Gynecologic cancer incidence is moving in 3 different directions at once, and clinicians outside gynecologic oncology are often the first to see the warning signs. Ovarian cancer incidence is falling as genetic testing and risk-reducing surgery catch more high-risk women before diagnosis, even as its prevalence climbs because patients are living longer on treatment. Cervical cancer incidence continues to decline thanks to Pap and HPV co-testing plus vaccination, though it has not been eliminated. Endometrial cancer is the outlier: incidence is rising, driven largely by aggressive, high-grade subtypes that disproportionately affect Black women.¹ In this episode of Targeted Talks, Sabrina Serani, managing editor of Targeted Oncology, spoke with Noelle Gillette Cloven, MD, a gynecologic oncologist at Texas Oncology's Fort Worth Cancer Center and executive chair of the GYN Research Committee at Sarah Cannon Research Institute, to discuss how these shifting patterns should inform testing, screening, and referral decisions in everyday practice. The conversation is timed to Gynecologic Cancer Awareness Month, observed each September to raise awareness of cervical, ovarian, uterine, vaginal, and vulvar cancers. A recurring theme was the distinction between germline and somatic testing in ovarian cancer. Germline testing, done via blood or cheek swab, identifies inherited mutations in genes such as BRCA1 and BRCA2, present in roughly 20% of ovarian cancers, and carries implications for the patient's relatives. Somatic testing of the tumor itself, including homologous recombination deficiency (HRD) status, is a separate question that determines which patients are likely to benefit from PARP inhibitor maintenance therapy after chemotherapy. Cloven emphasized that an adequate core biopsy, not a fine-needle aspiration, is essential to secure enough tissue for HRD testing and to distinguish high-grade from low-grade serous disease, since treatment approaches for the two differ substantially. Screening gaps surfaced repeatedly. Extended Pap and HPV testing intervals, while evidence-based, make it harder for patients to track when they are due, and Cloven pushed back on guidance to stop cervical cancer screening at 65, noting that more than a third of cervical cancer cases are diagnosed after that age. In endometrial cancer, postmenopausal bleeding is rarely missed, but irregular bleeding in women under 40 is often attributed to obesity or PCOS and treated with oral contraceptives without a biopsy, delaying diagnosis in a population where the disease is less common but not absent. Cloven also flagged a persistent misconception among patients and some clinicians: a Pap test screens only for cervical cancer, not for ovarian, endometrial, or vulvar disease, and a well-woman exam does not automatically include one. On the treatment horizon, Cloven pointed to antibody-drug conjugates producing response rates in platinum-resistant ovarian cancer that she described as the best she has seen in her career, immunotherapy's role in extending survival in metastatic cervical cancer, and early movement toward non-chemotherapy, receptor-targeted options for advanced endometrial cancer guided by molecular profiling. For clinicians outside gynecologic oncology, Cloven's practical takeaways were straightforward: take a thorough family history, since it is often the entry point to genetic testing; do not substitute imaging or a prescription for a pelvic exam when a patient has persistent symptoms; and consider a clinical trial referral at diagnosis rather than as a last resort, since it may offer earlier access to newer therapies. REFERENCE1. Gaber C, Meza R, Ruterbusch JJ, Cote ML. Endometrial cancer trends by race and histology in the USA: projecting the number of new cases from 2015 to 2040. J Racial Ethn Health Disparities. 2017;4:895-903. doi:10.1007/s40615-016-0292-2
