gynecology

In community health centers, use of self-collection of specimens for cervical cancer screening was significantly more effective than telephonic reminders. James W. Mold, MD, MPH

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Importance There are limited data on the effectiveness of mailed self-collection to increase cervical cancer screening (CCS) participation in underresourced health care settings.

Objective To compare the effectiveness of mailed self-collection kits, with and without patient navigation, to telephone reminders to increase CCS in a safety-net health system.

Design, Setting, and Participants This pragmatic, parallel, single-blinded, randomized clinical trial within a publicly funded safety-net health system in Houston, Texas, compared (1) telephone reminder (TR) for clinic-based screening, (2) TR with mailed self-collection (SC), and (3) TR with mailed SC and patient navigation among a random sample of CCS-eligible patients not up to date with CCS, including those with no CCS on record. The trial was conducted from February 20, 2020, to August 31, 2023.

Interventions All groups received a TR by a patient navigator to attend clinic-based CCS. In the SC and SC with patient navigation groups, participants were additionally mailed a self-collection kit to their home as an alternative to clinic-based CCS. In the SC with patient navigation group, the mailed kit was followed by a patient navigation telephone call.

Main Outcomes and Measures CCS participation was defined as attendance for clinic-based screening or return of a mailed self-collection kit within 6 months of randomization and determined through electronic health record review.

Results Of the 2474 participants in the intent-to-screen analyses (median [IQR] age, 49 [39-57] years), 2325 (94.0%) were from racial or ethnic minoritized populations (1655 [66.9%] identifying as Hispanic or Latino, 82 [3.3%] as non-Hispanic Asian, 535 [21.6%] as non-Hispanic Black or African American, and 53 [2.1%] as other or unknown race, including American Indian or Alaska Native and Native Hawaiian or Other Pacific Islander), and 1388 (56.1%) were covered by the county’s publicly funded financial assistance program. At 6 months, 144 of 828 participants (17.4%) in the TR group, 340 of 828 (41.1%) in the SC group, and 381 of 818 (46.6%) in the SC with patient navigation group had participated in CCS. Compared to TR, relative participation was 2.36 (95% CI, 1.99-2.80) times higher for SC and 2.68 (95% CI, 2.27-3.16) times higher for SC with patient navigation; screening difference was 23.7% (95% CI, 19.4%-27.9%) for SC and 29.2% (95% CI, 24.9%-33.5%) for SC with patient navigation.

Conclusions and Relevance In this randomized clinical trial in a safety-net health system, SC was effective for increasing CCS participation among underscreened patients; there were modest additional gains from SC with patient navigation. The large increase in CCS participation using SC compared to TR suggest that SC should be considered in safety-net settings with suboptimal CCS coverage.

Trial Registration ClinicalTrials.gov Identifier: NCT03898167

Author/s:

Jane R. Montealegre, Susan G. Hilsenbeck, Shaun Bulsara

Self-Collection for Cervical Cancer Screening in a Safety-Net Setting: The PRESTIS Randomized Clinical Trial

Megan George — Thu, 04 Sep 2025 19:41:13 +0000

Date Added:

September 4, 2025

Journal/Publication:

JAMA Internal Medicine

Publication Date:

June 6, 2025

URL:

Self-Collection for Cervical Cancer Screening in a Safety-Net Setting: The PRESTIS Randomized Clinical Trial

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1001/jamainternmed.2025.2971

Keywords

PMID (1):

40478588

MeSH

Uterine Cervical Neoplasms* / diagnosis

Single-Blind Method

Safety-net Providers*

Early Detection of Cancer* / methods

In community health centers, use of self-collection of specimens for cervical cancer screening was significantly more effective than telephonic reminders. James W. Mold, MD, MPH

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Importance There are limited data on the effectiveness of mailed self-collection to increase cervical cancer screening (CCS) participation in underresourced health care settings.

Objective To compare the effectiveness of mailed self-collection kits, with and without patient navigation, to telephone reminders to increase CCS in a safety-net health system.

Trial Registration ClinicalTrials.gov Identifier: NCT03898167

Author/s:

Jane R. Montealegre, Susan G. Hilsenbeck, Shaun Bulsara

Ovarian Cancer: A Review

Megan George — Fri, 25 Jul 2025 13:29:18 +0000

Date Added:

July 25, 2025

Journal/Publication:

JAMA

Publication Date:

July 21, 2025

URL:

Ovarian Cancer: A Review

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2025.9495

Keywords

Obstetrics and Gynecology

MeSH

Neoplasms, Glandular and Epithelial

Salpingo-oophorectomy

Lymph Node Excision

Chemotherapy, Adjuvant

Cytoreduction Surgical Procedures

A review of what we currently know about ovarian cancer. James W. Mold, MD, MPH

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Importance: Ovarian cancer is the eighth most common cause of cancer and cancer death in women worldwide. In 2022, ovarian cancer was diagnosed in approximately 324 398 individuals, and 206 839 died of ovarian cancer worldwide. In 2025, it is estimated that 20 890 US women will be diagnosed with ovarian cancer and 12 730 patients will die of ovarian cancer.

Observations: Approximately 90% of ovarian cancers are epithelial malignancies, of which 70% to 80% are high-grade serous ovarian cancers. Less common epithelial subtypes include endometrioid, clear cell, low-grade serous, mucinous, and carcinosarcoma. The median age at diagnosis of ovarian cancer is 63 years. Risk factors include older age, family history of breast or ovarian cancer, endometriosis, and nulliparity. Hereditary factors are associated with 25% of cases, predominantly linked to BRCA1/2 gene variants. At diagnosis, approximately 95% of patients experience nonspecific symptoms, such as abdominal pain, bloating, and urinary urgency and frequency, and about 80% have advanced-stage disease (stage III-IV), including extrapelvic disease, ascites, and abdominal masses. Diagnostic and staging evaluation includes pelvic ultrasound; computed tomography of the chest, abdomen, and pelvis; and serum tumor markers such as carbohydrate antigen 125, carbohydrate antigen 19-9, and carcinoembryonic antigen. First-line treatment for early-stage ovarian cancer, defined as limited to the ovary or fallopian tube (stage I) or confined to the pelvis (stage II), is surgery (hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and lymphadenectomy), followed by adjuvant chemotherapy (carboplatin and paclitaxel). With treatment, early-stage ovarian cancer has a 5-year overall survival of 70% to 95%. Advanced-stage ovarian cancer may be treated with primary cytoreductive surgery (removal of all visible cancer in the abdominal cavity) and adjuvant chemotherapy (carboplatin and paclitaxel) or with neoadjuvant chemotherapy followed by cytoreductive surgery and adjuvant chemotherapy. Most patients with advanced-stage ovarian cancer receive maintenance therapy with bevacizumab (a monoclonal antibody that blocks angiogenesis) and/or poly–adenosine diphosphate ribose polymerase (PARP) inhibitors. With treatment, the 5-year overall survival rate for advanced-stage ovarian cancer is 10% to 40%. However, individuals with BRCA-related gene variants have a 5-year overall survival rate of approximately 70% with PARP inhibitor treatment. Despite an initial remission rate of 80%, approximately 75% of patients with advanced-stage disease have ovarian cancer relapse within 2 years.

Conclusions and Relevance: Approximately 21 000 women are diagnosed with ovarian cancer annually in the US, and approximately 80% have advanced-stage ovarian cancer at diagnosis. First-line treatment of early-stage ovarian cancer is surgery and adjuvant platinum-based chemotherapy. Treatment of advanced-stage ovarian cancer includes cytoreductive surgery, platinum-based chemotherapy, and targeted maintenance therapies such as bevacizumab and/or PARP inhibitors.

Author/s:

Giuseppe Caruso, MD, S. John Weroha, MD, PhD, William Cliby, MD

Nonhormonal Treatment of Menopausal Vasomotor Symptoms

Erin Blanchette — Wed, 07 May 2025 21:26:26 +0000

Date Added:

May 7, 2025

Journal/Publication:

JAMA Internal Medicine

Publisher:

American Medical Association

Publication Date:

May 5, 2025

URL:

Nonhormonal Treatment of Menopausal Vasomotor Symptoms

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jamainternmed.2025.0990

Keywords

Obstetrics and Gynecology

PMID (1):

40323611

MeSH

A concise evidence-based review of non-hormonal approaches to treatment of menopausal vasomotor symptoms. James W. Mold, MD, MPH

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Vasomotor symptoms are the most widely recognized menopause symptoms in Western nations, with at least 75% of women reporting hot flashes or night sweats during or after the menopause transition. Many women struggle to choose between treatments, given lack of data on direct comparisons of different treatments, concerns about short-term adverse effects and longer-term treatment risks, and confusion about complementary or alternative remedies with unclear evidence of benefit.

Author/s:

Alison J Huang, Stephanie Faubion, Deborah Grady

Diagnosis and treatment of adenomyosis

Devin Evans — Wed, 24 Feb 2021 06:00:00 +0000

Date Added:

February 24, 2021

Journal/Publication:

Canadian Medical Association Journal

Publication Date:

February 16, 2021

Issue:

Volume:

193

URL:

Diagnosis and treatment of adenomyosis

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

https://doi.org/10.1503/cmaj.201607

Keywords

MeSH

A concise one-page summary of adenomyosis cause, diagnosis, and treatment. James W. Mold, MD, MPH

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Adenomyosis is a benign gynecological disorder characterized by aberrant development of endometrial glands and stroma within the myometrium, causing inflammation and neuroangiogenesis. Adenomyosis often coexists with other gynecological conditions and may cloud the clinical presentation.

Author/s:

Dason, Ebernella Shirin, Chan, Crystal, Sobel, Mara