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Objectives: Develop an endometrial cancer risk prediction model and externally validate it for UK primary care use. Design: Cohort study. Setting: The UK Biobank was used for model development and a linked primary (Clinical Practice Research Datalink, CPRD) and secondary care (HES), mortality (ONS) and cancer register (NRCAS) dataset was used for external validation. Population: Women aged 45–60 years with no history of endometrial cancer or hysterectomy. Methods: Model development was performed using a flexible parametric survival model and stepwise backward selection aiming to minimise the Akaike information criterion. Model performance on external validation was assessed through flexible calibration plots, calculation of the expected to observed ratio and C‐statistic and decision curve analysis. Main outcome measures: Endometrial cancer diagnosis within 1–10 years of the index date. Results: Model development included 222 031 women (902 incident endometrial cancer cases) and external validation 3 094 371 women (8585 endometrial cancer cases). The final model (with equation provided) incorporated age, body mass index, waist circumference, age at menarche, menopause and last birth, hormone replacement, tamoxifen and oral contraceptive pill use, type 2 diabetes, smoking and family history of bowel cancer. It was well calibrated on external validation (calibration slope 1.14, 95% confidence interval [CI] 1.11–1.17, E/O 1.03, 95% CI 1.01–1.05), with moderate/good discrimination (C‐statistic 0.70, 95% CI 0.69–0.70) and had improved net benefit compared with previously developed models. Conclusions: The Predicting risk of endometrial cancer in asymptomatic women model (PRECISION), using easily measurable anthropometric, reproductive, personal and family history, accurately quantifies a woman's 10‐year risk of endometrial cancer. Its use could determine eligibility for primary endometrial cancer prevention trials and for targeted resource allocation in UK general practices. [ABSTRACT FROM AUTHOR]

Objective: To understand whether self‐sampling can reduce carbon emissions (CO2e) from the NHS cervical screening programme (NHSCSP) by comparing the carbon footprint of three sampling strategies: routine cervical sampling, vaginal self‐sampling and first‐void (FV) urine collection. Design: Descriptive study. Setting: National Health Service (NHS), United Kingdom (UK). Population or Sample: Patients aged 25–64 years eligible for cervical screening in the UK. Methods: A carbon footprint analysis was undertaken for three cervical screening sampling approaches, from point of invitation to screening through to preparation for transport to the laboratory for HPV testing. A combination of primary and secondary data were used, with a bottom‐up approach applied to collection of primary data. Main Outcome Measures: We report CO2e per sampling approach, which is the unit used to express carbon footprint and harmonise the contributions of greenhouse gases with different global warming potentials. Results: The total carbon footprint of routine cervical sampling is 3670 g CO2e. By comparison, vaginal self‐sampling had a total carbon footprint of 423 g CO2e, and FV urine sampling 570 g CO2e. The largest share of emissions for routine sampling was attributable to the carbon footprint associated with an appointment in a primary care setting, which totalled 2768 g CO2e. Conclusions: Routine cervical sampling is up to 8.7‐fold more carbon‐intensive than self‐sampling approaches with equivalent effectiveness. We found negligible differences in the carbon footprint of alternative self‐sampling methods, supporting the need for an informed choice of screening options for participants, which includes sharing information on their environmental impacts. [ABSTRACT FROM AUTHOR]

Background Cervical cancer remains an important global public health concern. Understanding the factors contributing to a decline in screening uptake in high-income countries is fundamental to improving screening rates. We aimed to identify general practice and patient characteristics related to cervical screening coverage in England between 2013 and 2022. Methods We analyzed a panel of 59 271 General Practice (GP)-years from 7881 GP practices. We applied correlated random effects regression to examine the association between cervical screening uptake and a rich set of GP practice workforce, size, quality and patient characteristics. Results Our results show a decline in overall screening rates from 2013/14 to 2021/22 from 77% to 72%. We find GP workforce and list size characteristics are strongly related to screening rates. An increase in 1 FTE Nurse per 1000 patients is related to a 1.94 percentage point increase in cervical screening rates. GP practices located in more deprived areas have lower screening rates. Conclusions GP workforce and patient characteristics need to be considered by decision-makers to increase screening rates. The implementation of self-sampling screening methods could help address some of the current barriers to screening, including lack of healthcare staff and facilities. [ABSTRACT FROM AUTHOR]

The article discusses the importance of a life course approach in addressing the unmet health needs of women. It emphasizes the need for collaboration among various stakeholders, including men, to achieve maximum impact. The article highlights several studies published in BJOG that explore different aspects of women's health, such as fetal health indicators, prevention of preterm preeclampsia, interventions to reduce neurodisability in preterm infants, prevention of maternal and neonatal sepsis, management of post-partum hemorrhage, and the impact of vulval lichen sclerosis on pregnancy and postpartum. The article also covers topics like uterine transplantation, medical management of missed miscarriage, cost-effectiveness of treatments for pelvic organ prolapse, triage alternatives for cervical cancer screening, the association between paracetamol use and ovarian cancer risk, and the use of artificial intelligence in medical education. The author emphasizes the importance of prioritizing women's health and involving all stakeholders in research and healthcare services. [Extracted from the article]

The article discusses various topics related to obstetrics and gynecology, emphasizing the importance of the principle "first do no harm." It explores controversies surrounding procedures for urinary incontinence and pelvic organ prolapse, as well as the escalating rates of caesarean deliveries globally. The long-term impacts of interventions, such as caesarean deliveries and bariatric surgery, are also examined. Additionally, the article addresses the risks and outcomes associated with the COVID-19 pandemic in relation to pregnancy. The importance of patient-centered care, education, and innovation in improving healthcare outcomes is highlighted. The article concludes by emphasizing the need for evidence-based medicine and research to guide healthcare practices. [Extracted from the article]

Objective Design Setting Population Methods Main outcome measures Results Conclusions To evaluate the sensitivity of human papillomavirus (HPV) tested urine to detect high‐grade cervical precancer (cervical intraepithelial neoplasia grade 2+ [CIN2+]) using two urine collection devices.Randomised controlled trial.St Mary's Hospital, Manchester, UK.Colposcopy attendees with abnormal cervical screening; a total of 480 participants were randomised. Matched urine and cervical samples were available for 235 and 230 participants using a first‐void urine (FVU)‐collection device and standard pot, respectively.Urine was self‐collected and mixed with preservative – randomised 1:1 to FVU‐collection device (Novosanis Colli‐pee® 10 mL with urine conservation medium [UCM]) or standard pot. Matched clinician‐collected cervical samples were taken before colposcopy. HPV testing used Roche cobas® 8800. A questionnaire evaluated urine self‐sampling acceptability.The primary outcome measured sensitivity of HPV‐tested urine (FVU‐collection device and standard pot) for CIN2+ detection. Secondary outcomes compared HPV‐tested cervical and urine samples for CIN2+ and evaluated the acceptability of urine self‐sampling.Urine HPV test sensitivity for CIN2+ was higher with the FVU‐collection device (90.3%, 95% CI 83.7%–94.9%, 112/124) than the standard pot (73.4%, 95% CI 64.7%–80.9%, 91/124, p = 0.0005). The relative sensitivity of FVU‐device‐collected urine was 0.92 (95% CI 0.87–0.97, pMcN = 0.004) compared with cervical, considering that all women were referred after a positive cervical HPV test. Urine‐based sampling was acceptable to colposcopy attendees.Testing of FVU‐device‐collected urine for HPV was superior to standard‐pot‐collected urine in colposcopy attendees and has promising sensitivity for CIN2+ detection. General population HPV testing of FVU‐device‐collected urine will establish its clinical performance and acceptability as an alternative to routine cervical screening. [ABSTRACT FROM AUTHOR]

This article discusses a pilot clinical study that explores the use of measuring human epididymis protein 4 (HE4) alongside CA125 for the diagnosis of ovarian cancer. The study found that elevated levels of HE4 were present in cases of ovarian cancer and other conditions such as hepatic cirrhosis. The authors suggest that further research is needed to determine if measuring both markers can improve the diagnostic performance of the standard pathway for ovarian cancer detection. The study was funded by various organizations and approved by the Cambridge East Research Ethics Committee. [Extracted from the article]

Purpose: The prevalence of germline pathogenic variants (PVs) in homologous recombination repair (HRR) and Lynch syndrome (LS) genes in ovarian cancer (OC) is uncertain., Methods: An observational study reporting the detection rate of germline PVs in HRR and LS genes in all OC cases tested in the North West Genomic Laboratory Hub between September 1996 and May 2024. Effect sizes are reported using odds ratios (ORs) and 95% confidence intervals (95% CI) for unselected cases tested between April 2021 and May 2024 versus 50703 controls from the Breast Cancer Risk after Diagnostic Gene Sequencing study., Results: 2934 women were tested for BRCA1/2 and 433 (14.8%) had a PV. In up to 1572 women tested for PVs in non-BRCA1/2 HRR genes, detection rates were PALB2=0.8%, BRIP1=1.1%, RAD51C=0.4% and RAD51D=0.4%. In 940 unselected cases, BRIP1 (OR=8.7, 95% CI 4.6-15.8) was the third commonest OC predisposition gene followed by RAD51C (OR=8.3, 95% CI 3.1-23.1), RAD51D (OR=6.5, 95% CI 2.1-19.7) and PALB2 (OR=3.9, 95% CI 1.5-10.3). No PVs in LS genes were detected in unselected cases., Conclusions: Panel testing in OC resulted in a detection rate of 2-3% for germline PVs in non-BRCA1/2 HRR genes, with the largest contributor being BRIP1. Screening for LS in unselected cases of OC is unnecessary., (Copyright © 2024. Published by Elsevier Inc.)

Objective: To understand whether self-sampling can reduce carbon emissions (CO 2 e) from the NHS cervical screening programme (NHSCSP) by comparing the carbon footprint of three sampling strategies: routine cervical sampling, vaginal self-sampling and first-void (FV) urine collection., Design: Descriptive study., Setting: National Health Service (NHS), United Kingdom (UK)., Population or Sample: Patients aged 25-64 years eligible for cervical screening in the UK., Methods: A carbon footprint analysis was undertaken for three cervical screening sampling approaches, from point of invitation to screening through to preparation for transport to the laboratory for HPV testing. A combination of primary and secondary data were used, with a bottom-up approach applied to collection of primary data., Main Outcome Measures: We report CO 2 e per sampling approach, which is the unit used to express carbon footprint and harmonise the contributions of greenhouse gases with different global warming potentials., Results: The total carbon footprint of routine cervical sampling is 3670 g CO 2 e. By comparison, vaginal self-sampling had a total carbon footprint of 423 g CO 2 e, and FV urine sampling 570 g CO 2 e. The largest share of emissions for routine sampling was attributable to the carbon footprint associated with an appointment in a primary care setting, which totalled 2768 g CO 2 e., Conclusions: Routine cervical sampling is up to 8.7-fold more carbon-intensive than self-sampling approaches with equivalent effectiveness. We found negligible differences in the carbon footprint of alternative self-sampling methods, supporting the need for an informed choice of screening options for participants, which includes sharing information on their environmental impacts., (© 2023 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.)