Question: Should a 34 year old who had Adenocarcinoma-in-situ excised 4 years ago with very small but clear margins and who has subsequently had normal follow-up smears and has completed her family have a hysterectomy or continue conservative follow-up?
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Answer: Two guidelines on follow-up after adenocarcinoma in situ or cervical cancer were identified:
The ASCCP 2006 consensus guidelines(1) say that [in women with AIS] “Longterm follow-up is recommended for women who do not undergo hysterectomy.”
The 2008 sign guideline on cervical cancer (2) notes that evidence for the effectiveness of post-treatment surveillance is inconsistent. The guideline makes the following recommendations:
“Cervical cytology or vault smears are not indicated to detect asymptomatic recurrence of cervical cancer.”
“Patients with early stage disease who have had fertility conserving surgery should have a smear at six months, 12 months and annually for four years before being returned to the cervical screening programme”.
(Evidence level IV)
- Wright TC Jr, Massad LS, Dunton CJ, Spitzer M, Wilkinson EJ, Solomon D, 2006 American Society for Colposcopy and Cervical Pathology-sponsored Consensus. 2006 consensus guidelines for the management of women with cervical intraepithelial neoplasia or adenocarcinoma in situ. Am J Obstet Gynecol 2007 Oct;197(4):340-5
- Scottish Intercollegiate Guidelines Network. Management of cervical cancer. 2008.
Search date: April 2010
Classification of evidence levels
Ia Evidence obtained from meta-analysis of randomised controlled trials.
Ib Evidence obtained from at least one randomised controlled trial.
IIa Evidence obtained from at least one well-designed controlled study without randomisation.
IIb Evidence obtained from at least one other type of well-designed quasi-experimental study.
III Evidence obtained from well-designed non-experimental descriptive studies, such as comparative studies, correlation studies and case studies.
IV Evidence obtained from expert committee reports or opinions and/or clinical experience of respected authorities.
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