Cervical squamocolumnar junction is the target site of human papillomavirus — It is well established that the transformation zone, a metaplastic area of the cervix that includes the junction of the squamous cells of the ectocervix and columnar cells, is the site of most cervical intraepithelial neoplasia and carcinoma and that human papillomavirus (HPV) infection is the principal etiology. A study of hysterectomy and cervical biopsy specimens suggests that the primary area of HPV-associated carcinogenesis is not the entire transformation zone, but a small population of cuboidal cells within the squamocolumnar junction [28]. This group of cells had a unique gene expression profile similar to that found in squamous and glandular high-grade cervical intraepithelial neoplasia and carcinoma. (See "Cervical intraepithelial neoplasia: Definition, incidence, and pathogenesis", section on 'Overview of HPV infection'.)

Decreased risk of endometrial cancer with later age at last birth — The association between increasing parity and a decreased risk of endometrial cancer is well established. A large meta-analysis of individual data found that childbearing at an older age, independent of parity, was also associated with a decreased risk of endometrial carcinoma [29]. For each five years of age older than 25 years, the risk of endometrial cancer was decreased by 13 percent. (See "Endometrial carcinoma: Epidemiology and risk factors", section on 'Increasing age at last birth'.)

Carboplatin plus paclitaxel for metastatic cervical cancer — For women who present with metastatic cervical cancer and those with recurrent or persistent disease despite chemoradiation, cisplatin-based combination therapy is routinely administered, although cisplatin is associated with significant toxicity, including severe nausea and vomiting, neuropathy, and nephrotoxicity. Therefore, alternatives to cisplatin in the first-line treatment of metastatic cervical cancer have been explored in clinical trials. The preliminary results of a phase III trial comparing paclitaxel with either carboplatin or cisplatin in the first-line treatment of women with metastatic or persistent cervical cancer were presented at the 2012 ASCO meeting [30]. There were no differences in the overall response rate and in overall survival between the treatment arms. However, carboplatin resulted in significantly less toxicity. Subgroup analysis suggested that carboplatin was beneficial primarily to women who were previously treated with primary chemoradiation. These results support the use of carboplatin in the setting of persistent or metastatic cervical cancer. (See "Management of recurrent or metastatic cervical cancer", section on 'First-line chemotherapy'.)

Ovarian cancer symptoms and complete cytoreduction — Symptoms associated with ovarian cancer have been identified (eg, abdominal bloating, early satiety, pelvic or abdominal pain), but the impact on ovarian cancer survival of actively eliciting these symptoms is unknown. One potential role for identification of symptoms is to diagnose ovarian cancer when optimal cytoreduction is possible. A prospective study identified 11 women with ovarian, fallopian tube, or primary peritoneal cancer among 1455 who were found to have ovarian cancer symptoms using targeted questioning at routine medical visits and a public health campaign [31]. These women were more likely than those who presented with these malignancies through standard care to have completely resectable disease (72 versus 23 percent). However, 239 women required investigation to identify the 11 ovarian cancers, with a prevalence of one per 132 women (0.76 percent) who had symptoms. (See "Early detection of epithelial ovarian cancer: Role of symptom recognition", section on 'Role of early detection'.)

Expectant management of hydatidiform mole — Women with hydatidiform mole are typically treated with chemotherapy for presumed malignant gestational disease if the serum human chorionic gonadotropin (hCG) level remains elevated at six months after uterine evacuation. However, some data suggest that continued surveillance is reasonable in some women. A retrospective study including over 12,000 women with hydatidiform mole followed with serial hCG measurements found that the level normalized in 99 percent within six months after uterine evacuation [32]. hCG levels remained elevated in 76 women; ten of these patients received chemotherapy and 66 women were managed with continued hCG surveillance. The hCG level normalized within six to 12 months after evacuation in 45 of the 66 patients (89 percent). (See "Gestational trophoblastic disease: Management of hydatidiform mole", section on 'Diagnosis of persistent disease'.)

BRCA mutations and ovarian cancer prognosis — A meta-analysis of 26 observational studies found that BRCA gene mutation carriers with ovarian cancer, particularly BRCA2 mutation carriers, have a significantly better prognosis than noncarriers [33]. The five-year all-cause mortality rate for noncarriers was 47 percent compared with 45 percent for BRCA1 mutation carriers and 36 percent for BRCA2 mutation carriers. (See"Epithelial ovarian, fallopian tube, and primary peritoneal carcinoma: Clinical features and diagnosis".)

                         28.Herfs M, Yamamoto Y, Laury A, et al. A discrete population of squamocolumnar junction cells implicated in the pathogenesis of cervical cancer. Proc Natl Acad Sci U S A 2012; 109:10516.

                        29.Setiawan VW, Pike MC, Karageorgi S, et al. Age at Last Birth in Relation to Risk of Endometrial Cancer: Pooled Analysis in the Epidemiology of Endometrial Cancer Consortium. Am J Epidemiol 2012; 176:269.

                         30.Kitagawa R, Katsumata N, Shibata T, et al. A randomized, phase III trial of paclitaxel plus carboplatin (TC) versus paclitaxel plus cisplatin (TP) in stage IVb, persistent or recurrent cervical cancer: Japan Clinical Oncology Group study (JCOG0505). J Clin Oncol 2012; 30:Abstr 5006.

                         31.Gilbert L, Basso O, Sampalis J, et al. Assessment of symptomatic women for early diagnosis of ovarian cancer: results from the prospective DOvE pilot project. Lancet Oncol 2012; 13:285.

                         32.Agarwal R, Teoh S, Short D, et al. Chemotherapy and human chorionic gonadotropin concentrations 6 months after uterine evacuation of molar pregnancy: a retrospective cohort study. Lancet 2012; 379:130.

                          33.Bolton KL, Chenevix-Trench G, Goh C, et al. Association between BRCA1 and BRCA2 mutations and survival in women with invasive epithelial ovarian cancer. JAMA 2012; 307:382.