Publications by authors named "Trevor Tejada-Berges"

15 Publications

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A prospective controlled study of sexual function and sexually related personal distress up to 12 months after premenopausal risk-reducing bilateral salpingo-oophorectomy.

Menopause 2021 Mar 15. Epub 2021 Mar 15.

School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia Gynaecological Oncology Service, Chris O'Brien Lifehouse, Sydney, Australia Department of Obstetrics and Gynaecology, University of Melbourne and The Royal Women's Hospital, Melbourne, Australia Gynae-oncology and Dysplasia Unit, The Royal Women's Hospital, Melbourne, Australia Basser Center for BRCA, University of Pennsylvania, Philadelphia, PA Prince of Wales Clinical School, University of New South Wales, Sydney, Australia Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, Australia Gynaecology Research Centre, The Royal Women's Hospital, Melbourne, Australia.

Objective: Premenopausal risk-reducing bilateral salpingo-oophorectomy (RRBSO) may impair sexual function, but the nature and degree of impairment and impact of estrogen therapy on sexual function and sexually related personal distress after RRBSO are uncertain.

Methods: Prospective observational study of 73 premenopausal women at elevated risk of ovarian cancer planning RRBSO and 68 premenopausal controls at population risk of ovarian cancer. Participants completed the Female Sexual Function Index and the Female Sexual Distress Scale-Revised. Change from baseline in sexual function following RRBSO was compared with controls at 12 months according to estrogen therapy use.

Results: Baseline sexual function domains did not differ between controls and those who underwent RRBSO and subsequently initiated (56.2%) or did not initiate (43.8%) estrogen therapy. At 12 months, sexual desire and satisfaction were unchanged in the RRBSO group compared with controls. After RRBSO, nonestrogen therapy users demonstrated significant impairment in sexual arousal (β-coefficient (95% confidence interval) -2.53 (-4.86 to -0.19), P < 0.03), lubrication (-3.40 (-5.84 to -0.96), P < 0.006), orgasm (-1.64 (-3.23 to -0.06), P < 0.04), and pain (-2.70 (-4.59 to 0.82), P < 0.005) compared with controls. Although sexually related personal distress may have been more likely after RRBSO, irrespective of estrogen therapy use, there was insufficient data to formally test this effect.

Conclusions: The findings suggest premenopausal RRBSO adversely affects several aspects of sexual function which may be mitigated by the use of estrogen therapy. Further research is needed to understand the effects of RRBSO on sexual function and sexually related personal distress, and the potential for estrogen therapy to mitigate against any adverse effects.
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http://dx.doi.org/10.1097/GME.0000000000001766DOI Listing
March 2021

Assessment of current follow-up for complete molar pregnancies: A single centre review.

Aust N Z J Obstet Gynaecol 2020 Oct 8. Epub 2020 Oct 8.

Department of Gynaecology Oncology, Chris O'Brien Lifehouse, Sydney, Australia.

Background: Current guidelines recommend that resolution of a complete molar pregnancy (CMP) can only be confirmed once a negative β-human chorionic gonadotropin (β-hCG) has been maintained for six months following uterine surgical evacuation. However, multiple studies have found that the risk of developing gestational trophoblastic neoplasia (GTN) once a negative β-hCG had been obtained is negligible, which suggests that a shorter follow-up may be reasonable.

Aim: To determine the trend in β-hCG following diagnosis of a CMP and the incidence of GTN, in a single unit.

Materials And Methods: All patients presenting to the tertiary hospital, Royal Prince Alfred Hospital Early Pregnancy Assessment Service (RPAH EPAS), with a histopathological diagnosis of a CMP between 2010 and 2017 were included. Data collected included age, parity, β-hCG at diagnosis, subsequent β-hCG levels, incidence of GTN and treatment required.

Results: Sixty-seven patients were diagnosed with CMP between January 2010 and July 2017 through RPAH EPAS. The mean age of women diagnosed with a CMP was 33 years. None of the 40 patients who spontaneously achieved a negative β-hCG and completed their six months follow-up had a subsequent rise in β-hCG. The median number of days from surgical evacuation to normalisation of β-hCG was 55.5 days. Sixteen out of 67 patients who had a CMP required further management for persistent GTN. None of these patients achieved a negative β-hCG prior to further management.

Conclusions: Consideration could be made to decreasing the period of β-hCG monitoring for women who achieve a spontaneous negative β-hCG following surgical evacuation of a CMP.
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http://dx.doi.org/10.1111/ajo.13258DOI Listing
October 2020

Endometrial adenocarcinoma arising in a pelvic implant following uterine morcellation: A case report.

Case Rep Womens Health 2020 Apr 18;26:e00174. Epub 2020 Jan 18.

Gynaecological Oncology, Chris O'Brien Lifehouse, Sydney, Australia.

We report a unique case of a 60-year-old woman developing endometrial cancer in a uterine deposit 18 years after she had undergone laparoscopic subtotal hysterectomy with morcellation for benign pathology. She had used unopposed estrogen as menopausal hormone therapy. She presented with a pelvic mass that was causing pressure symptoms. On imaging, the mass had an enhancing vascular nodular component and appeared to abut normal ovaries and the residual cervix. She proceeded to laparotomy, where a 12 cm pelvic mass was found morbidly adherent to the bladder anteriorly and to the cervical stump. The pelvic mass was excised, and trachelectomy and bilateral salpingo-oophorectomy were performed. Adjacent to this mass was a separate, 5 cm adnexal mass, which was also excised. Histopathology of the smaller pelvic mass was consistent with endometrial adenocarcinoma grade 1, arising in complex endometrial hyperplasia with atypia surrounded by myometrium consistent with a uterine implant. This case highlights the need for consideration and discussion of possible risks of subtotal hysterectomy and morcellation of the uterus for benign disease. Furthermore, given the results in this patient, the use of unopposed estrogen in such patients is discouraged due to possible effects on any residual endometrium still present.
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http://dx.doi.org/10.1016/j.crwh.2020.e00174DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7075787PMC
April 2020

Re: Neoadjuvant chemotherapy for advanced ovarian cancer. Who really benefits?

Aust N Z J Obstet Gynaecol 2018 12;58(6):E25-E26

The Sydney Gynaecologic Group, Chris O Brien Lifehouse, Camperdown, New South Wales, Australia.

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http://dx.doi.org/10.1111/ajo.12827DOI Listing
December 2018

Breast Cancer: Genetics and Risk Assessment.

Clin Obstet Gynecol 2016 12;59(4):673-687

Lifehouse Gynaecological Oncology Group, The University of Sydney, Sydney, Australia.

As health care providers, we play a crucial role in the assessment of a patient's risk for hereditary breast cancer syndromes. The panorama of genetic assessment and testing has evolved dramatically since the identification of the BRCA genes. Next-generation sequencing technology has facilitated the development of multigene panels, but 1 consequence has been an increased identification of pathogenic variants at odds with a family history as well as variants of uncertain significance for which treatment guidelines are not defined. Progress in this field requires close collaboration between patients and clinicians with a thorough understanding in cancer genetics.
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http://dx.doi.org/10.1097/GRF.0000000000000236DOI Listing
December 2016

HE4, CA125, the Risk of Malignancy Algorithm and the Risk of Malignancy Index and complex pelvic masses - a prospective comparison in the pre-operative evaluation of pelvic masses in an Australian population.

Aust N Z J Obstet Gynaecol 2015 Oct 14;55(5):493-7. Epub 2015 Jul 14.

Lifehouse Gynaecology Oncology Group, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia.

Background: Human epididymis protein 4 (HE4) has been proposed as a novel biomarker for the diagnosis of epithelial ovarian cancer. Using HE4 and CA125, the risk of malignancy algorithm (ROMA) has been shown to be effective in the stratification of epithelial ovarian cancer risk.

Aims: To determine the effectiveness of HE4 and ROMA in the diagnosis of malignancy of women presenting with a complex pelvic mass in an Australian population and to compare it with CA125 and the risk of malignancy index (RMI).

Materials And Methods: Prospective recruitment of women was conducted between October 2012 and March 2014 (n = 50). CA125 and HE4 serum concentrations were collected and stored for subsequent analysis. Sensitivities, specificities, positive predictive values (PPV) and negative predictive values (NPV) were calculated for HE4, CA125, ROMA and the RMI. Receiver operating characteristic (ROC) area under the curves (AUC) were also calculated for comparison.

Results: There was a higher HE4 level in women with ovarian cancer compared with women with benign pathology (P = 0.008), and this observation was seen in benign versus stage 1 ovarian cancer women (P = 0.025). HE4 had a better specificity than CA125 for the diagnosis of ovarian cancer in all women (P = 0.022), and this effect was also observed in premenopausal women (P = 0.012). Furthermore, the ROC-AUC for HE4 was superior than CA125 in all women (P = 0.0451). The ROMA algorithm was not inferior to the RMI calculation in this population.

Conclusions: In an Australian population, HE4 and ROMA are useful in the diagnosis of epithelial ovarian cancer.
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http://dx.doi.org/10.1111/ajo.12363DOI Listing
October 2015

Cervical cancer prevention: Asian-American women's knowledge and participation in screening practices.

Womens Health Issues 2014 Mar-Apr;24(2):e231-6. Epub 2014 Feb 16.

Massachusetts General Hospital Cancer Center, Boston, Massachusetts.

Objective: The purpose of this study was to compare cervical cancer knowledge and prevention strategy participation among Chinese-American women compared with Southeast-Asian-American women.

Methods: We performed a cross-sectional survey of Chinese and Southeast Asian women in Rhode Island. Anonymous surveys were administered following informed consent. The survey included demographics and questions related to health care practices, cervical cancer, and the human papilloma virus (HPV). Categorical variables were compared by Fisher's exact test. Mean scores of correct answers on the knowledge questions were compared by Student's t-test and analysis of variance.

Results: Ninety-six Chinese women and 132 Southeast Asian women were included in the analysis. Sixty-seven percent of Chinese women had at least a college education compared with 37% of Southeast Asian women (p < .0001). Nineteen percent of Chinese women reported annual household incomes of greater than $100,000 compared with 3% of Southeast Asian women (p = .0003). Twenty percent of Southeast Asian women did not have health insurance compared with 10% of Chinese women (p = .06). Among both groups, 25% of participants either never had a pap test or did not know if they ever had a pap test. There was a greater lack of knowledge about the relationship between HPV and cervical cancer among Chinese (mean 2.9 out of 8 questions) compared with Southeast Asian (mean 3.6 out of 8 questions; p = .02).

Conclusions: Regardless of ethnic subgroup, education, or income, all participants had a poor knowledge of cervical cancer and HPV. This study supports the need for improvement in cervical cancer prevention education among all Asian women.
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http://dx.doi.org/10.1016/j.whi.2013.12.005DOI Listing
June 2014

Endometrial carcinomas with significant mucinous differentiation associated with higher frequency of k-ras mutations: a morphologic and molecular correlation study.

Int J Gynecol Cancer 2013 Sep;23(7):1231-6

Department of Pathology, Women & Infants Hospital of Rhode Island, Brown University, Providence, RI 02905, USA.

Objectives: K-ras gene product in the mitogen-activated protein kinase/extracellular signal-regulated kinase pathway is critical in the development of certain types of malignancies. K-ras mutation-associated pancreatic and ovarian carcinomas often display mucinous differentiation. Previous studies have shown that k-ras mutation is found in 10% to 30% of endometrial carcinomas. We investigated k-ras mutations in several morphologic subtypes of endometrial carcinomas with particular emphasis on various degrees of mucinous differentiation.

Methods: Genomic DNA was extracted from formalin-fixed paraffin-embedded (FFPE) tissue sections. Polymerase chain reaction amplification for k-ras codons 12 and 13 were performed, followed by sequencing using capillary electrophoresis. The Fisher exact test is used to compare the prevalent difference of k-ras mutation among the groups. P < 0.05 was considered significant.

Results: K-ras mutations were detected in 8 (80%) of 10 mucinous carcinomas, 12 (67%) of 18 endometrioid carcinomas (ECs) with significant mucinous differentiation (ECMD), 4 (25%) of 16 ECs, and 1 (9%) of 11 serous carcinomas. The differences were statistically significant between mucinous carcinomas versus EC (P < 0.01) and ECMD versus EC (P < 0.05).

Conclusion: The findings suggest that mucinous carcinoma and endometrioid carcinoma with significant mucinous component are more likely to be associated with k-ras mutation. Potential clinical implications of k-ras mutation lies in the management of recurrent or higher-stage endometrial mucinous tumors, which would not be responsive to treatment protocols containing epidermal growth factor receptor inhibitors.
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http://dx.doi.org/10.1097/IGC.0b013e31829ea82fDOI Listing
September 2013

Necrotizing infection of the breast after core needle biopsy.

Breast J 2013 Mar-Apr;19(2):201-2. Epub 2013 Jan 7.

Department of Obstetrics & Gynecology, Women and Infants' Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island 02905, USA.

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http://dx.doi.org/10.1111/tbj.12088DOI Listing
September 2013

Premalignant lesions: diagnosis, evaluation, and management.

Clin Obstet Gynecol 2011 Mar;54(1):133-40

The Warren Alpert School of Medicine of Brown University, Department of Obstetrics and Gynecology, Program in Women's Oncology, Women and Infants' Hospital, Providence, Rhode Island, USA.

Acceptance and incorporation of widespread mammographic screening has led to an increase in the incidence of detection of "premalignant" breast lesions. Despite advances in our understanding of these diseases, their actual malignant potential remains somewhat unpredictable. Best current management of these diseases requires a multidisciplinary, coordinated approach between the disciplines of breast surgery, radiology, pathology, medical oncology, and radiation oncology at a minimum. Although this strategy has led to excellent outcomes, future advances in our understanding of the biologic determinants and behavior of these diseases will hopefully result in a more accurate assessment of the risk of progression to invasive breast cancer and allow us to individualize treatment more effectively.
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http://dx.doi.org/10.1097/GRF.0b013e31820837d1DOI Listing
March 2011

Clinical characteristics and choices regarding risk-reducing surgery in BRCA mutation carriers.

Gynecol Obstet Invest 2010 21;69(4):270-3. Epub 2010 Jan 21.

Cancer Risk and Prevention Program and The Breast Health Center Program in Women's Oncology, The Warren Alpert Medical School of Brown University, Providence, R.I., USA.

Background/aims: BRCA mutation carriers have a high lifetime risk of developing breast and ovarian malignancies. As genetic testing becomes widely available, preventative measures are a choice. We evaluated the characteristics of BRCA mutation carriers who chose prophylactic surgery (PS) compared to those who opted for surveillance.

Methods: A retrospective chart review of patients with a mutation in the BRCA1 or BRCA2 genes was performed.

Results: Ninety women were included, of whom 46 (51%) underwent PS. They were more likely to be a BRCA2 mutation carrier, parous, married, employed, and had a prior history of breast cancer. PS included 39 bilateral salpingo-oophorectomies and 13 mastectomies. Pathology was typically benign; however, 15% showed ductal carcinoma in situ of the breast, 8% reported infiltrating ductal carcinoma of the breast, 3% was adenocarcinoma of the fallopian tube, and 3% was adenocarcinoma of the ovary.

Conclusion: It is notable that BRCA1 mutation carriers were less inclined to elect for PS. Evaluating the reasons for pursuing PS among women with a BRCA mutation is necessary and will require a larger data set. Long-term follow-up is required to describe the potential side effects of PS on quality of life.
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http://dx.doi.org/10.1159/000276573DOI Listing
September 2010

Ovarian cancer associated with testosterone supplementation in a female-to-male transsexual patient.

Gynecol Obstet Invest 2006 23;62(4):226-8. Epub 2006 Jun 23.

Program in Women's Oncology, Department of Obstetrics & Gynecology, Brown Medical School, Providence, RI 02905, USA.

Ovarian cancer is the most fatal gynecologic malignancy. Women often present late and though median survival has improved, a majority of women will succumb to their disease. The incidence of ovarian cancer among female-to-male transsexuals is not known. We report only the second case of ovarian cancer in a female-to-male transsexual while on androgen supplementation therapy. Staining of his tumor for androgen receptors showed abundant expression. Androgen supplementation in this population may be associated with an increased risk of both ovarian cancer and of endometrial cancer. Consideration for bilateral salpingo-oophorectomy as part of gender reassignment surgery should be given, especially in this poorly studied group of patients whose overall risk of ovarian cancer remains unknown.
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http://dx.doi.org/10.1159/000094097DOI Listing
February 2007

Two for good measure: six versus eight cycles of carboplatin and paclitaxel as adjuvant treatment for epithelial ovarian cancer.

Gynecol Oncol 2006 Feb 5;100(2):417-21. Epub 2005 Dec 5.

Program in Women's Oncology, Women and Infants' Hospital, 101 Dudley Street, Providence, RI 02905, USA.

Introduction: Although the standard of care for advanced epithelial ovarian cancer (EOC) is six cycles (6C) of platinum-taxane (PT), there have been no studies on the optimal duration of treatment in the era of adjuvant taxanes. At our center, some women receive eight cycles (8C) of PT, based on physician judgment. We were interested in evaluating the outcomes of women treated with 8C of PT for EOC as compared to a cohort who received 6C.

Methods: We retrospectively identified women with Stage III or IV EOC between 1998 and 2003 who received 6C or 8C of PT. The endpoints were disease-free (DFS) and overall survival (OS). CA-125 response was defined as a decrease in CA-125 of 50% in four serial samples or of 75% over three samples.

Results: One hundred and twenty-two women met criteria for inclusion; 84 received 6C, and 38 received 8C. Comparing the cohorts receiving 6C versus 8C, 71% versus 26% were optimally debulked (P < 0.01). 79 patients were evaluable by CA-125 (52 6C/27 8C), and all responded. 88% receiving 6C and 81% receiving 8C normalized their CA-125 at end of treatment (P = 0.20). The proportion with a normal CA-125 at Cycle 2 was 29% versus 12%, respectively (P = 0.15) and, at Cycle 4, was 88% versus 36%, respectively (P < 0.01). DFS was 13 months with 6C and 8 months with 8C (P = 0.01). OS was 31 versus 23.5 months (P = 0.02), respectively. When the survival analysis is restricted to suboptimal debulked patients only, the DFS is 12.5 versus 8 months (P = 0.02), and OS is 32 versus 26.5 months (P = 0.15), respectively.

Conclusions: Two further cycles of PT did not improve DFS or OS for patients with advanced EOC. Patients who do not achieve remission after 6C are unlikely to benefit from additional chemotherapy using the same agents and should be considered for clinical trials involving novel agents with different mechanisms of action.
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http://dx.doi.org/10.1016/j.ygyno.2005.10.031DOI Listing
February 2006