While earlier diagnosis and better treatment have produced improved results in gynecologic cancer, diagnostic techniques and therapeutic regimens should be evaluated not just by tumor remissions or five-year cures but also by whether simpler methods might be equally effective, at lower cost, with less disability, with a shorter hospital stay, and with less disturbance to the patient and her family. The objectives of treatment should be to achieve the maximum in tumor cure with the lowest level of complications. Because of deaths from injuries related to overtreatment, less invasive and less toxic therapy may at times prove more effective than more radical treatment.
Cancer 48:642-649, 1981.
EA.I'HS FROM
~K are being reduced by earlier diagnosis and more effective treatment. The FIG0 annual reports on the results of the treatment of gynecologic cancer over the past 20 years tend to show more cases in the earlier stages and slightly improved results of treatment in each stage (Fig. 1).
Certain countries and institutions have done better than others. For example, the five-year cure rates in cervical cancer in three countries are shown in Table 1 . This could, perhaps, be related to some unrecognized racial differences, a more effective health system with earlier diagnoses, or some statistical legerdemain. It could also be related to treatment programs with better benefit-risk ratios, resulting in less injuries and deaths and higher cure rates.
Having worked in various clinics in countries A, B, andC, what 1 saw led me to believe that the better benefit-risk ratio was at least in part responsible. Radical surgery was not ordinarily done as a routine or in randomized series but was limited to cases where the benefit-risk ratios favored the patient. "Remission rates" from randomized trials of various chemotherapeutic combinations were less popular end points of treatment. Radiation therapy did not have as its sole objec-