Why American women are not receiving state-of-the-art gynecologic cancer care.

American women are not receiving state-of-the-art gynecologic cancer care. The three most common gynecologic cancers-endometrial, ovarian, and cervical-are quite uncommon in the United States when compared with othermalignancies. Nevertheless, their importance is clearly out of proportion to their incidence since the annual death rate from ovarian cancer alone is about one third that of breast cancer. And cervical cancer is a very common malignancy of women worldwide. The major problem accounting for suboptimal treatment of ovarian and endometrial cancers in the United States is incomplete surgical staging performed by nongynecologic oncologists. In the case of cervical cancer treatment, suboptimal care is attributable to specialty territoriality and the lack of randomized data. Factors influencing substandard gynecologic cancer for American women include the following: (1) the unregulated nature of the American health care system, (2) failure of professional education related to training in surgical principles and techniques and referral practices, (3) inadequate interactions between subspecialists and referring physicians, (4) disincentives for physicians to refer patients out of managed care networks or group practices, (5) disagreements between clinicians representing competing disciplines, and (6) conflicts of interest on the part of academic physicians or cooperative groups. Recommended initiatives include the following: (1) embracingthe quality of patient care as the overarching principle; (2) designing clinical trials that lead to advances in patient outcomes; (3) emphasizing public education (direct consumer information) as well as professional education; (4) partnering with local, state, and national patient advocacy groups to ensure optimal treatment for gynecologic cancers; (5) implementing practice guidelines; (6) developing referral guidelines; (7) improving communication skills of academic physicians in relating to referring physicians; (8) continuing to conduct and publish outcomes studies; and (9) establishing centers of excellence. It is time to make a commitment to substantially improving gynecologic cancer care for American women, and, I believe, the proposed initiatives will begin to accomplish this essential goal.