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Fertility-conserving surgery safe for early cervical cancer

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – In young women with stage IA1 cervical cancer, a fertility-preserving conization does not reduce survival compared to hysterectomy, researchers report in the March Obstetrics and Gynecology.

With either procedure, 5-year survival is excellent, approaching 100%, the findings indicate.

Small series and case control studies have suggested that conization is safe, but large studies comparing conization and hysterectomy for stage IA1 cervical cancer have been lacking until now, according to lead author Dr. Jason D. Wright, from Columbia University College of Physician and Surgeons, New York, and colleagues.

For the current analysis, the researchers used data from the Surveillance, Epidemiology, and End Results database from 1988 to 2005. They identified 1409 women, age 40 or younger, with stage IA1 cervical cancer; 841 had hysterectomy and 568 underwent conization.

On logistic regression analysis, predictors of conization included Asian ethnicity, single status, diagnosis later in the study period, and residence in the eastern United States. In addition, women younger than 30 had a 78% higher likelihood of conization compared to women above 35.

At 5 years, 98% of those treated with conization and 99% treated with hysterectomy were alive.

“Our study suggests that fertility-conserving surgery is safe for young women with stage IA1 squamous cell carcinoma of the cervix,” the authors conclude. “Young women with microinvasive cervical tumors should weigh the risks and benefits of conization in the context of individual preferences and tumor characteristics.”

Reference:

Obstet Gynecol 2010;115:585-590.