Landmark Gynae Studies

Question 1

Inclusion criteria LACE trial?

Answer 1

Stage I endometrial cancer. Endometrioid adenocarcinoma of any grade.

Question 2

LACE trial disease free survival 4.5years for control and intervention groups?

Answer 2

TAH = 81.3%
TLH 81.6%

7% conversion from TLH to TAH
2% requested TLH instead of TAH after assigned to TAH

Question 3

Secura et al findings hormonal IUD?

Answer 3

acceptable- 32% uptake
Failure rate 5.1/1000 teen-years (compared to 158.5/1000 population stats)
Continuation of use at 24 months by 2/3rds

Question 4

Follow up time of Secura et al?

Answer 4

2-3 years

Question 5

Design of Secura et al trial?

Answer 5

Cohort

Question 6

Design of Zhang et al 2005 misoprostol trial?

Answer 6

RCT. Compared 800mcg PV misoprostol Day 1 and 3 with vacuum aspiration

Question 7

Advantages of misoprostol management of missed miscarriage vs. vacuum aspiration?

Answer 7

• less surgical risk
• no anaesthetic
• usually start treatment same day
• 84% success day 8
• can be at home
• no increased risk posed to future fertility/pregnancy (cervical incompetence, Asherman’s Syndrome)

Question 8

Disadvantages of misoprostol medical management miscarriage?

Answer 8

• 16% failure (vs. 3% vacuum)
• refractory pain, nausea
• unscheduled hospital visit
• more likely to have 3g/dL Hb drop
• may require surgery anyway for failure, bleeding.

Question 9

PLCO trial aim?

Answer 9

Does screening for ovarian cancer with Ca125 and TVUSS reduce mortality?

Question 10

Protocol PLCO trial?

Answer 10

• TVUSS baseline + annual: ovarian volume >10cm3, ovarian cyst >10cm3, solid/papillary component, mixed component.
• Ca 125 baseline + annual

Question 11

Outcomes PLCO trial?

Answer 11

• no difference in stage at diagnosis (77 vs. 78% stage III & IV)
• incidence non-significantly different
• mortality same
• 7.7 vs 5.8% risk of oophorectomy in intervention group (RR 1.33)

Question 12

WHI 2002 E+P hazard ratio outcomes?

Answer 12

VTE 2.11 (1.26-3.55)
trend towards 
- increased invasive breast cancer
- decreased colorectal cancer 37%
- osteoporotic fractures reduced 23%

AMS: transdermal preparation reduces risk VTE. Micronised progesterone and dydrogesterone = lower risk profile.
breast cancer = risk increased with duration of use, decreased after cessation, increased with use after 60yo.

Question 13

SPIN trial question?

Answer 13

use of LMWH and aspirin reduce rate of pregnancy loss in women with 2 or more losses?

Question 14

Inclusion criteria SPIN study?

Answer 14

<7w
confirmed IUP on USS
normal FBC, RCA, TFT

excluded if APLS or thrombophilia or any other known cause.

Question 15

Outcomes SPIN trial?

Answer 15

No difference in pregnancy loss rate

Question 16

Kaandorp 2010 study question?

Answer 16

does aspirin and LMWH improve live birth rate in women with recurrent unexplained miscarriage?

Question 17

Exclusion criteria Kaandorp 2010?

Answer 17

<6w since conception, other indication for VTE prophylaxis, endocrine disorders

Question 18

Outcome Kaandorp SP?

Answer 18

no difference between aspirin, aspirin + heparin or placebo groups.
Live birth ranged 54.5-57%

Question 19

Million women study question?

Answer 19

What are the effects of HRT use and the incidence of fatal breast cancer?

Question 20

Design Milliion women study?

Answer 20

cohort

Question 21

Results Million women study?

Answer 21

O+P HRT increases breast cancer and death. Proportional to duration of use

• current O+P >10y = RR 2.31 (2.08-2.56)
• current O >10y = RR 1.37 (1.22-1.54)

Past use does not increase risk. Not different by type of oestrogen or progesterone used, or whether cyclical or continuous.

Question 22

Parker 2005 study question?

Answer 22

At what age is prophylactic oophorectomy at time of hysterectomy for benign disease beneficial?

Question 23

Parker 2005 findings?

Answer 23

Ovarian conservation without HRT reduces death from CHD (15%–> 7%), Hip fracture (5% –> 3.4%).

Above age 64yo, confidence interval bands for groups overlap.

Overlap earlier if using HRT. Ages 50-54yo, survival @ 80yo:

• conservation + ET= 62.5%
• oophorectomy + ET= 62.2%