Does catching cancer earlier with surveillance always translate to better outcomes for gynecologic cancer patients? On this episode of BackTable Women’s Health, hosts Dr. Mona Guo and Dr. Marcia Ciccone interview Dr. Ritu Salani, Professor of OBGYN at UCLA and lead author of the updated SGO surveillance clinical practice statements. They discuss how post–curative-intent surveillance has evolved amid limited prospective evidence, review the latest guidelines, and highlight the real-world challenges of balancing early detection, patient safety, and cost.
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Timestamps
00:00 - Introduction03:05 - Evolving Guidelines and Consensus10:02 - Lead-Time Bias and Cost Considerations12:05 - Maintenance Therapy and Surveillance Nuances14:44 - Ovarian and Endometrial Cancer: Imaging vs Exam20:24 - Key Takeaways from the TOTEM Trial24:04 - Future Tools, Lifestyle Counseling, and Shared Care27:21 - Cytology, HPV Testing, and Post-Radiation Surveillance31:13 - Hormone Therapy Considerations34:37 - ctDNA and MRD Testing37:39 - Emerging Technologies and Limitations43:22 - Rapid Fire Takeaways45:33 - Closing Thoughts
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More about this episode
The conversation explores practice variability, the lack of clear survival benefits from routine imaging and tumor markers, and the risks of cascade testing and lead-time bias. Dr. Salani reviews the TOTEM trial data for endometrial cancer, the importance of symptom review and pelvic exams (especially for lower genital tract cancers), and the reduced role of cytology, even in cervical cancer after radiation. They also discuss shared-care models, lifestyle counseling, hormone therapy considerations, and the promise and limitations of emerging technologies like ctDNA and MRD testing during maintenance therapy.
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Resources
TOTEM Trialhttps://ascopubs.org/doi/abs/10.1200/jco.22.00471
2010 Ovarian Cancer CA-125 Trialhttps://pubmed.ncbi.nlm.nih.gov/20888993/
Society of Gynecologic Oncology Clinical Practice Statement on Surveillancehttps://pubmed.ncbi.nlm.nih.gov/41308226/
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