SCREENING IN GYNECOLOGIC CANCERS

Gynecologic malignancies account for approximately 13% of cancers in w omen. Ovarian and uterine cancer are among the five most common causes of cancer deaths in women, exceeded in incidence only by cancers of t he breast, colon, and lung. Improved survival in patients with genital cancers predominantly reflects early diagnosis and not improved treat ments. Even cancers for which there are effective screening and satisf actory treatments are seen more often than is acceptable. It is paramo unt that those entrusted with the health of women be knowledgeable abo ut all cancer screening techniques and be able to identify the patient at risk for gynecologic malignancy. The provider's obligation to be v igilant about the signs and symptoms of cancer must be matched by the patients' responsibility to her own health. Regular gynecologic examin ations, Papanicolaou (Pap) tests, and immediate reporting of unusual s igns and symptoms are requirements that cannot be dismissed by patient s. Education directed toward patients and health care providers can op timize survival. The Pap test for cervical cancer remains a universall y accepted screening procedure. Human papillomavirus (HPV) DNA typing, cervicography, loop electrosurgical excision procedure (LEEP), transv aginal ultrasonography, color flow doppler, endometrial sampling, and serum CA 125 measurements are some of the newer techniques being inves tigation as potential screening tools. Although additional prospective studies are needed to establish the value of these modalities, there is little doubt that prognostic information obtained from these modali ties will influence the clinical care of patients in the near future.