Prevention over screening for ovarian cancer in patients with high-risk germline mutations: Misinterpreting the findings of ALDO.

In November 2022, the findings of the Avoiding Late Diagnosis of Ovarian cancer (ALDO) study were published. Subsequent media coverage suggested that investigators had found a safe alternative to risk-reducing bilateral salpingoophorectomy (rrBSO) in patients with pathogenic BRCA1 and BRCA2 germline mutations who chose to decline or defer risk-reducing surgery. Unfortunately, this media coverage was largely misleading. Specifically, in the ALDO trial, 4 of 6 patients found to have ovarian cancer by the ALDO screening methodology were diagnosed with advanced-stage disease. The primary endpoint of the ALDO study was the rate of complete surgical cytoreduction, rather than stage at diagnosis or overall survival, which is an inappropriate surrogate for benefit in a population at risk of ovarian cancer. The ALDO trial again demonstrates that screening women at high-risk of ovarian cancer should not be considered a safe alternative to risk-reducing surgery, and can lead to false reassurance and the development of preventable cases of ovarian cancer. While we should continue to investigate new screening options, future efforts should largely focus on why patients decline rrBSO in the first place and how we can pivot our efforts to better address concerns related to rrBSO, including sequelae of surgical menopause. Furthermore, as we continue to understand the role of the fallopian tube in the epithelial ovarian cancer (EOC) disease process, we must identify the role of salpingectomy alone in prevention of EOC.

Mixed squamous and clear cell ovarian adenocarcinoma arising from endometriosis in a 71 year old patient.

•This 71 year old patient was diagnosed with mixed squamous and clear cell ovarian adenocarcinoma.•Patient was surgically staged with guidance from frozen section.•Patient received adjuvant treatment with carboplatin and paclitaxel for 6 cycles.

Metastatic ovarian carcinosarcoma in a patient undergoing in-vitro fertilization: A case report.

INTRODUCTION AND IMPORTANCE: Ovarian carcinosarcomas (OCS) are highly aggressive tumors containing both carcinomatous and sarcomatous elements. Patients are typically older postmenopausal women who present with advanced disease, however rarely young women can be affected. CASE PRESENTATION: A 41-year-old woman undergoing fertility treatment was found to have a new 9-10 cm pelvic mass on routine transvaginal ultrasound (TVUS) 16 days after embryo transfer. Diagnostic laparoscopy revealed a mass in the posterior cul-de-sac that was surgically excised and sent to pathology for evaluation. Pathology was consistent with carcinosarcoma of gynecologic origin. Further work-up revealed advanced disease with apparent rapid progression. Patient underwent interval debulking surgery after four cycles of neoadjuvant chemotherapy with carboplatin and paclitaxel with final pathology consistent with primary ovarian carcinosarcoma and complete gross resection of disease. CLINICAL DISCUSSION: In the setting of advanced disease neoadjuvant chemotherapy with a platinum-based chemotherapy regimen followed by cytoreductive surgery is a standard approach to treatment of OCS. Given the rarity of disease, most data regarding treatment has been extrapolated from other forms of epithelial ovarian cancer. Specific risk factors for disease development of OCS including the long-term effects of assisted reproductive technology remain understudied. CONCLUSION: While OCS are rare highly aggressive biphasic tumors that primarily affect older postmenopausal woman, we present a unique case of OCS incidentally found in a young woman undergoing fertility treatment via in-vitro fertilization.

Factors associated with attendance at the postpartum blood pressure visit in pregnancies complicated by hypertension.

OBJECTIVES: Women with hypertensive disorders of pregnancy should have a blood pressure evaluation no later than 7-10 days after delivery. The objective of this study was to identify the factors associated with patient attendance at the postpartum blood pressure follow-up visit. STUDY DESIGN: This was a retrospective cohort study of postpartum women who had a hypertensive disorder of pregnancy. Postpartum follow-up rates were recorded, and characteristics of women who attended a postpartum visit for blood pressure evaluation were compared to women who did not return for the visit. Multiple logistic regression was performed. MAIN OUTCOME MEASURES: Characteristics of women who returned for a blood pressure visit. RESULTS: There were 378 women who met inclusion criteria; 193(51.1%) attended the blood pressure visit. Women who returned were older and more likely to have preeclampsia, severe features, magnesium sulfate use, or severe hypertension during hospitalization. They were less likely to have gestational hypertension. Adjusted analysis demonstrated that black/non-Hispanic women (OR 0.53, 95% CI 0.34-0.83), the presence of any preeclampsia diagnosis (OR 2.19, 95% CI 1.03-4.81), and whether the woman underwent a cesarean delivery (OR 3.06, 95% CI 1.85-5.14) remained significant factors in predicting adherence. CONCLUSIONS: Women who returned for a blood pressure visit were more likely to have had significant hypertensive disease or a cesarean delivery. Non-Hispanic black women had the lowest rate of follow-up. Given black women have the highest rates of maternal morbidity and mortality nationwide, effective interventions to increase follow-up for them are needed.

A mixed method approach to understanding the factors surrounding delayed diagnosis of type one diabetes.

AIMS: This study examined delayed type one diabetes (T1D) diagnosis, along with the associated severity markers, in the United States. Qualitative reflection was explored to add depth of understanding. METHODS: 975 parents of a minor child with T1D were recruited through snowball, social media requests to complete a 55-question online survey on the experience of diagnosis. RESULTS: 34% of children with T1D had a delayed diagnosis. When compared to those without a delayed diagnosis, these children were more likely to have an Emergency Room diagnosis (39.8% vs. 24.6%), be transported by ambulance or life flight (30.7% vs. 15.3%), be hospitalized (93.7% vs. 83.9%), spend time in an Intensive Care Unit (42.2% vs. 21.3%), and be in diabetic ketoacidosis (DKA) (42.2% vs. 21.3%). Younger children were at increased risk, with higher rates of DKA and fewer days of symptoms. Many parents experienced frustration receiving a prompt diagnosis for their child, including an inability to schedule a physician appointment, proper glucose testing, and concerns being dismissed by professionals. CONCLUSION: More physician and parent education is needed. Doctors should conduct glucose screenings when diabetes symptoms are present. Parents need education to recognize excessive thirst and frequent urination as reasons to seek medical treatment.

The effects of a nutrition education intervention on vending machine sales on a university campus.

OBJECTIVE: To determine the effects of a nutrition information intervention on the vending machine purchases on a college campus. PARTICIPANTS AND METHODS: Five high-use vending machines were selected for the intervention, which was conducted in the fall of 2011. Baseline sales data were collected in the 5 machines prior to the intervention. At the time of the intervention, color-coded stickers were placed near each item selection to identify less healthy (red), moderately healthy (yellow), and more healthy (green) snack items. Sales data were collected during the 2-week intervention. RESULTS: Purchases of red- and yellow-stickered foods were reduced in most of the machines; moreover, sales of the green-stickered items increased in all of the machines. CONCLUSIONS: The increased purchases of healthier snack options demonstrate encouraging patterns that support more nutritious and healthy alternatives in vending machines.