Centre François Baclesse

The impact of HPV vaccination on cervical cancer and condylomas is well-established, but its effectiveness against high grade vulvar and vaginal lesions (VIN/VaIN) and related cancers remains less clear due to their rarity. This systematic review assessed the efficacy of quadrivalent (qHPV) and 9-valent (9vHPV) vaccines in both primary and tertiary prevention of these conditions. Eleven studies met the inclusion criteria. qHPV showed 100% efficacy against HPV16/18-related VIN/VaIN and cancers in per-protocol populations, with reduced but still significant efficacy (71%) in intention-to- treat analyses. The 9vHPV vaccine further reduced risks associated with additional HPV types (31/33/45/52/58). Real-life data revealed decreased incidence of vulvar and vaginal cancers following vaccination, particularly among younger women. While vaccination appeared to reduce recurrence rates after initial treatment of HPV-related lesions, randomized trials have not confirmed a clear adjuvant benefit. Overall, HPV vaccination proves highly effective in preventing vulvar and vaginal disease, especially when administered before HPV exposure.PROSPERO number: CRD420250638054.

Women carrying a germline BRCA1 or BRCA2 mutation (gBRCAm) have a 70 % lifetime risk of breast cancer (BC). Aromatase inhibitors (AI) decrease BC incidence in high-risk populations but have not been specifically assessed in gBRCAm carriers.

LIBER was a randomized, double-blind, placebo-controlled, phase III trial. Post-menopausal women aged between 40 and 70 years carrying a gBRCAm were randomly allocated either 5 years of letrozole (2.5 mg/day) or placebo. Women with prior BC in remission for more than 5 years ago were eligible to assess the risk of second BC. Randomization was stratified by type of gBRCAm (BRCA1 versus BRCA2), previous bilateral oophorectomy, and prior BC. The primary endpoint was the 5-year incidence of invasive BC. Safety and quality of life were analyzed.

Between 2008 and 2013, 170 women were randomized: 86 to placebo and 84 to letrozole. At 5 years, treatment adherence was 73.5 % with placebo and 76.7 % with letrozole. After a median follow-up of 72.7 months (95 % CI 71.5-78.5), the 5-year incidence of invasive BC was 13.1 % with placebo and 7.8 % with letrozole: hazard ratio, 0.70 (95 % CI 0.29-1.66), p = 0.416. Safety events and quality of life did not statistically differ in the arm.

Due to the underpowered nature of the trial and the observed trend, it cannot be ruled out that using AI to prevent invasive breast cancer could be effective for BRCA1/2 carriers overall, or for specific subgroups within a larger sample size. Further randomised controlled trials are needed to determine the potential benefits of AI for gBRCA1/2m carriers.

The European Society of Gynaecological Oncology has updated its Curriculum for sub-specialty training in gynecological oncology. This update aligns with the European Training Requirements, which are defined by the European Union of Medical Specialists to harmonize post-graduate medical education across Europe and ensure alignment with the core training framework of the European Board and College of Obstetrics and Gynaecology. Recognized by these key European umbrella organizations (including European Union of Medical Specialists and European Board and College of Obstetrics and Gynaecology) this revised curriculum is consensus-based, competence-oriented, and provides validated tools for systematic and structured assessment of trainee progress. Reflecting the realities of clinical practice, the modular structure enables individualized training pathways, including special-interest modules such as Diagnostic and Interventional Ultrasound. A new Women's Health module has been introduced to address evolving priorities in gynecologic oncology. The updated European Society of Gynaecological Oncology Curriculum sets the benchmark for structured, flexible, and high-quality training in gynecological oncology, supporting harmonization of education and mobility of specialists across Europe.