Young Adults With Cervical Cancer Can Follow Tailored Surveillance Strategies
Some young adult patients who receive fertility-sparing surgery for early-stage cervical cancer may be able to extend their follow-up intervals to 6 or even 12 months, researchers reported (https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(23)00467-9/fulltext) in study results published in Lancet Oncology.
Using data from the Netherlands Cancer Registry and Dutch Nationwide Pathology Databank, researchers conducted a population-based, retrospective cohort study of 1,462 patients aged 18–40 with cervical cancer who were treated with fertility-sparing surgery from 2000–2020. They analyzed 19,568 pathology reports from initial diagnosis, treatment, and follow-up to identify the cumulative incidence of recurrent cervical intraepithelial neoplasia grade 2 or worse (CIN2+) and recurrence-free survival, overall and stratified by results for cytology and high-risk human papillomavirus (HPV).
After a median follow-up of 6.1 years, the cumulative CIN2+ recurrence rate was 15% (n = 128), researchers identified a cumulative cervical cancer recurrence rate of 5.4% (n = 52) and overall 10-year recurrence-free CIN2+ survival at 89.3%. At one-year follow-up, they found that the 10-year recurrence-free survival was 92.1% for normal cytology, 84.6% for low-grade cytology, and 43.1% for high-grade cytology and that patients positive for high-risk HPV had a lower recurrence-free survival (73.6%) than patients who were negative (91.1%).
“Patients who are negative for high-risk HPV with normal or low-grade cytology at 6–24 months after fertility-sparing surgery could be offered a prolonged follow-up interval of 6 months,” the researchers concluded. They added that a 12-month follow-up period could be appropriate if a patient has two consecutive negative tests for high-risk HPV without high-grade cytology.
HPV infection is a major risk factor for cervical and other cancers, but vaccination can prevent more than 90% (https://www.cdc.gov/hpv/hcp/protecting-patients.html#:~:text=HPV%20vaccination%20could%20prevent%20more,the%20United%20States%20every%20year.&text=Cervical%20cancer%20is%20the%20only,detection%20at%20an%20early%20stage.) of those cancers from ever developing. Join ONS in supporting legislation (https://www.ons.org/sites/default/files/2021-07/HPV%20Legislation.pdf) to provide funding and raise awareness (https://voice.ons.org/advocacy/us-representatives-introduce-hpv-cancer-prevention-legislation) for HPV vaccination.