Gestational trophoblastic disease epidemiology and trends

Worldwide, GTD continues to be a significant reproductive health problem. Unfortunately, most of the early epidemiological data has been reported from developing regions of the world with less access to proper diagnostic tools, and where ideal therapy is not available. Nevertheless, newer epidemiological studies continue to report higher rates of HM and CC in women of Asian descent, and in American Indians, although rates are declining in all regions of the world. Maternal age, previous HM, race and geographical region have been identified as clear risk factors for GTD. Although potential etiological factors have been reported, a definitive cause has not yet been found. Probably, exposure to risk factors and intrinsic defects in gametogenesis and fertilization both contribute. Characterization of types of GTD into specific histologic subsets will enhance the investigation of potential risk factors. For future studies to effectively address environmental and genetic factors across continents and cultures, accurate reproductive denominators, use of a standardized classification system, and use of the same technology to define index cases are essential. The malignant potential of cases identified using these newer technologies also requires further investigation; until then, however, followup of these cases is prudent.