TAILIEUCHUNG - Kaiser Permanente Medicine 50 Years Ago: The Gynecological Cancer Detection Clinic

Temporal trends in unsafe abortion have been inconsistent internationally (figure 2). Between 1995 and 2000, a decline of 5 or more percentage points took place in the unsafe abortion rate in eastern, middle, and western Africa, the Caribbean, and Central America. Other developing areas had no appreciable change in the rate of unsafe abortion. 6 Unsafe abortions vary substantially by age across regions: adolescents (15–19 years) account for 25% of all unsafe abortions in Africa, whereas the percentage in Asia, Latin America, and the Caribbean is much lower (figure 3). By contrast, 42% and 33% of all unsafe abortions in Asia and. | By Wilson Footer MD Commentary by Steven A. Vasilev MD MBA Kaiser Permanente Medicine 50 Years Ago The Gynecological Cancer Detection Clinic From the Department of Obstetrics and Gynecology Permanente Hospitals Oakland and Richmond California. Reprinted from the Permanente Foundation Medical Bulletin. 1944 Oct 2 4 165-74. The greatest problem with which we are confronted in the practice of gynecology is startlingly evident from the fact that among white women cancer is the leading cause of death by a considerable margin for the 20-year period from 35-54 years of age. A study of the current statistics indicates that if present conditions of mortality remain unchanged cancer will take as its toll by death 14 out of every 100 women. 1 If we had no means of attacking this scourge it would be discouraging enough to know as a certainty that 14 percent or one in every seven of the women in the prime of life are going to die from this disease. The fact that this situation persists in spite of knowledge that we can cure 96 of certain very malignant tumors specifically those of the cervix is the greatest condemnation of the present lay and professional handling of cancer. Bowen2 reported two cases of precancerous dermatoses that had been present 19 and four years without becoming invasive but which showed the cytological changes found in undoubted cancers. Although the illustrations of his second case have been used to demonstrate what is now called Bowen s disease the lesion had not become invasive. In fact Bowen credited Wende3 with demonstrating what had been suspected by others namely that these intraepithelial changes could progress to true malignancy. Schottlander and Kermauner4 have been credited with observing the presence of carcinoma confined to the squamous epithelium at the periphery of invasive carcinoma of the cervix. Since then Schiller5 6 7 8 has repeatedly emphasized that carcinoma of the cervix can be diagnosed before invasion occurs and has introduced the

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