including systems improvements and navigator programs could address barriers by assisting patients with scheduling, insurance issues, and transportation and providing interpretation, education, emotional support, and motivational interviewing.
No-show rates interfere with quality primary care. Interventions designed to target reasons for no-show are needed to help reduce the no-show rate, improve access and decrease health disparities in underserved patient populations.
ung cancer is the leading cause of cancer mortality in the United States among both men and women and is estimated to account for over one-quarter of all cancer deaths in 2018 (Fig 1) (1). Although the 5-year survival rate is 56% when patients present with localized disease, 57% of patients have distant disease at diagnosis, which carries a 5-year survival rate of only 4.7% (1). In 2011, National Lung Screening Trial (NLST) investigators reported that, compared with chest radiography, screening for lung cancer in high-risk current and former smokers with three rounds of annual low-dose CT reduced lung cancer mortality by 20% (2). At the end of 2013, the U.S. Preventive Services Task Force (USP-STF) issued a grade B recommendation for lung cancer screening (LCS) with annual low-dose CT for eligible individuals (3). Consequently, provisions of the Patient Protection and Affordable Care Act have required private insurers to cover LCS without cost sharing since January 2015 (4). In February 2015, the Centers for Medicare and Medicaid Services (CMS) added the LCS counseling and shared decision-making visit and lowdose CT screening for eligible beneficiaries to the list of covered preventive services (5).Analysis of 2015 National Health Interview Survey data estimated that 3.9% of 6.8 million eligible smokers in the United States underwent low-dose CT screening over the previous 12 months (6). In 2016, 1.9% of 7.6 million eligible individuals were screened based on analysis of the American College of Radiology (ACR) Lung Cancer Screening Registry (Fig 2) (7). In 2017, this registry indicated that 254 127 screening low-dose CT examinations were performed, an increase from 159 673 in 2016, which equals a growth rate of 59% (8). These data show that the fraction of eligible smokers who have undergone screening is small, though potentially increasing.Radiologists are essential to every LCS program. Increased awareness of challenges faced by patients and referring providers (Fig 3) will empower radiologists to continue to collaboratively guide nationwide multidisciplinary efforts to implement LCS. For radiology practices participating in efforts to initiate or improve implementation, better understanding of these challenges may help refine current initiatives, develop new interventions, and foster interdisciplinary collaboration. Recommendations and practice guidelines for implementation have been
Linguistically and culturally tailored PN decreased disparities over time in breast cancer screening among female refugees from Somalia, the Middle East and Bosnia.
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