References

  1. 1.Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209-249.
  2. 2.National Cancer Institute. Cancer stat facts: cervical cancer. https://seer.cancer.gov/statfacts/html/cervix.html
  3. 3.Cheng X, Wang P, Cheng L, et al. Trends in cervical cancer incidence and mortality in the United States, 1975-2018: a population-based study. Front Med (Lausanne). 2025;12:1579446.
  4. 4.Tsige AW, Beyene DA. Cervical cancer: challenges and prevention strategies: a narrative review. Health Sci Rep. 2024;7(6):e2149.
  5. 5.Luvián-Morales J, Gutiérrez-Enríquez SO, Granados-García V, et al. Risk factors for the development of cervical cancer: analysis of the evidence. Front Oncol. 2024;14:1378549.
  6. 6.Naldini G, Grisci C, Chiavarini M, et al. Association between human papillomavirus and chlamydia trachomatis infection risk in women: a systematic review and meta-analysis. Int J Public Health. 2019;64(6):943-955.
  7. 7.Hosono S, Matsuo K, Kajiyama H, et al. Association between dietary calcium and vitamin D intake and cervical carcinogenesis among Japanese women. Eur J Clin Nutr. 2010;64(4):400-409.
  8. 8.Schubert M, Bauerschlag DO, Muallem MZ, et al. Challenges in the diagnosis and individualized treatment of cervical cancer. Medicina (Kaunas). 2023;59(5):925.
  9. 9.El-Zein M, Richardson L, Franco EL. Cervical cancer screening of HPV vaccinated populations: cytology, molecular testing, both or none. J Clin Virol. 2016;76(suppl 1):S62-S68.
  10. 10.Karimi-Zarchi M, Allahqoli L, Nehmati A, et al. Can the prophylactic quadrivalent HPV vaccine be used as a therapeutic agent in women with CIN? A randomized trial. BMC Public Health. 2020;20(1):274.
  11. 11.Centers for Disease Control and Prevention. Administering HPV vaccine. Updated November 16, 2021. https://www.cdc.gov/vaccines/vpd/hpv/hcp/administration.html
  12. 12.American College of Obstetricians and Gynecologists’ Committee on Adolescent Health Care, American College of Obstetricians and Gynecologists’ Immunization, Infectious Disease, and Public Health Preparedness Expert Work Group. Human papillomavirus vaccination: ACOG committee opinion, number 809. Obstet Gynecol. 2020;136(2):e15-e21.
  13. 13.Nguyen T, Nougaret S, Castillo P, et al. Cervical cancer in the pregnant population. Abdom Radiol (NY). 2023;48(5):1679-1693.
  14. 14.US Preventive Services Task Force. Draft recommendation statement. Cervical cancer: screening. https://www.uspreventiveservicestaskforce.org/uspstf/draft-recommendation/cervical-cancer-screening-adults-adolescents
  15. 15.American College of Obstetricians and Gynecologists. Practice advisory: updated cervical cancer screening guidelines. https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2021/04/updated-cervical-cancer-screening-guidelines
  16. 16.Marcus JZ, Cason P, Downs LS, et al. The ASCCP Cervical Cancer Screening Task Force endorsement and opinion on the American Cancer Society updated cervical cancer screening guidelines. J Low Genit Tract Dis. 2021;25(3):187-191.
  17. 17.Fontham ETH, Wolf AMD, Church TR, et al. Cervical cancer screening for individuals at average risk: 2020 guideline update from the American Cancer Society. CA Cancer J Clin. 2020;70(5):321-346.
  18. 18.Curry SJ, Krist AH, Owens DK, et al.; US Preventive Services Task Force. Screening for cervical cancer: US Preventive Services Task Force recommendation statement. JAMA. 2018;320(7):674-686.
  19. 19.Schiffman M, Castle PE, Jeronimo J, et al. Human papillomavirus and cervical cancer. Lancet. 2007;370(9590):890-907.
  20. 20.Moscicki AB, Flowers L, Huchko MJ, et al. Updated review for guidelines for cervical cancer screening in immunosuppressed women without HIV infection. J Low Genit Tract Dis. 2025;29(2):168-179.
  21. 21.Perkins RB, Guido RS, Castle PE, et al. 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. J Low Genit Tract Dis. 2020;24(2):102-131.
  22. 22.Burness JV, Schroeder JM, Warren JB. Cervical colposcopy: indications and risk assessment. Am Fam Physician. 2020;102(1):39-48.
  23. 23.Chapter 5: the colposcopic examination step-by-step. In: Sellors JW, Sankaranarayanan R, eds. Colposcopy and Treatment of Cervical Intraepithelial Neoplasia: A Beginners’ Manual. International Agency for Research on Cancer. 2003-2004. https://screening.iarc.fr/colpochap.php?lang=1&chap=5
  24. 24.Santoro A, Inzani F, Angelico G, et al. Recent advances in cervical cancer management: a review on novel prognostic factors in primary and recurrent tumors. Cancers (Basel). 2023;15(4):1137.
  25. 25.Bhatla N, Aoki D, Sharma DN, et al. Cancer of the cervix uteri: 2021 update. Int J Gynaecol Obstet. 2021;155(suppl 1):28-44.
  26. 26.Lin AJ, Dehdashti F, Massad LS, et al. Long-term outcomes of cervical cancer patients treated with definitive chemoradiation following a complete metabolic response. Clin Oncol (R Coll Radiol). 2021;33(5):300-306.
  27. 27.National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Cervical Cancer. Version 4.2025. Published 2025.https://www.nccn.org
  28. 28.Tewari KS. Cervical cancer. N Engl J Med. 2025;392(1):56-71.
  29. 29.Zhou S, Peng F. Patterns of metastases in cervical cancer: a population-based study. Int J Clin Exp Pathol. 2020;13(7):1615-1623.
  30. 30.Palagudi M, Para S, Golla N, et al. Adverse effects of cancer treatment in patients with cervical cancer. Cureus. 2024;16(2):e54106.
  31. 31.Restaino S, Pellecchia G, Arcieri M, et al.; Gynecologic Oncology Group. Management for cervical cancer patients: a comparison of the guidelines from the international scientific societies (ESGO-NCCN-ASCO-AIOM-FIGO-BGCS-SEOM-ESMO-JSGO). Cancers (Basel). 2024;16(14):2541.
  32. 32.National Comprehensive Cancer Network. Guidelines for patients: cervical cancer (Version 2025). https://www.nccn.org/patients/guidelines/content/PDF/cervical-patient-guideline.pdf
  33. 33.Cervical Cancer Treatment: Patient Version. PDQ Cancer Information Summaries [Internet]. National Cancer Institute; 2025. https://www.ncbi.nlm.nih.gov/books/NBK65985/
  1. 1.American Cancer Society. Key statistics for endometrial cancer. https://www.cancer.org/cancer/types/endometrial-cancer/about/key-statistics.html
  2. 2.Cancer Facts & Figures for African American/Black People 2022-2024. American Cancer Society; 2022.https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/cancer-facts-and-figures-for-african-americans/2022-2024-cff-aa.pdf
  3. 3.Oliver KE, Enewold LR, Zhu K, et al. Racial disparities in histopathologic characteristics of uterine cancer are present in older, not younger blacks in an equal-access environment. Gynecol Oncol. 2011;123(1):76-81.
  4. 4.Giaquinto AN, Miller KD, Tossas KY, et al. Cancer statistics for African American/Black People 2022. CA Cancer J Clin. 2022;72(3):202-229.
  5. 5.Clarke MA, Long BJ, Del Mar Morillo A, et al. Association of endometrial cancer risk with postmenopausal bleeding in women: a systematic review and meta-analysis. JAMA Intern Med. 2018;178(9):1210-1222.
  6. 6.Felix AS, Yang HP, Bell DW, et al. Epidemiology of endometrial carcinoma: etiologic importance of hormonal and metabolic influences. Adv Exp Med Biol. 2017;943:3-46.
  7. 7.Lu KH, Broaddus RR. Endometrial cancer. N Engl J Med. 2020;383(21):2053-2064.
  8. 8.Colombo N, Preti E, Landoni F, et al.; ESMO Guidelines Working Group. Endometrial cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013;24(suppl 6):vi33-vi38.
  9. 9.Amiri M, Bidhendi-Yarandi R, Fallahzadeh A, et al. Risk of endometrial, ovarian, and breast cancers in women with polycystic ovary syndrome: a systematic review and meta-analysis. Int J Reprod Biomed. 2022;20(11):893-914.
  10. 10.Marin AG, Filipescu A, Petca A. The role of obesity in the etiology and carcinogenesis of endometrial cancer. Cureus. 2024;16(4):e59219.
  11. 11.Morice P, Leary A, Creutzberg C, et al. Endometrial cancer. Lancet. 2016;387(10023):1094-1108.
  12. 12.American College of Obstetricians and Gynecologists. Endometrial cancer. Practice bulletin, number 149. https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2015/04/endometrial-cancer
  13. 13.American College of Obstetricians and Gynecologists. The role of transvaginal ultrasonography in evaluating the endometrium of women with postmenopausal bleeding. Committee opinion, number 734. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/05/the-role-of-transvaginal-ultrasonography-in-evaluating-the-endometrium-of-women-with-postmenopausal-bleeding
  14. 14.Fleischer AC, Wheeler JE, Lindsay I, et al. An assessment of the value of ultrasonographic screening for endometrial disease in postmenopausal women without symptoms. Am J Obstet Gynecol. 2001;184(2):70-75.
  15. 15.Ryan NAJ, Glaire MA, Blake D, et al. The proportion of endometrial cancers associated with Lynch syndrome: a systematic review of the literature and meta-analysis. Genet Med. 2019;21(10):2167-2180.
  16. 16.American College of Obstetricians and Gynecologists. Lynch syndrome. Practice bulletin, number 147. https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2014/11/lynch-syndrome
  17. 17.Hampel H, Frankel WL, Martin E, et al. Screening for the Lynch syndrome (hereditary nonpolyposis colorectal cancer). N Engl J Med. 2005;352(18):1851-1860.
  18. 18.American College of Obstetricians and Gynecologists. Tamoxifen and uterine cancer. Committee opinion, number 601. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2014/06/tamoxifen-and-uterine-cancer
  19. 19.Management of endometrial intraepithelial neoplasia or atypical endometrial hyperplasia: ACOG clinical consensus no. 5. Obstet Gynecol. 2023;142(3):735-744.
  20. 20.Menendez-Santos M, Gonzalez-Baerga C, Taher D, et al. Endometrial cancer: 2023 revised FIGO staging system and the role of imaging. Cancers (Basel). 2024;16(10):1869.
  21. 21.Niu S, Molberg K, Castrillon DH, et al. Biomarkers in the diagnosis of endometrial precancers. Molecular characteristics, candidate immunohistochemical markers, and promising results of three-marker panel: current status and future directions. Cancers (Basel). 2024;16(6):1159.
  22. 22.Rimel BJ, Burke WM, Higgins RV, et al. Improving quality and decreasing cost in gynecologic oncology care. Society of Gynecologic Oncology recommendations for clinical practice. Gynecol Oncol. 2015;137(2):280-284.
  23. 23.Kandoth C, Schultz N, Cherniack AD, et al.; Cancer Genome Atlas Research Network. Integrated genomic characterization of endometrial carcinoma. Nature. 2013;497(7447):67-73.
  24. 24.Morrow CP, Bundy BN, Kurman RJ, et al. Relationship between surgical-pathological risk factors and outcome in clinical stage I and II carcinoma of the endometrium: a Gynecologic Oncology Group study. Gynecol Oncol. 1991;40(1):55-65.
  25. 25.Creutzberg CL, Nout RA, Lybeert ML, et al.; PORTEC Study Group. Fifteen-year radiotherapy outcomes of the randomized PORTEC-1 trial for endometrial carcinoma. Int J Radiat Oncol Biol Phys. 2011;81(4):e631-e638.
  26. 26.Werner HMJ, Mills GB. Targeted therapies for gynecologic cancers: beyond PARP inhibitors. Gynecol Oncol. 2022;166(3):663-672.
  27. 27.Rütten H, Verhoef C, van Weelden WJ, et al. Recurrent endometrial cancer: local and systemic treatment options. Cancers (Basel). 2021;13(24):6275.
  28. 28.Pecorelli S. Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int J Gynaecol Obstet. 2009;105(2):103-104.
  29. 29.Sundar S, Balega J, Crosbie E, et al. BGCS uterine cancer guidelines: recommendations for practice. Eur J Obstet Gynecol Reprod Biol. 2017;213:71-97.
  30. 30.Oaknin A, Bosse TJ, Creutzberg CL, et al.; ESMO Guidelines Committee. Endometrial cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol. 2022;33(9):860-877.
  31. 31.Blake P, Swart AM, Orton J, et al.; ASTEC/EN.5 Study Group. Adjuvant external beam radiotherapy in the treatment of endometrial cancer (MRC ASTEC and NCIC CTG EN.5 randomised trials): pooled trial results, systematic review, and meta-analysis. Lancet. 2009;373(9658):137-146.
  32. 32.Uccella S, Zorzato PC, Dababou S, et al. Conservative management of atypical endometrial hyperplasia and early endometrial cancer in childbearing age women. Medicina (Kaunas). 2022;58(9):1256.
  33. 33.Vasileva R, Wohrer H, Gaultier V, et al. Pregnancy and obstetric outcomes after fertility-sparing management of endometrial cancer and atypical hyperplasia: a multicentre cohort study. Hum Reprod. 2024;39(6):1231-1238.
  34. 34.Bourou MZ, Matsas A, Vrekoussis T, et al. Conservative treatment of endometrial cancer in women of reproductive age (review). Mol Clin Oncol. 2023;19(1):55.
  35. 35.Obermair A, Baxter E, Brennan DJ, et al. Fertility-sparing treatment in early endometrial cancer: current state and future strategies. Obstet Gynecol Sci. 2020;63(4):417-431.
  36. 36.Agnew H, Kitson S, Crosbie EJ. Interventions for weight reduction in obesity to improve survival in women with endometrial cancer. Cochrane Database Syst Rev. 2023(3):CD012513.
  37. 37.Onstad MA, Schmandt RE, Lu KH. Addressing the role of obesity in endometrial cancer risk, prevention, and treatment. J Clin Oncol. 2016;34(35):4225-4230.
  1. 1.National Cancer Institute. Cancer stat facts: ovarian cancer. https://seer.cancer.gov/statfacts/html/ovary.html
  2. 2.Mei S, Chelmow D, Gecsi K, et al. Health disparities in ovarian cancer: report from the Ovarian Cancer Evidence Review Conference. Obstet Gynecol. 2023;142(1):196-210.
  3. 3.Reid BM, Permuth JB, Sellers TA. Epidemiology of ovarian cancer: a review. Cancer Biol Med. 2017;14(1):9-32.
  4. 4.Burke W, Barkley J, Barrows E, et al. Executive summary of the Ovarian Cancer Evidence Review Conference. Obstet Gynecol. 2023;142(1):179-195.
  5. 5.Walker JL, Powell CB, Chen LM, et al. Society of Gynecologic Oncology recommendations for the prevention of ovarian cancer. Cancer. 2015;121(13):2108-2120.
  6. 6.Menon U, Karpinskyj C, Gentry-Maharaj A. Ovarian cancer prevention and screening. Obstet Gynecol. 2018;131(5):909-927.
  7. 7.Wheeler LJ, Desanto K, Teal SB, et al. Intrauterine device use and ovarian cancer risk: a systematic review and meta-analysis. Obstet Gynecol. 2019;134(4):791-800.
  8. 8.Balayla J, Gil Y, Lasry A, et al. Ever-use of the intra-uterine device and the risk of ovarian cancer. J Obstet Gynaecol. 2021;41(6):848-853.
  9. 9.ACOG committee opinion no. 774: opportunistic salpingectomy as a strategy for epithelial ovarian cancer prevention. Obstet Gynecol. 2019;133(4):e279-e284.
  10. 10.Falconer H, Yin L, Grönberg H, Altman D. Ovarian cancer risk after salpingectomy: a nationwide population-based study. J Natl Cancer Inst. 2015;107(2):dju410.
  11. 11.Findley AD, Siedhoff MT, Hobbs KA, et al. Short-term effects of salpingectomy during laparoscopic hysterectomy on ovarian reserve: a pilot randomized controlled trial. Fertil Steril. 2013;100(6):1704-1708.
  12. 12.Hanley GE, McAlpine JN, Pearce CL, et al. The performance and safety of bilateral salpingectomy for ovarian cancer prevention in the United States. Am J Obstet Gynecol. 2017;216(3):270.e1-270.e9.
  13. 13.Grossman DC, Curry SJ, Owens DK, et al.; US Preventive Services Task Force. Screening for ovarian cancer: US Preventive Services Task Force recommendation statement. JAMA. 2018;319(6):588-594.
  14. 14.Yoshida R. Hereditary breast and ovarian cancer (HBOC): review of its molecular characteristics, screening, treatment, and prognosis. Breast Cancer. 2021;28(6):1167-1180.
  15. 15.Menon U, Gentry-Maharaj A, Burnell M, et al. Ovarian cancer population screening and mortality after long-term follow-up in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS): a randomised controlled trial. Lancet. 2021;397(10290):2182-2193.
  16. 16.American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Gynecology. Practice bulletin no. 174: evaluation and management of adnexal masses. Obstet Gynecol. 2016;128(5):e210-e226.
  17. 17.Committee opinion no. 716: the role of the obstetrician-gynecologist in the early detection of epithelial ovarian cancer in women at average risk. Obstet Gynecol. 2017;130(3):e146-e149.
  18. 18.National Institute for Health and Care Excellence. Ovarian cancer: recognition and initial management. Clinical guideline: CG122. https://www.nice.org.uk/guidance/cg122/resources/ovarian-cancer-recognition-and-initial-management-35109446543557
  19. 19.Moore RG, McMeekin DS, Brown AK, et al. A novel multiple marker bioassay utilizing HE4 and CA125 for the prediction of ovarian cancer in patients with a pelvic mass. Gynecol Oncol. 2009;112(1):40-46.
  20. 20.Prat J; FIGO Committee on Gynecologic Oncology. Staging classification for cancer of the ovary, fallopian tube, and peritoneum. Int J Gynaecol Obstet. 2014;124(1):1-5.
  21. 21.Ledermann JA, Raja FA, Fotopoulou C, et al.; ESMO Guidelines Working Group. Newly diagnosed and relapsed epithelial ovarian carcinoma: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013;24(suppl 6):vi24-vi32.
  22. 22.Bast RC, Hennessy B, Mills GB. The biology of ovarian cancer: new opportunities for translation. Nat Rev Cancer. 2009;9(6):415-428.
  23. 23.Metcalf RL, Fry DJ, Swindell R, et al. Thrombosis in ovarian cancer: a case control study. Br J Cancer. 2014;110(5):1118-1124.
  1. 1.National Cancer Institute. Cancer stat facts: vulvar cancer. https://seer.cancer.gov/statfacts/html/vulva.html
  2. 2.Pedrão PG, Guimarães YM, Godoy LR, et al. Management of early-stage vulvar cancer. Cancers (Basel). 2022;14(17):4184.
  3. 3.Hampl M, Sarajuuri H, Wentzensen N, et al. Effect of human papillomavirus vaccines on vulvar, vaginal, and anal intraepithelial lesions and vulvar cancer. Obstet Gynecol. 2006;108(6):1361-1368.
  4. 4.Centers for Disease Control and Prevention. Vaccines and immunizations: HPV vaccination recommendations. https://www.cdc.gov/vaccines/vpd/hpv/hcp/recommendations.html
  5. 5.Vue NC, Sassani J, Prairie B, et al. Clinical outcomes with utilization of high-potency topical steroids in patients with lichen sclerosus-associated vulvar cancer. Gynecol Oncol. 2024;187:58-63.
  6. 6.Regauer S. Immune dysregulation in lichen sclerosus. Eur J Cell Biol. 2005;84(2-3):273-277.
  7. 7.Allbritton JI. Vulvar neoplasms, benign and malignant. Obstet Gynecol Clin North Am. 2017;44(3):339-352.
  8. 8.Xu L, Selk A, Garland SM, et al. Prophylactic vaccination against human papillomaviruses to prevent vulval and vaginal cancer and their precursors. Expert Rev Vaccines. 2019;18(11):1157-1166.
  9. 9.Kesić V, Vieira-Baptista P, Stockdale CK. Early diagnostics of vulvar intraepithelial neoplasia. Cancers (Basel). 2022;14(7):1822.
  10. 10.American College of Obstetricians and Gynecologists’ Committee on Adolescent Health Care, American College of Obstetricians and Gynecologists’ Immunization, Infectious Disease, and Public Health Preparedness Expert Work Group. Human papillomavirus vaccination: ACOG committee opinion, number 809. Obstet Gynecol. 2020;136(2):e15-e21.
  11. 11.Chargari C, Wasserman J, Gabro A, et al. Vulvar carcinoma: standard of care and perspectives. J Clin Oncol. 2024;42(8):961-972.
  12. 12.Burns RB, Potter JE, Ricciotti HA, et al. Screening pelvic examinations in adult women: grand rounds discussion from the Beth Israel Deaconess Medical Center. Ann Intern Med. 2015;163(7):537-547.
  13. 13.Rigel DS, Carucci JA. Malignant melanoma: prevention, early detection, and treatment in the 21st century. CA Cancer J Clin. 2000;50(4):215-236.
  14. 14.Committee opinion no. 675: management of vulvar intraepithelial neoplasia. Obstet Gynecol. 2016;128(4):e178-e182.
  15. 15.Oonk MHM, Planchamp F, Baldwin P, et al. European Society of Gynaecological Oncology guidelines for the management of patients with vulvar cancer - update 2023. Int J Gynecol Cancer. 2023;33(7):1023-1043.
  16. 16.Kwolek DG, Gerstberger S, Tait S, et al. Ovarian, uterine, and vulvovaginal cancers: screening, treatment overview, and prognosis. Med Clin North Am. 2023;107(2):329-355.
  17. 17.Cao H, Wang S, Zhang Z, et al. Prognostic value of overexpressed p16INK4a in vulvar cancer: a meta-analysis. PLoS One. 2016;11(3):e0152459.
  18. 18.Rakislova N, Clavero O, Alemany L, et al.; VVAP study group. “Histological characteristics of HPV-associated and -independent squamous cell carcinomas of the vulva: a study of 1,594 cases”. Int J Cancer. 2017;141(12):2517-2527.
  19. 19.Virarkar M, Vulasala SS, Daoud T, et al. Vulvar cancer: 2021 revised FIGO staging system and the role of imaging. Cancers (Basel). 2022;14(9):2264.
  20. 20.Abu-Rustum NR, Yashar CM, Arend R, et al. Vulvar cancer, version 1.2025, NCCN clinical practice guidelines in oncology. https://www.nccn.org/professionals/physician_gls/pdf/vulvar.pdf
  21. 21.Ovarian Cancer Research Alliance. Vulvar cancer. https://ocrahope.org/for-patients/gynecologic-cancers/vulvar-cancer/
  22. 22.Hinten F, Molijn A, Eckhardt L, et al. Vulvar cancer: two pathways with different localization and prognosis. Gynecol Oncol. 2018;149(2):310-317.
  23. 23.Salani R, Khanna N, Frimer M, et al. An update on post-treatment surveillance and diagnosis of recurrence in women with gynecologic malignancies: Society of Gynecologic Oncology (SGO) recommendations. Gynecol Oncol. 2017;146(1):3-10.

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