Toward Precision Medicine in Gynecology and Obstetrics

Abstract

This chapter is an introduction to the contents of this book on precision medicine in gynecology and obstetrics, describing “where are we now, and where should we go” with regard to evidence-based medicine (EBM). At the end of the twentieth century, we faced a drastic change in clinical medicine, i.e., a big wave of EBM which was the application of epidemiology to clinical decision making. Standard treatment under the guidelines based on epidemiologic evidence is very useful in our daily clinical practice. Such treatment is appropriate for more than half of patients, but it may not benefit the remaining patients owing to the heterogeneity of disease. However, recent advances in medical technologies is clearly disclosing the diversity of disease with regard to the differences in genome, epigenome, and expression profiling. Medical treatment has been personalized according to the specific, genomic nature of the patient. Thus, the second big wave of EBM, which is genome-based personalized medicine, started at the beginning of the twenty-first century and is now expanding as “precision medicine”. Here we see the current and future perspectives on precision medicine in gynecology and obstetrics, namely, genome evidence-based personalized medicine, clinical practice, and decision making.