Experts interview: safeguarding fertility in the battle against gynecologic cancer

For decades, gynecologic cancer treatment has used aggressive surgical intervention and chemotherapy. These methods often harmed fertility. They also caused severe side effects and an uncertain prognosis.

Cancer genetic testing has transformed cancer care by enabling precise treatment, predicting recurrence risk, and preserving fertility, once impossible for young patients.

To explore how genetic testing guides precision medicine for both gynecologic cancer patients and clinicians, we spoke with two leading experts: Professor Wu Xiaohua, Professor of Medical Oncology at Fudan University's Obstetrics and Gynecology Hospital, and Professor Du Bin, Chief of Pathology at Shanghai First Maternity and Infant Hospital.

Rising Threat of Gynecologic Cancers

Gynecologic cancers—cervical, endometrial, and ovarian—pose a growing threat to women's health worldwide. In 2022 alone, these diseases led to 1.47 million new cases and over 680,000 deaths, according to a 2024 Journal of Global Health study. Cervical cancer remains the deadliest, particularly in regions with high HIV rates and limited access to screening.

While some cancers have shown improved outcomes—ovarian cancer survival rose from 36% in 1975 to 51% in 2019—others like endometrial cancer have seen declining survival and rising mortality, as shown in a study published in CA: A Cancer Journal for Clinicians.

Gynecologic cancers are often mistaken for other conditions, such as period cramps or bleeding. Prof. Wu recalls a 29-year-old patient who was diagnosed too late,  "She had developed an abdominal mass since experiencing stomach pain in high school. During surgery, we found widespread tumors. With profound regret, we performed a complete resection."

Ovarian cancer is highly occult, as Prof. Wu explained, "Seventy percent of ovarian cancer patients are diagnosed at an advanced stage. Of these, seventy percent relapse within 2–3 years, and seventy percent do not survive beyond five years."

Protecting Fertility Rights

For generations, treating cervical cancer meant sacrificing fertility—a devastating consequence for young women. In 2006, Professor Wu Xiaohua and his team performed one of China's first abdominal radical trachelectomies (ART), a procedure that removes cancerous tissue while preserving the uterus. Their patient later gave birth, marking a milestone in fertility-sparing surgery.

Then, in 2011, a breakthrough emerged: the "Fudan Standard." Developed by Prof. Wu and his multidisciplinary team at Fudan University Shanghai Cancer Center, this pioneering medical guideline transformed treatment for young cervical cancer patients. Previously, fertility-sparing surgery was limited to tumors under 2 cm. The Fudan Standard safely expanded eligibility to tumors up to 4 cm, doubling the percentage of eligible women under 45 (from 18% to 36%) while slashing recurrence rates from 12% to just 2%.

The innovation gained further traction in 2015 when Wu's team introduced a technique to enhance tumor margin assessment during ART. Published in the European Journal of Cancer, this advancement allowed surgeons to make real-time decisions, minimizing the need for additional procedures. Remarkably, none of the patients treated with this method experienced recurrence, confirming its long-term safety and efficacy.

Today, the fight against gynecologic cancers increasingly hinges on integrating genetics and precision diagnostics, with tools like tumor gene testing refining treatment strategies and safeguarding patients' quality of life.

Prevention Over Treatment

Genetic Testing for Preventive Screening and Precision Medicine is as vital as surgery in Gynecologic Cancer Care. "Prevention is better than treatment—this is a fundamental principle," Prof. Wu emphasizes.

Guided by this philosophy, as early as 2016, he collaborated with BGI Genomics to conduct China's first multi-center study on BRCA1/2 mutation rates in ovarian cancer, analyzing data from 826 patients across Sichuan, Guangdong, Shanghai, Shandong, Beijing, and other regions.

The groundbreaking findings revealed that 28.5% of ovarian cancer patients carried BRCA mutations—a discovery that opened new avenues for precision diagnosis and treatment. "We overcame significant challenges to establish China's first BRCA mutation database for ovarian cancer patients," Prof. Wu noted.

Subsequently, the prospective study on the relationship between Homologous recombination deficiency (HRD) status and platinum-based chemotherapy response in ovarian cancer has help build the foundation for many subsequent research. He highlighted BGI Genomics' cutting-edge genetic sequencing technology as instrumental has bridging clinical practice and genomics research.

Precision Medicine Improves Outcome

Gene testing technology has now been widely applied in the diagnosis of various cancers and other diseases. According to Prof. Du Bin, Chief of Pathology at Shanghai First Maternity and Infant Hospital, with the advancement of oncology, clinical tumor diagnosis demands increasingly higher pathological standards. Tumor genetic testing has become one of the essential tools to meet these requirements and serves as a crucial component of precision medicine.

"Modern cancer care demands highly precise diagnostics, and tumor gene testing is a critical weapon in our arsenal," he states.

Using endometrial cancer as an example, Prof. Du explains how molecular subtyping has transformed treatment approaches. Back in the days with the absence of molecular classification, all patients may be treated in the same way, which lead to varies treatment outcomes.

"Genetic testing reveals a tumor's DNA profile, enabling precision treatment—a major advance over conventional cancer therapy that benefits both doctors and patients," said Prof. Du, "With these advanced tools, we can now perform highly accurate genetic testing to improve treatment outcome."

As genetic testing becomes integral to oncology, its applications continue to expand, guiding therapy selection, improving survival rates, and reducing patient suffering. For doctors like Prof. Wu and Prof. Du, it represents not just scientific progress, but hope for countless patients battling cancer. Their works have helped women with ovarian, cervical, and endometrial cancers to get more personalized and suitable treatment, proving that cutting-edge science can coexist with compassionate care.

About BGI Genomics

BGI Genomics, headquartered in Shenzhen, China, is the world's leading integrated solutions provider of precision medicine. Our services cover more than 100 countries and regions, involving more than 2,300 medical institutions. In July 2017, as a subsidiary of BGI Group, BGI Genomics (300676.SZ) was officially listed on the Shenzhen Stock Exchange.