Protecting Fertility While Treating Gynecologic Cancers: Advances in Precision Medicine

For many years, treatments for gynecologic cancers such as cervical, ovarian, and endometrial cancers relied heavily on aggressive surgery and chemotherapy. While effective against cancer, these methods often compromised fertility and brought significant side effects, leading to uncertain outcomes for many young women. However, recent developments in genetic testing and precision medicine are transforming the landscape of gynecologic cancer care, enabling more personalized and fertility-preserving options.

Genetic testing plays a crucial role in modern cancer management by allowing precise treatment plans, assessing recurrence risks, and most importantly for young women, preserving reproductive abilities. Experts such as Professor Wu Xiaohua from Fudan University and Professor Du Bin from Shanghai First Maternity and Infant Hospital emphasize the importance of incorporating genetic insights into clinical decision-making.

The threat posed by gynecologic cancers continues to grow globally, with 1.47 million new cases and over 680,000 deaths reported in 2022. Cervical cancer remains the deadliest, especially in regions with limited health resources. While survival rates for some cancers like ovarian cancer have improved—rising from 36% in 1975 to 51% in 2019—others, such as endometrial cancer, have seen worsening outcomes. Early diagnosis remains critical, but the subtle symptoms often lead to delays, as seen in cases like a young woman diagnosed late after experiencing abdominal pain since high school.

Fertility-sparing surgery has made significant strides. In 2006, Professor Wu and his team performed one of China's first abdominal radical trachelectomies, allowing women to retain their uterus after cancer removal. The development of the 'Fudan Standard' in 2011 further expanded eligibility criteria, enabling more women with tumors up to 4 cm to undergo fertility-preserving procedures with minimal risks. Enhanced techniques introduced in 2015 allow surgeons to assess tumor margins accurately during surgery, drastically reducing recurrence rates.

Prevention through genetic screening remains a cornerstone of reducing gynecologic cancer burden. In 2016, Prof. Wu's team conducted China's first multi-center study on BRCA1/2 mutation rates, revealing that 28.5% of ovarian cancer patients carried these mutations. This discovery has paved the way for personalized risk assessments and targeted therapies, ultimately improving patient outcomes.

Gene testing technology has also been instrumental in refining diagnosis and treatment strategies for endometrial and other cancers. Prof. Du highlights that molecular subtyping enables clinicians to tailor treatments more effectively, moving away from one-size-fits-all approaches and toward truly personalized care. These advances not only improve survival but also enhance quality of life for women battling gynecologic cancers.

In conclusion, the integration of genetics and precision medicine is revolutionizing gynecologic cancer treatment, offering hope for better outcomes, preserved fertility, and more individualized care for women worldwide.