Obstetrics & Gynecology

Low-risk endometrial cancer with isolated nodal tumor cells may not need adjuvant therapy

This cohort study assessed overall survival in uterine factor–based low-risk endometrial cancer with isolated tumor cells in regional lymph nodes managed without adjuvant therapy. Survival outcomes suggested that omission of adjuvant treatment did not compromise overall survival in these carefully selected patients. These findings support surveillance alone after surgery for low-risk patients with isolated nodal tumor cells. Results can inform postoperative counseling and shared decisions around adjuvant therapy de-escalation. 1

Cancer incidence after medically assisted reproduction largely mirrors the general population

This Australian population-based cohort included 417984 women aged 18–55 years exposed to ART, IUI/OS, or clomiphene from 1991 to 2018. Overall invasive cancer incidence matched population rates for ART (SIR 1.00) and IUI/OS (SIR 0.99), with a small increase for clomiphene (SIR 1.04). Uterine cancer, melanoma, ovarian cancer (ART and IUI/OS), and in situ breast cancer (ART) had elevated SIRs, but absolute rate differences were small. Cervical and lung cancers were less frequent than expected, and invasive breast cancer incidence was not increased. 2

HPV-negative results drive very low long-term CIN2+ risk, limiting cotest added value

This cohort linked a randomized cervical screening trial to a provincial program, following 8078 women up to 10 years after exit cotesting. HPV-positive with abnormal cytology had the highest CIN2+ risk, followed by HPV-positive with normal cytology. HPV-negative women had very low cumulative CIN2+ risk, regardless of cytology result or whether considered alone or as a negative cotest. CIN2+ risk after a negative HPV test alone was similar to that after a negative cotest and lower than after normal cytology alone. 3

Body-identical estrogen COCs show lower VTE reporting disproportions than EE-based pills

This FAERS disproportionality analysis compared venous thromboembolism reports for various combined oral contraceptives versus EE/levonorgestrel and the overall COC class. Estetrol/drospirenone and E2V/dienogest had lower proportional reporting ratios than EE/levonorgestrel and the therapeutic class reference. Their VTE reporting resembled drospirenone-only and norethindrone-only pills, whereas EE/drospirenone showed the highest VTE signal. These findings suggest body-identical estrogen COCs may have a more favorable thrombotic safety profile than EE-based combinations, though causal inference is limited. 4