In a recent publication, Dr. Janice Kwon discusses the importance of evaluating existing standards of care on an ongoing basis and prioritizing quality of life and long-term survivorship, particularly for interventions in early-stage cancers and risk-reducing strategies that often yield long-term life expectancy. This work was featured as an oral plenary session at ASCO 2025.
Historically, radical hysterectomy was offered as the standard of care for early-stage cervical cancer and chemoradiotherapy for locally advanced disease, both of which would end any chance of future fertility. Kwon et al. describe a “humbling” body of emerging evidence that has prompted a shift toward de-escalation. Unlike radical hysterectomy, simple hysterectomy does not involve removal of the parametrium or upper vagina, which the landmark SHAPE trial found to result in less long-term urinary and sexual dysfunction with no differences in effectiveness. Simple hysterectomy is now offered to patients with early-stage, low-risk cervical cancer.
Because there is no effective screening test for ovarian cancer, those at high risk are advised to undergo risk-reducing bilateral salpingo-oophorectomy (removal of both fallopian tubes and ovaries), which renders them menopausal at an early age. Ongoing clinical trials are evaluating the effectiveness of a risk-reducing salpingectomy followed by a delayed oophorectomy. This strategy would delay onset of menopause, improving quality of life.
This work is an excellent example of patient-oriented research and care. As standards evolve, so must our willingness to continually challenge and improve care to ensure that it is not only effective, but compassionate and sustainable.
Source
Kwon JS, Plante M, Hickey M, Huguenin A, Hmaidan S, Woodard TL. Is Less More? Maximizing Outcomes by Tailoring Treatments to Patients: Oncofertility and Oncomenopause. Am Soc Clin Oncol Educ Book. 2025 Jun;45(3):e481126. doi: 10.1200/EDBK-25-481126. Epub 2025 May 28. PMID: 4043543