Incidence of subsequent abnormal cytology in cervical cancer patients completing five-years of post treatment surveillance without evidence of recurrence

ObjectiveTo determine the incidence of subsequent abnormal cervical or vaginal cytology and confirmatory histology in women completing five-years of surveillance for cervical cancer without recurrence.MethodsFollowing IRB approval, a tumor registry database identified women managed for all stages of cervical cancer from 1990 to 2003 who after completion of 60 months of active surveillance following primary therapy underwent continued vaginal or cervical cytologic surveillance. Retrospective review was performed to determine demographics, clinicopathologic variables, vaginal or cervical cytology and outcomes.ResultsSixty-one women were identified with a median age at diagnosis of 41 (range 23–81). 72% of women were Caucasian, 16% were African–American with the remainder primarily Asian. Squamous cell carcinoma was the most common histology and present in 47 women (77%) with an equal proportion of women having G1 and G2 tumors. 80% of patients had early stage disease (Stages IA1–IIA). Median follow-up after completing five-years of active surveillance for all patients was 143 months and a total of 303 Pap tests were performed with the mean/median number of five cytologic evaluations per patient. A total of 17 (5.6%) [95% CI, 3.5–8.8%] abnormal Pap tests were reported, which led to the performance of three diagnostic procedures. One case of moderate vaginal dysplasia was diagnosed and treated.ConclusionsContinued annual cytologic screening is of low yield in women completing five-years of surveillance that have remained free of recurrence. The incorporation of newer testing modalities including HPV testing may allow increases in the screening interval in this group of patients at relatively low risk for recurrence.

Research highlights
► Continued annual pap testing in cervical cancer patients disease free five-years from definitive therapy appears to be low yield.
► The majority of Pap test abnormalities are not associated with underlying dysplasia or cancer.
► Clinical trials to evaluate potentially superior prolonged surveillance strategies are warranted.