[Prevention of cervical and endometrial cancer: role of surgery]

Epidemiology and natural history of cervical and endometrial carcinomas are not identical. So, the part of surgery in their prevention is different. For cervical carcinoma, mass screening and prevention allowed reduction of rates of incidence and mortality. Surgery concerns such intra-epithelial neoplasias. All the procedures, either destructive, either ablative, expose to failures as recurrence of intra-epithelial neoplasia and more as invasive carcinoma. For high grade epidermoid intra-epithelial neoplasia, conisation is the best of ablative procedures to set up an accurate pathologic diagnosis and consequently to determine adequate therapy: conservative by conisation, total hysterectomy or extended hysterectomy and lymphadenectomy. For in situ adenocarcinoma, removal of the whole cervix or total hysterectomy appears in numerous circumstances more safety. For endometrial carcinoma, there is no efficacious screening nor secondary prevention procedure available. Natural history, specially pre-invasive disease, is not well known. Atypical hyperplasia is a real pre-invasive disease and evolve to invasive carcinoma in 25%, and no more than 25% of this lesions regress under progestative therapy. Destructive procedures, biopsy-curettage and even endometrectomy under hysteroscopy don't realise and efficacious treatment of atypical hyperplasia and prevention of carcinoma. Total hysterectomy is the only one true prevention of endometrial carcinoma after failure of progestative therapy for patients who desire be pregnant, in first place for women who don't.